Effects of internalized stigma on symptoms and quality of life in schizophrenic patients; mediated by dysfunctional attitude
Keywords:Internalized Stigma, Schizophrenia, Quality of Life, Dysfunctional Attitude.
The objective of this study was to determine the effects of internalized stigma on symptoms, quality of life of schizophrenic patients; mediated by dysfunctional attitude. A descriptive correlational research design was used to investigate the relationship between symptoms, quality of life and dysfunctional attitude in schizophrenic patients. Linear regression was used to investigate the mediational effects of dysfunctional attitude. Purposive sampling technique was used for the selection of the participants. The study was conducted on diagnosed schizophrenic patients from psychiatry ward of Nishtar Hospital Multan, Fountain House Rehabilitation Centre Lahore and Punjab Institute of Mental Health Rehabilitation Centre Lahore. The sample of the study was 50 registered patients of schizophrenia. Calculated sample size was 50 schizophrenic patients among them 34 were Males and 16 were Females. Internalized Stigma of Mental Illness Scale was used to see the effects of stigma on schizophrenic patients (ISMI, Ritsher, 2003), along with Positive and Negative Syndrome Scale was used to evaluate the positive and negative symptoms in schizophrenic patients (Kay, et al., 1987), World Health Organization Quality of life BREF Scale (WHOQOL-BREF, 2003) was used to assess the quality of life of schizophrenic patients, along with another scale of Dysfunctional Attitude Scale (DAS, Weissman, 1978) was also used to assess the cognitive functioning of the schizophrenic patients. Studies showed that internalized stigma had significant positive correlation with dysfunctional attitude and negative significant correlation with symptoms and quality of life of schizophrenic patients. Internalized stigma had strong significant effects on the symptoms, quality of life and dysfunctional attitude. Studies also showed that people with mental illness has to face negative stereotype, rejection and finally alienation from society because of stigma which is a big hurdle in their process of recovery and treatment.
 Addington, D. MBBS, MRC Psych, FRCPC Professor Dept of Psychiatry Foothills Hospital 1403 - 29th Street NW Calgary, Alberta Canada T2N2T9 P: 403.944.4548 F: 403.270.3451.
 Alfred,T., & Kamajian, (2010, November 11) â€œSchizophrenia Images and Pictures of Brains.â€ Retrieved from http://www.schizophrenia.com/schizpictures.html.
 American Psychiatric Association. (2013, Oct 3). Diagnostic and statistical manual of mental Disorders: DSM-5. Washington, D.C: American Psychiatric Association.
 Awad, A.G, Voruganti, L.N.P, Heslegrave, R.J. (1997). A conceptual model of quality of life in Schizophrenia: description and preliminary clinical validation. Quality of Life Res, 6:21-26. http://dx.doi.org/10.1023/A:1026409326690.
 Bandura, A. (1989). Regulation of cognitive processes through perceived self-Efficacy. Developmental Psychology, 25,729 735. http://dx.doi.org/10.1037/0012-16184.108.40.2069.
 Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.
 Beck, A. T., and wenzel, A., Riskind. (2006) Congnitive therapy and Research. Vol. 30,773-81.
 Bellack, A. S., Mueser, K. T., Morrison, R. L., Tierney, A., & Podell, K. (1990). Remediation of Cognitive deficits in schizophrenia. American Journal of Psychiatry, 147,650-655.
 Benjamin & Hankin (2004). Cognitive Therapy for Research.Vol 28, 309 â€“ 345. http://dx.doi.org/10.1023/B:COTR.0000031805.60529.0d.
 Bobes, J., (2001) Current status of quality of life assessment in schizophrenic patients. Eur Arch Psychiatry Clin Neurosc. ; 251(suppl 2): ll/38â€“ll/42. http://dx.doi.org/10.1007/bf03035125.
 Bobes, J., Garcia-Portilla, M.P. Quality of life in schizophrenia. In: Katschnig H, Freeman H, Sartorius N, eds. Quality of Life in Mental Disorders. Chichester, UK: John Wiley & Sons Ltd; (2005), 153â€“168.
 Bordieri, J., Drehmer, D., (1986). Hiring decisions for disabled workers: Looking at the cause. Journal of Applied Social Psychology 16, 197-208. http://dx.doi.org/10.1111/j.1559-1816.1986.tb01135.x.
 Buckley, P.F., Miller, B.J., Lehrer, D.S., & Castle, D. J., (2009, March). "Psychiatric Comorbidities and schizophrenia". Schizophr Bull 35 (2): 383â€“402. http://dx.doi.org/10.1093/schbul/sbn135.
 Byrne, P. (2000). Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6, 65-72. http://dx.doi.org/10.1192/apt.6.1.65.
 Corrigan, P.W., Calabress, J.D., (2005). Stratgies for assessing and diminishing self-stigma. In: Corrigan,P.W.( Ed), on the stigma of mental illness: Practical strategies for Research And social change, American Psychological Association, Washington, DC,pp.239-256. http://dx.doi.org/10.1037/10887-011.
 Eack. S. M., Newhill, CE, (2007), Psychiatric Symptoms and Quality of Life in Schizophrenia: A Meta-Analysis. Schizophrenia Bullettin, 33(5):1225-1237. http://dx.doi.org/10.1093/schbul/sbl071.
 Ertugrul, A.M. D., Berna UluÄŸ, M. D., M. P. H. (2004, January). Social Psychiatry and Psychiatric Epidemiology, Volume 3.
 Goffman, E. (1963) Stigma: notes on the management of spoiled identity.New York: Prentice Hall, 3.
 Gorczynski, P., Faulkner, G. (2010). "Exercise therapy for schizophrenia". Cochrane Database of Systematic Reviews (5). http://dx.doi.org/10.1002/14651858.CD004412.pub2.
 Harrow, M., Jobe, T.H. (2013, March, 19). "Does long-term treatment of dchizophrenia with Antipsychotic medications facilitate recovery?â€ Schizophrenia bulletin 39.
 Heatherton, T. F., Kleck, R. E., Hebl, M. R., Hull, J. G. (2000). The Social Psychology of Stigma. Guilford Press.
 Hinshaw, S.P., Stier. A. (2008) Stigma as related to mental disorders. Annu Rev Clin Psychol. 4:367-93. http://dx.doi.org/10.1146/annurev.clinpsy.4.022007.141245.
 Hocking. B. (2003), the Second Australian National Survey of Psychosis Medical Journal of Australia, 27 June 2013.
 Hor, K., Taylor, M., (2010, November). "Suicide and schizophrenia: a systematic review of rates and risk factors". Journal of psychopharmacology, Oxford, England, 24 (4 Suppl): 81â€“ 90. http://dx.doi.org/10.1177/1359786810385490.
 Jones, E., Farina, A. Hastorf , A., Markus, H., Miller, D., Scott, R. (1984) Social stigma: The Psychology of marked relationships, New York: Freeman,
 Kay, S.R., Fiszbein, A., & Opler, L.A. (1987). "The positive and negative syndrome scale (PANSS) for schizophrenia." (PDF). Schizophr Bull 13 (2): 261â€“76. http://dx.doi.org/10.1093/schbul/13.2.261.
 Laursen, T.M., Munk-Olsen, T., Vestergaard, M. (2012, March). "Life expectancy and Cardio vascular mortality in persons with schizophrenia". Current opinion in Psychiatry 25 (2): 83â€“8. http://dx.doi.org/10.1097/YCO.0b013e32835035ca.
 Lehman, A.F. (1997), Instruments for measuring quality of life in mental illnesses. In Quality Of Life in Mental Disorders. Edited by: Katschnig, H., Freeman, H., Sartorius N. New York, NY: Wiley; 79-94
 Leucht, S., Tardy, M., Komossa, K., (2012, June). "Antipsychotic drugs versus placebo for Relapse prevention in schizophrenia: a systematic review and meta-analysis". Lancet 379 (9831): 2063â€“71 http://dx.doi.org/10.1016/S0140-6736(12)60239-6.
 Luckstead, A., Drapalski, A., Calmes, C., Forbes, C., DeForge, B. & Boyd, J. (2011). Ending Self-Stigma: Pilot Evaluation of a New Intervention to Reduce Internalized Stigma among People with Mental Illness. Psychiatric Rehabilitation Journa,l 35 (1), 51- 54. http://dx.doi.org/10.2975/35.1.2011.51.54.
 Mahmood .A, (2014, September 20).â€™ Mental illness in Pakistan: The toll of neglect, â€˜The Dawn, Retrieved from http://www.DAWN.com
 Makara, M., Studzinska, Wolynaik, M., &Partyka, I. (2010) Journal of Pre- clininca Reasearch volume 5.
 Mark, L., Hatzenbuehler, & Katie, A. McLaughlin. (2013) society of behavioral medicine,
 Marshall, M., Rathbone, J. (2011, Jun 15). "Early intervention for psychosis". The Cochrane Database of systematic reviews. http://dx.doi.org/10.1002/14651858.CD004718.pub3.
 Parson, R. D., Stephanie, Lewis, H. & Deborah, S. (2001).Educational Psychology: A Practitioner- Researcher Model of Teaching. Singapore: Thomson Learning Inc.
 Paul, H. L., Jenifer, L. Vohs. J. (2009) vol 1127. http://dx.doi.org/10.12669/pjms.305.5239.
 Paul, H. Lysker, Louanne W. Davis, Debbie, M., Warman, A., Nicole, B. (2007) Volume 149.
 Picchioni, M. M., & Murray, R. M. (2007, July). "Schizophrenia". BMJ 335 (7610): 91â€“5. Putman, S. (2008) Mental illness: diagnostic title or derogatory term? Attitudes towards mental illness. Developing learning resources for use within a clinical call centre. A systematic literature review on attitudes towards mental illness. J Psychiatry Mental Health Nurs: 15(8):684-93
 Picchioni, M. M., Murray, R.M. (2007, July). "Schizophrenia". BMJ 335 (7610): 91â€“5 Pak J Med Sci 2014; 30(5):1123
 Ritsher (Boyd), J., Otilingam, P.G., Grajales, M. (2003) Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Res 121: 31â€“49. http://dx.doi.org/10.1016/j.psychres.2003.08.008.
 Ritsher, B. J., Otilingam, P. G., & Crajales, M. (2003). Internalized Stigma of Mental Illness: Psychometric Properties of a New Measure. Psychiatry Research. 121, 31-49. http://dx.doi.org/10.1016/j.psychres.2003.08.008.
 Rosenfield S: (1997) Labeling mental illness. The effects of received services and perceived Stigma on life satisfaction.Am Sociol Rev, 62:660-672. http://dx.doi.org/10.2307/2657432.
 Saifi, S., & Mehmood, T. (2011). Effects of socio-economic status on student achievement. International Journal of Social Sciences and Education, 1(2), 119-128.
 Sartorius N. (1997) Fighting schizophrenia and its stigma: A new World Psychiatric Association educational programme.Br J Psychiatry, 170:297. http://dx.doi.org/10.1192/bjp.170.4.297.
 Sibitz, I., Friedrich, M.E., Unger, A., Bachmann, A., Benesch, T., Amering, M. & Psychiatr, P. (2013, Mar) 40(2):83-91. Epub 2013 Jan 25. German.
 Skevington, S.M., Lotfy, M., O'Connel, K. A., WHOQOL Group. (2004). The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13(2), 299-310. http://dx.doi.org/10.1023/b:qure.0000018486.91360.00.
 Stafford, M.R., Jackson, H., Mayo-Wilson, E., Morrison, A.P., Kendall, T. (2013, January 18) "Early interventions to prevent psychosis: systematic review and meta-analysis". BMJ (Clinical research Ed.) 346. http://dx.doi.org/10.1136/bmj.f185.
 Tandon, R., Keshavan, M.S., Nasrallah, H. A. (March, 2008). "Schizophrenia, "Just the Facts": what we know in 2008 part 1: overview". Schizophrenia Research 100 (1â€“3):.01.022. PMID
 The WHOQOL Group. (1995) the World Health Organization Quality of Life Assessment (the WHOQOL): position paper from the World Health Organization. Soc Sci Med.; 41:1403â€“1409. http://dx.doi.org/10.1016/0277-9536(95)00112-K.
 Van Os, J., Kapur, S. (2009, August). "Schizophrenia". Lancet 374 (9690): 635â€“45. http://dx.doi.org/10.1016/S0140-6736(09)60995-8.
 Weissman, A. (1978). The dysfunctional attitudes scale: A validation study. Philadelphia: University of Pennsylvania.
 Weissman, A. N. & Beck, A. T. (1978). Development and validation of the Dysfunctional Attitudes Scale: a preliminary investigation. In: Proceedings of the meeting of the American Educational Research Association. Toronto,
 Ying LU, Xiaoping WANG. (2012) Shanghai Archives of Psychiatry, Vol.24, No.2.