The Related Factors Associated With Stigma Stress Among People With Severe Mental Disorder

ObjectivesMental disorders are usually chronic diseases with high prevalence,high disability and high disease burden.However,there is a huge treatment gap in mental disorders.According to research,the stigma of mental disorders is an important factor influencing the treatment gap.Among them,stigma hinders patients with severe mental disorders to access mental health services,standardized treatment and rehabilitation.From the perspective of stigma stress,this study aims to understand the related factors of stigma stress among patients with severe mental disorders,which can reduce harm brought by stigma,increase their resources to cope with stigma,obtain more comprehensive psychosocial rehabilitation,and provide scientific evidence and data support for reducing stigma in patients with severe mental disorders.MethodsA survey was conducted on outpatients and inpatients with severe mental disorders in the Affiliated Brain Hospital of Guangzhou Medical University.Demographic information was collected using a self-compiled general demographic information questionnaire.The Stigma Stress Scale(SSS)was used to evaluate the stigma stress of patients with severe mental disorders.The patients were then divided into high stigma stress group(high SSS)and low stigma stress group(low SSS)according to the difference between the stigma injury and related coping resources felt by the patients;Internalized Stigma of Mental Illness scale(ISMI)was used to evaluate the internal stigma of patients with severe mental disorders;Self-esteem scale(SES)was used to evaluate the level of self-esteem in patients with severe mental disorders;Tendency to Expect Rejection Scale(TERS)was used to evaluate patients with severe mental disorders sensitivity to rejection;Patient Health Questionnaire-9(PHQ-9)was used to assess depression in patients with severe mental disorders.The survey was carried out from November 2020 to October 2021.Result1.A total of 204 patients with severe mental disorders were enrolled in this study.Among them,the average age of the patients was 32.36(SD=11.51)years old;82(40.2%)were male and 122(59.8%)were female;the average disease duration was8.13(SD=8.30)years;106(52.0%)of them were outpatients,the other 98(48.0%)were hospitalized patients;more than half of the interviewed patients were unmarried(62.7%);almost evenly split between the employed(50.5%)as well as the unemployed(49.5%).2.The results showed that female(t=-1.990,P=0.048),patients who had never been hospitalized(t=-2.556,P=0.011)had higher SSS scores.The unmarried(MD=4.065,P=0.017)patients had higher SSS scores than the married ones,with statistically significant differences.Female(t=-2.648,P<0.01),unemployed(t=-3.466,P<0.01),never hospitalized(t=-3.406,P<0.01),patients who had not received involuntary hospitalization(t=-3.054,P<0.01)had higher TERS scores.The unmarried(MD=5.590,P<0.01)patients had higher scores than the married ones,patients of depression(MD=2.232,P<0.01)had higher TERS score than bipolar disorder,patients with more hospitalizations(r=-0.162,P=0.021)score higher in TERS,with statistically significant difference.3.The average score of the SSS of the respondents with high stigma stress group(high SSS)was 6.09±4.98 points,the average score of the TERS was 65.02±9.34points,the ISMI was 71.11±12.34 points,the SES was 25.86±5.49 points,and the PHQ-9 scale was 12.74±7.21 points;while in the low stigma stress group(low SSS),the mean score of the SSS was-10.57±7.96 points,TERS was 52.26±12.48 points,the ISMI was 55.72±12.70 points,the SES was 20.74±4.84 points,and the PHQ-9was 6.14±6.14 points.The score of TERS(t=8.126,P<0.01),ISMI(t=8.135,P<0.01),SES(t=6.743,P<0.01),PHQ-9(t=6.753,P<0.01)of the interviewed patients in two group was significantly different.4.The SSS scores of the interviewed patients with severe mental disorders were significantly positively correlated related to TERS(r=0.514,P<0.01),ISMI(r=0.628,P<0.01),SES(r=0.525,P<0.01),PHQ-9(r=0.484,P<0.01).TERS score was significantly positive correlated with SSS(r=0.514,P<0.01),ISMI(r=0.593,P<0.01),SES(r=0.599,P<0.01),PHQ-9(r=0.634,P<0.01).5.The results of the additional items showed that the scores of the additional items"worried about the future life"(r=-0.540,P<0.01)and"disappointed with the future life"(r=-0.539,P<0.01)of patients with severe mental disorders were significantly negatively correlated with SSS.6.Multivariate linear regression was used to analyze the influencing factors of stigma stress in patients with severe mental disorders.The results showed that internal stigma(β=0.364,t=4.565,P<0.01)and the additional items"worried about the future life"(β=-0.178,t=-2.239,P=0.026)were the factors affecting stigma stress in patients with severe mental disorders.Multiple linear regression was used to analyze the influencing factors of rejection sensitivity in patients with severe mental disorders.The results showed that depression(β=0.332,t=4.904,P_t<0.01),self-esteem(β=0.194,t=2.614,P_t<0.01)and stigma stress(β=0.135,t=2.043,P_t=0.042)were factors affecting rejection sensitivity in patients with severe mental disorders.ConclusionStigma is one of the important factors hindering them from seeking medical treatment and receiving full-course treatment.This study explores new way to reduce stigma from the perspective of stigma stress.The results show that the level of stigma stress among patients with severe mental disorders is related to the level of internal stigma,worried about the future life,rejection sensitivity,self-esteem,depression,gender,hospitalization and marital status.The rejection sensitivity of patients with severe mental disorders was related to the level of depression,self-esteem,internal stigma,stigma stress,gender,work status,hospitalization,marital status and diagnosis.In the future anti-stigma action,it is necessary to pay more attention to patients with the above characteristics,and adopt corresponding intervention strategies to reduce their rejection sensitivity in interpersonal relationships,reduce the harm of stigma,increase their ability to attain social resources to cope with stigma.Thereby,the strategies can reduce the level of their stigma and promoting their comprehensive psychosocial recovery.