Phenomenology of psychiatric stigma: A factor of patients’ motivation to treatment

Abstract

Introduction

Psychiatric patients often are self-stigmatized and hardly involve in the treatment.

Objectives

Associations of self-stigmatizing beliefs in psychiatric inpatients and their treatment motivation.

Methods

63 inpatients; ICD-10: F2–65%, F3–13%, F4+F6–14%, F06–8%; mean age 34±13, illness duration 12±11 years. Treatment Motivation Assessment Questionnaire (TMAQ), Internalized Stigma of Mental Illness scale (ISMI); K-mean cluster analysis; dispersion analyses; p≤0.05.

Results

18 patients of cluster 1 (C1) demonstrated explicit self-stigmatization. In comparison with 25 subjects from cluster 3 (C3) stigmatized patients (C1) had higher levels of overall ISMI scores (2.9±0.3) caused by alienation (3.1±0.5), stereotype endorsement (2.5±0.5), social withdrawal (2.7±0.4), and discrimination experience (2.7±0.4). 20 patients of cluster 2 (C2) had an implicit stigma. They were more self-stigmatized (ISMI score 2.7±0.3) in contrast with subjects from cluster 3 (1.9±0.2) due to a lower level of stigma resistance (C2: 3.8±0.5 and C3 3.1±0.6 – reverse scores). Patients with implicit self-stigma (C2) had the lowest intensity of treatment motivation (Z-scores -1.2±0.6) compering with others (C1 and C3) due to the lowest TMAQ factor 1 (reliance on own knowledge and skills to cope with the disorder: -1.0±0.6) and factor 4 (willingness to cooperate with doctor: -0.9±1.0). Differences between explicitly and implicitly stigmatized patients manifested also in lower TMAQ factor 3 for the second group (awareness of the psychological mechanism of maladaptation: -0.5±0.9).

Conclusions

Despite alienation, stereotype endorsement, social withdrawal, discrimination experience some patients could sustain stigma due to cooperation with doctors and reliance on their own knowledge and skills to cope with illness.