Research Paper: Exploring Stigma in Patients with Schizophrenia and Its Correlation with Socio-demographic Variables

Research Aims and Research Question

The study is aimed at exploring stigma in patients with schizophrenia and its correlation with socio-demographic variables. The research study was guided by the following research question: is there a relationship between socio-demographic variables and stigma in patients with schizophrenia?

Background and Rationale

Schizophrenia is a severe mental disorder whose onset is late adolescence or early adulthood. The disorder has been associated with impaired thinking, feeling, and behavior. Because of this, individuals with schizophrenia can be described as having lost touch with reality. This disorder has also been linked to poor quality of life as well as continued disability. Apart from the need to cope with the symptomatic complexity of the illness itself, people with schizophrenia face a constant and continued challenge of negative societal attitudes towards the condition (stigma).

Stigma has been conceptualized as social devaluation and discrimination towards individuals with a characteristic which is considered socially undesirable, thus making the affected individuals to have a 'spoiled identity,' leading to social devaluation and discrimination (Rohleder et al. 2010, p.106). Regarding mental disorders, stigma has been variously defined as a form of deviance that makes other people judge another person as not legitimate to engage in social interaction. Such judgments are based on the perception that the individuals do not possess the abilities or skills to participate in such interaction. The social devaluation of the person is also prejudiced by perceived dangerous and unpredictable nature of the individual having a particular illness or disorder (Grover, Singh and Mattoo 2016, p.291).

Stigmatization related to mental illnesses has been linked with discrimination in employment opportunities, housing deprivations, and social exclusion which lead to impaired quality of life. Most individuals find it difficult to seek mental health treatment because they do not want to be regarded as mentally ill and would like to avoid the negative connotations, tags, and consequences related to stigma. Stigmatization has also been found to have a negative influence on mental health, such as impaired self-esteem, lower social functioning, higher depression, social anxiety, and inefficacy. The relationship between stigmatization and socio-demographic variables has been explored in many studies. However, there exist inconsistency in statistical significance and predictability of these variables on stereotypical thinking and discriminating behavior. Greater perceived stigmatization has been found to lead to increased re-hospitalization rates (Loch 2012, p.185) and lengthened the duration of illness (Shrivastava, Bureau and Johnston 2012, p.83). Because of the negative impacts associated with stigmatization in patients with schizophrenia, it is important to explore whether socio-demographic factors are associated with stigma.

Research Methods

Research Approach

The study utilized cross-sectional research design in examining the relationship between stigma in patients with schizophrenia and patients socio-demographic variables. Cross-sectional research method was the most appropriate for the current study because are economical and easy to manage and there is no loss to follow-up because subjects are interviewed only once (Sedgwick 2014, p.2)

Sample Size and Type

The sample for the study was selected and recruited purposefully. The sample consisted of 50 schizophrenic patients as per DSM V. The research subjects were between the age of 18 and 50 years and comprised of individuals who have the condition for at least 1-year duration. The participants were also from different ethnic backgrounds and were required to be able to be literate in English. Potential participants who were mentally retarded, those who were dependent on drugs, and those with organic brain syndrome were excluded from the study.

Data Collection Method

Assessment of stigma was done using three scales which measures different aspects of stigma. They included the following instruments:

Internalized stigma of mental illness scale (ISMIS)

ISMIS is an instrument used in the assessment of internalized stigma or self-stigma, from the viewpoint of an individual experiencing stigmatization. The instrument consists of 29 questionnaire items assessed on a 4-point scale ranging from strongly agree (1) to strongly disagree (4). A higher score on ISMIS scale is an indicator of higher level of self-stigma. Using a cut-off of 2.5, the participants were grouped as either stigmatized or not. The total ISMIS scores were calculated as follows: The ISMIS is comprised of 29 items which yield 5 subscales scores as well as a composite score. Calculation of each of the subscale score is by summing item scores and dividing by the number of items the respondent has answered. If the one or more of the items is not answered by the participant, the total number of items to be divided decrease. For instance, if a respondent answers 20 out of the 29 questionnaire items, all the responded to items are summed and divided by the total number of responded to items, which are 20. The final score ranges from 1-4. Stigma Resistance items are reverse-coded. A participants score of 3- 4 shows severe internalized stigma, a score of 2.5- 4 shows moderate internalized stigma, a score of 2- 2.5 indicates mild internalized stigma, and lastly a score of 1- 2 means minimal to no internalized stigma.

ISMIS instrument has been reported to have high reliability and validity. Tanabe, Hayashi, and Ideno (2016, p.1) have established that the overall internal consistency reliability of ISMIS instrument is .91 based while the reliability coefficients of the subscales are between .5 and .81. Using test-retest reliability, the authors reported composite reliability of .85. Additionally, factor analysis of ISMIS questionnaire items has shown that the instrument has a four-factor solution (social withdrawal, discrimination experience, stereotype endorsement, and the alienation subscales). Moreover, the instrument has also been found to have high criterion-related validity based on its correlation of .61 with the Beck Depression Inventory (Tanabe, Hayashi and Ideno 2016, p.1). Additionally, it has high criterion-related validity with the Empowerment Scale and the Rosenberg Self-Esteem Scale

Data Analysis Approach.

Data analysis was conducted through descriptive data analysis and inferential data analysis in SPSS version 23. The descriptive statistical analysis was used to get an overview of the socio-demographic profile of patients. The first socio-demographic variable that was analyzed using descriptive statistics is age. The participants mean age and the standard deviation were calculated. The age was measured in years. Next, the participants socio-gender, marital status, and ethnicity were also analyzed descriptively. The mean and standard deviation were also calculated and reported. All the descriptive analysis were conducted in SPSS version 20.

Next, the relationship between different socio-demographic variables and stigma was analyzed using inferential statistics. First, the relationship between gender (male or female) and stigmatization scores were examined using independent t-test procedure in SPSS version 20. This is because there were two categorical independent groups (male or female) and one continuous dependent variable. Second, the relationship between participants marital status (Single, Divorced, or Married) and stigmatization scores be analyzed using one-way ANOVA procedure in SPSS version 20. This is because there are three categorical independent groups (Single, Divorced, or Married) and one continuous dependent variable. Lastly, the relationship between participants ethnicity (Black, White, or Hispanic/Latino) and stigmatization scores were analyzed using one-way ANOVA procedure in SPSS version 20. This is because there were three categorical independent groups (Black, White, or Hispanic/Latino) and one continuous dependent variable.

Research Timetable

Activities 2018

2 3 4 5 6 7 8 9 10 11 12

Development of research aims, research questions, and hypotheses

Background and rationale for of the study

Literature review

Developing research methods

Data collection

Data analysis

Writing the results section

Discussion, conclusion, and recommendation

Project submission

Sources

Grover, S., Singh, A. and Mattoo, S. (2016). Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit. Indian Journal of Psychiatry, 58(3), p.291.

Grover, Singh, and Mattoo (2016) study is useful in understanding the background of the study (stigma experienced by patients with schizophrenia).

Loch, A. (2012). Stigma and higher rates of psychiatric re-hospitalization: Sao Paulo public mental health system. Revista Brasileira de Psiquiatria, 34(2), p.185.

This article has been chosen because it highlights the effects of schizophrenia on patients.

Rohleder, P., Kalichman, S., Simbayi, L. and Swartz, L. (2010). HIV/AIDS in South Africa 25 Years On. New York, NY: Springer Science+Business Media, LLC, p.106.Sedgwick, P. (2014). Cross sectional studies: advantages and disadvantages. BMJ, 348(mar26 2), pp.g2276-g2276.

This article gives reasons for and against cross-sectional research design

Shrivastava, A., Bureau, Y. and Johnston, M. (2012). Stigma of Mental Illness-1: Clinical reflections. Mens Sana Monographs, 10(1), p.83.

This article is important in understanding the causes and effects of stigma related to mental illness.

Tanabe, Y., Hayashi, K. and Ideno, Y. (2016). The Internalized Stigma of Mental Illness (ISMI) scale: validation of the Japanese version. BMC Psychiatry, 16(1), p.1.

This article is important as it discusses the reliability and validity of ISMIS scale used in gathering data on participants internalized stigma.

Ethical Issues

The proposed study will be conducted in strict adherence to ethical research procedures. First, approval will be sought from the Universitys Institutional Review Board (IRB). Second, written informed consent will be sought from the research subjects. Before seeking written consent from the participants, the purpose, the risks, and the benefits of the study will be explained to the prospective participants. Participants will be free to withdraw from the study at any stage. Next, participants information will be kept confidential and anonymous. The data will not be made accessible to the researcher alone.

Data Collection

ISMIS instrument was used to collect data on participants internalized stigma or self-stigma, from the viewpoint of an individual experiencing stigmatization. The instrument consists of 29 questionnaire items assessed on a 4-point scale ranging from strongly agree (1) to strongly disagree (4). After distributing the questionnaire instruments to the participants, the researcher guided them on how to fill the questionnaire. Participants were asked not to indicate their name on the questionnaire item or anything which might reveal their identity. After the participants understood how to fill the questionnaire, they were given 30 minutes to complete filing the questionnaire. For each question, each of the participants was required to mark whether he or she strongly disagree (1), disagree (2), agree (3), or strongly agree (4).

Results

Socio-Demographic Profile of Patients

The sample for this study comprised of 100 individuals. The mean age of the participants was 29.14 years was 36.8 (SD= 7...