Internalized Stigma in Patients with Mental Illness - Research Paper Example

Internalized Stigma in Australian Patients with acute Mental Illness Name: Institution: Date: Word Count: 1600 Abstract The aim of the research was to analysis the internalized stigma in patients with serious mental health in Australia and single out the ingredients that contribute to internalized stigma among different sociological populations, psychosocial, and clinical factors employing a cross-sectional research design. The data used was collected from a total of 20 clinical patients (10males, 10 females) based on questionnaires the completed. The surveys gathered data on socio-demography, clinical factors from which a descriptive statistics was carried out to value hopelessness, the level of self-esteem and internalized stigma. High levels of internalized stigma were predictable independently by low self-esteem, great desperation among the psychosocial variables. The paper found out that not only real psych education for insight gaining can lead to improvement in internalized stigma. For management of internalized stigma in patients who are mentally ill, there is a need to enhance self-esteem and hope. The study also recommends the installation of a consistent psychosocial approach, such as the development of skills for coping with family during social conflict thus helping the mentally ill patients deal with internalized stigma. Internalized Stigma in Australian Patients with Serious Mental Illness Introduction Mental illness is a disorder that has an effect on the mood or feeling and thinking of a person. Such conditions affect the relationship of someone with others and functionality each day. Every individual usually have a different experience, even people with the similar diagnosis. People suffering from mental illness are prone to the stigma associated with their disorder. The prevalence and manifestation of the stigma related to mental illness may differ by culture although it is a universal phenomenon. Unlike other medical conditions, the mental illness stigma is still high and more prevalent in developed countries than others (Kim et al., 2015). Some pieces of research further suggest that internalized stigma due to mental health problems is more severe in the Asian cultures than the western cultures because of the universal group-cantered nature among the populations of the Asian continent (Abdullah and Brown, 2011). The toughest obstacle to be overcome is the internal stigma that people with mental conditions develop because of the social stigma. There are increased numbers of studies to find out the effect of external discrimination on the internal stigma of the mentally ill. For example, leaving out the sick people during employment and housing make them feel communal isolation. Sometimes people form a negative attitude towards them apart from discrimination yet produce similar effects (Brophy et al., 2016). Having a sound knowledge of the associations between attitudes towards and beliefs about mental illness is a significant concern for the health workers and the community. Many researchers have undertaken several studies to acquire the knowledge of the associations between attitudes and opinions present about the mental disorder and the societal acceptance of the individuals suffering from mental illnesses. Some of the works have analysis of the views of the mental illness in the people suffering from such conditions (Üçok, Brohan, Rose & Sartorius, 2012; Ellison, Mason, & Scior, 2013), while other studies have done investigations about mental illness among the healthcare professionals (Milton, Mullan, & Hunt, 2016). Worldwide perception shows that attitudes towards mental health that stigmatizes are found across cultures (Griffiths et al., 2006; Reavley & Jorm, 2012). The problem with labeling mental illness has implications for attitudes toward mental disorders. An analysis of a large sample of Australian subjects investigated the relationships between beliefs concerning the causes of mental disease and stigma and indicated that persons who believed weakness of personality was the cause of mental disorders showed increased levels of stigmatizing attitudes (Reavley & Jorm, 2014). Further, the general public has a tendency to keep a greater social distance from persons diagnosed with mental illness, particularly within close personal relationships (e.g., reluctance to marry someone with mental illness; Ando et al., 2013; Leiderman, Vazquez, & Berizzo, 2011). There is a tendency for the individuals who have an experience of stigma on the mental disease to be further impacted negatively in the mental health when they internalize the shame and thus exhibit reduced self-worth and self-esteem. For example, Kim et al. (2015) did an examination on internalized stigma patients in Korea having been diagnosed with the mental disease and singled out that many patients with high standards of larger social conflicts, greater hopelessness, and reduced levels of self-esteem, unlike those patients who registered lower levels internalized stigma. The physical and emotional perception leads to internalized stigma which is very painful and destructive. As a result, the internalized stigma of mental illness (ISMI) was produced to analyze perceptions of mentally ill people. The ISMI has 29 questionnaires that measure self-stigma for people with psychiatric problems. The tool was developed with a substantial contribution from consumers and has between widely used by different cultures globally (Chang et al., 2014). According to Boyd et al. (2014), the ISMI is 47 different versions and languages across the world and for every version there are those for depression, eating disorders, smoking, epilepsy, among other social and clinical issues. The various versions have been reliably valid in different systems, languages, and cultures. In their study, the authors found out in ISMI the internalized stigma highly correlates with low self-esteem, long depression, and severe symptoms. This paper will partly replicate the Kim et al. (2015) study. More specifically the research will examine internalized stigma in a sample of mental health patients in Australia, and variables that are associated with internalized stigma. Rationale of the Study Internalized stigma is burdensome to patients, families, and medical facilities. This phenomenon delays treatment, increases health risks, violence, and abnormal behaviours leading to more adverse effects like marital issues, psychological stress, social stress, fear, depression, and among other social difficulties. The patients and their families are neglected by society (Kim et al., 2015). This research, therefore, seeks to identify the magnitude of perceived internal stigma of the patients and relatives members Objectives To assess the significance of the internalized stigma among mentally ill patients To examine the association internalized stigma with the causing factors. Research Hypothesis This paper will seek to statically answer the following three hypotheses: H1: There is negative correlation between self-esteem and internalized stigma. H2: There is a positive correlation between hopelessness and internalized stigma. H3: There is a positive correlation between insight and internalized stigma. Method Procedure and Participants The data for 20 participants (10 male and ten female) with age ranging between 21 and 56 was available for analysis. The average age of the female participants was 35.2 while the median age of the male patients was 38.1. Participants were discharged patients of a mental health unit of a local hospital following treatment. The questionnaires were only made available to those members who had the ability to produce consent voluntarily. Patients’ age and sex are the only demographic information that the survey includes. All the surveys were unique in their own way. The particulars of participants’ mental disorder were not known. There was need for ethical approval that was achievable by the Charles Sturt University Human Research Ethics Committee as well as the Hospital Ethics Board. The patients received a self-addressed envelope along with the questionnaire containing the survey questions after discharge from the mental health unit to bring back to the students upon completion through email. Measures The study comprised of a four-item Beck Hopelessness Scale (BHS) measured as true or false; a one-item Self-Esteem Scale (SES) measured on a 7-point Likert scale from 1 (not very true of me) to 7 (very true of me) measured in response to the statement, ‘I have high self-esteem’; the 29-item Internalized Stigma of Mental Illness Scale (ISMI) with a measure on a 4-point Likert scale with the range from 1 (strongly disagree) to 4 (strongly agree); and a one-item General Illness Awareness Scale (GIAS) measured on a scale of 1-10 ranging from 1 (strongly disagree) to 10 (strongly agree), in response to the statement, ‘I truly believe I have a mental illness/disorder’ i ISMI - Internalised Stigma of Mental Illness Scale (Range 1-4; based on total score obtained by each participant divided by total number of items in the (Range 1-4) Self-Est 1-7 BHS - Beck's Hopelssness Scale- (Range of 0-4) GIAS General Illness Awareness (Range 1-10) Table 2 Correlations among Self-esteem, Hopelessness, Insight, and internalized stigma Self-esteem Hopelessness Insight Internalised stigma -0.87 0.94 -0.64 The correlation for the self-esteem and insight are both negative, meaning that as scores on self-esteem go up the scores on the insight go down, and vice-versa. Discussion In this particular cross-sectional research, the paper did an analysis of internalized stigma and the associating outcomes among Australian patients with severe mental disorders. There was a distinction between the results of this study with other previous works regarding percentages and scores of participants with internalized stigma. Hopelessness, self-esteem, the levels of insight, and social conflict independently predict internalized stigma. For a comprehensive management of health care of the patients suffering from mental diseases, there is a need for a sound understanding of internalized stigma. The results show a positive correlation between the internalized stigma and insight, a negative correlation self-esteem and internalized stigma. There is a negative correlation between hopelessness and internalized stigma. Self-esteem and Internalized stigma are significantly correlated, with 87 percent of total change in the Internalized stigma independently explained by the total variation in self-esteem. The direction of correlation is negative showing an inverse relationship. There is also a significant correlation between Internalized stigma and hopelessness where the change in desperation explains 94 percent of the total change in Internalized stigma. The association between Internalized stigma and insight is not active with insight explaining 64% of the total variation in the Internalized stigma. The current research not only associates a higher degree of insight to internalized stigma but also indicates insight as an independent predictor of internalized stigma. To beware of their conditions individuals suffering from mental diseases need to have some proper insight. Thus having a greater degree of insight makes individuals have higher standards of internalized stigma (Kim et al., 2015). Out of the many psychosocial factors having an association with internalized stigma, higher degrees of hopelessness and lower levels self-esteem did predict increased levels of internalized stigma independently. The findings of this study coupled with the outcomes of works done previously are the suggestion that factors such as hopelessness and self-esteem, form significant clinical intervention targets to help patients with mental disorders in overcoming the shame and at the same time increasing insight levels. In conclusion, high levels of internalized stigma were predictable independently by low self-esteem, great desperation among the psychosocial variables. The paper found out that not only real psych education for insight gaining can lead to improvement in internalized stigma. For management of internalized stigma in patients who are mentally ill, there is a need to enhance self-esteem and hope. The study also recommends the installation of a consistent psychosocial approach, such as the development of skills for coping with family during social conflict thus helping the mentally ill patients deal with internalized stigma. References Abdullah, T. & Brown, T. L. (2011). Mental illness stigma and ethno-cultural beliefs, values, and norms: An integrative review. Clinical Psychology Review, 31 (6), 934–948. https://login.ezproxy.csu.edu.au/login?url=http://dx.doi.org/10.1016/j.cpr.2011.05.003 Boyd, J. E., Adler, E. P., Otilingam, P. G., & Peters, T. (2014). Internalized Stigma of Mental Illness (ISMI) scale: a multinational review. Comprehensive psychiatry, 55(1), 221-231. Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (2016). Consumers and carer perspectives on poor practice and the use of seclusion and restraint in mental health settings: Results from Australian focus groups. International Journal of Mental Health Systems, 10,1-10. doi:10.1186/s13033-016-0038-x http://search.proquest.com.ezproxy.csu.edu.au/docview/1798216572?rfr_id=info%3Axri%2Fsid%3Aprimo Chang, C. C., Wu, T. H., Chen, C. Y., Wang, J. D., & Lin, C. Y. (2014). Psychometric evaluation of the internalized stigma of mental illness scale for patients with mental illnesses: measurement invariance across time. PloS one, 9(6), e98767. Ellison, N., Mason, O., & Scior, K. (2013). Bipolar disorder and stigma: A systematic review of the literature. Journal of Affective Disorders, 151(3), 805-820. doi:10.1016/j.jad.2013.08.014 http://www.sciencedirect.com.ezproxy.csu.edu.au/science/article/pii/S0165032713006368 Griffiths, K. M., Nakane, Y., Christensen, H., Yoshioka, K., Jorm, A. F., & Nakane, H. (2006). Stigma in response to mental disorders: A comparison of Australia and Japan. BMC Psychiatry, 621-12. doi:10.1186/1471-244X-6-21 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525161/ Kim, W. J., Song, Y. J., Ryu, H. S., Ryu, V., Kim, J. M., Ha, R. Y., ... & Cho, H. S. (2015). Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness. Psychiatry research, 225(3), 433-439. Milton, A. C., Mullan, B., & Hunt, C. (2016). Information giving challenges and support strategies at the time of a mental health diagnosis: Qualitative views from Australian health professionals. Social Psychiatry and Psychiatric Epidemiology, 51(5), 735-746. doi: 10.1007/s00127-016-1187-6 http://link.springer.com.ezproxy.csu.edu.au/article/10.1007%2Fs00127-016-1187-6 Reavley, N. J. & Jorm, A. F. (2012). Stigmatising attitudes towards people with mental disorders: Changes in Australia over 8 years. Psychiatry Research, 197(3), 302-306. http://ezproxy.csu.edu.au/login?url=http://dx.doi.org/10.1016/j.psychres.2012.01.011 Üçok, A., Brohan, E., Rose, D., Sartorius, N. (2012). Anticipated discrimination among people with schizophrenia. Acta Psychiatrica Scandinavica, 125 (1), 77–83. http://ezproxy.csu.edu.au/login?url=http://dx.doi.org/10.1111/j.1600-0447.2011.01772.x Appendix Males: Mean age= (37+48+24+23+56+39+29+44+30+51)/10=381/10=38.1 ISMI mean=(3.6+3.79+3.55+3.24+3.2+2.9+3+2.9+2.41+1.65)/10=30.14/10=3.014 SES mean = (2+1+3+2+2+3+2+3+6+6)/10=30/10=3 BHS mean = (4+4+3+3+4+3+3+3+3+1)/10=31/10=3.1 GIASi mean = (3+3+4+4+4+3+4+4+8+5)/10=42/10=4.2 ISMI d^2 SES d d^2 BHS d d^2 GIASi d d^2 3.6 0.586 0.343396 2 -1 1 4 0.9 0.81 3 -1.2 1.44 3.79 0.776 0.602176 1 -2 4 4 0.9 0.81 3 -1.2 1.44 3.55 0.536 0.287296 3 0 0 3 -0.1 0.01 4 -0.2 0.04 3.24 0.226 0.051076 2 -1 1 3 -0.1 0.01 4 -0.2 0.04 3.1 0.086 0.007396 2 -1 1 4 0.9 0.81 4 -0.2 0.04 2.9 -0.114 0.012996 3 0 0 3 -0.1 0.01 3 -1.2 1.44 3 -0.014 0.000196 2 -1 1 3 -0.1 0.01 4 -0.2 0.04 2.9 -0.114 0.012996 3 0 0 3 -0.1 0.01 4 -0.2 0.04 2.41 -0.604 0.364816 6 3 9 3 -0.1 0.01 8 3.8 14.44 1.65 -1.364 1.860496 6 3 9 1 -2.1 4.41 5 0.8 0.64 30.14 3.54284 30 26 31 6.9 42 19.6 Standard deviations And the Greek upper case S –  - means ‘Sum’ or ‘Add up’. ISMI==1.015511 SES= =1.619328 BHS==1.47573 GIASi==1.135292 Females: mean Age= (36+27+29+45+21+28+46+55+33+32)/10=352/10=35.2 ISMI=(3.69+3.66+2.79+2+1.76+1.62+1.28+1.28+1.1+1)/10=20.18/10=2.018 SES = (3+2+4+4+5+6+7+7+5+5)/10=48/10=4.8 BHS= (4+4+3+2+2+1+1+0+0+1)/10=18/10=1.8 GIASi = (4+5+6+6+7+6+8+5+6+5)/10=58/10=5.8 Calculating Standard Deviation ISMI d d^2 SES d d^2 BHS d d^2 GIASi d d^2 3.69 1.672 2.795584 3 -1.8 3.24 4 2.2 4.84 4 -1.8 3.24 3.66 1.642 2.696164 2 -2.8 7.84 4 2.2 4.84 5 -0.8 0.64 2.79 0.772 0.595984 4 -0.8 0.64 3 1.2 1.44 6 0.2 0.04 2 -0.018 0.000324 4 -0.8 0.64 2 0.2 0.04 6 0.2 0.04 1.76 -0.258 0.066564 5 0.2 0.04 2 0.2 0.04 7 1.2 1.44 1.62 -0.398 0.158404 6 1.2 1.44 1 -0.8 0.64 6 0.2 0.04 1.28 -0.738 0.544644 7 2.2 4.84 1 -0.8 0.64 8 2.2 4.84 1.28 -0.738 0.544644 7 2.2 4.84 0 -1.8 3.24 5 -0.8 0.64 1.1 -0.918 0.842724 5 0.2 0.04 0 -1.8 3.24 6 0.2 0.04 1 -1.018 1.036324 5 0.2 0.04 1 -0.8 0.64 5 -0.8 0.64 20.18 9.28136 48 23.6 18 19.6 58 11.6 ISMI== 1.015511 SES= = 1.619328 BHS== 1.47573 GIASi== 1.135292 Read More

Having a sound knowledge of the associations between attitudes towards and beliefs about mental illness is a significant concern for the health workers and the community. Many researchers have undertaken several studies to acquire the knowledge of the associations between attitudes and opinions present about the mental disorder and the societal acceptance of the individuals suffering from mental illnesses. Some of the works have analysis of the views of the mental illness in the people suffering from such conditions (Üçok, Brohan, Rose & Sartorius, 2012; Ellison, Mason, & Scior, 2013), while other studies have done investigations about mental illness among the healthcare professionals (Milton, Mullan, & Hunt, 2016).

Worldwide perception shows that attitudes towards mental health that stigmatizes are found across cultures (Griffiths et al., 2006; Reavley & Jorm, 2012). The problem with labeling mental illness has implications for attitudes toward mental disorders. An analysis of a large sample of Australian subjects investigated the relationships between beliefs concerning the causes of mental disease and stigma and indicated that persons who believed weakness of personality was the cause of mental disorders showed increased levels of stigmatizing attitudes (Reavley & Jorm, 2014).

Further, the general public has a tendency to keep a greater social distance from persons diagnosed with mental illness, particularly within close personal relationships (e.g., reluctance to marry someone with mental illness; Ando et al., 2013; Leiderman, Vazquez, & Berizzo, 2011). There is a tendency for the individuals who have an experience of stigma on the mental disease to be further impacted negatively in the mental health when they internalize the shame and thus exhibit reduced self-worth and self-esteem.

For example, Kim et al. (2015) did an examination on internalized stigma patients in Korea having been diagnosed with the mental disease and singled out that many patients with high standards of larger social conflicts, greater hopelessness, and reduced levels of self-esteem, unlike those patients who registered lower levels internalized stigma. The physical and emotional perception leads to internalized stigma which is very painful and destructive. As a result, the internalized stigma of mental illness (ISMI) was produced to analyze perceptions of mentally ill people.

The ISMI has 29 questionnaires that measure self-stigma for people with psychiatric problems. The tool was developed with a substantial contribution from consumers and has between widely used by different cultures globally (Chang et al., 2014). According to Boyd et al. (2014), the ISMI is 47 different versions and languages across the world and for every version there are those for depression, eating disorders, smoking, epilepsy, among other social and clinical issues. The various versions have been reliably valid in different systems, languages, and cultures.

In their study, the authors found out in ISMI the internalized stigma highly correlates with low self-esteem, long depression, and severe symptoms. This paper will partly replicate the Kim et al. (2015) study. More specifically the research will examine internalized stigma in a sample of mental health patients in Australia, and variables that are associated with internalized stigma. Rationale of the Study Internalized stigma is burdensome to patients, families, and medical facilities. This phenomenon delays treatment, increases health risks, violence, and abnormal behaviours leading to more adverse effects like marital issues, psychological stress, social stress, fear, depression, and among other social difficulties.

The patients and their families are neglected by society (Kim et al., 2015). This research, therefore, seeks to identify the magnitude of perceived internal stigma of the patients and relatives members Objectives To assess the significance of the internalized stigma among mentally ill patients To examine the association internalized stigma with the causing factors.

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