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Self perception of stigma in mentally ill patients in Tehran, Iran. Helia Ghanean MD. PhD student Umea university, department of psychiatry , Sweden Iran university of medical sciences. Iran , population 70 million. Persian Azari Kurdish, Lur, Baloch, Turkmen.
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Self perception of stigma in mentally ill patients in Tehran, Iran Helia Ghanean MD. PhD student Umea university, department of psychiatry , Sweden Iran university of medical sciences
Iran , population 70 million. Persian Azari Kurdish, Lur, Baloch, Turkmen. 90% Shia Muslim, Sunni Muslim, Zoroastrian, Jewish, Christian. Tehran, the capital, 11 million inhabitants.
Stigma • Mental illness is probably one of the most stigmatizing disorder in all cultures. • Stigmatization: • External factors. • Internal factors.
Holly Quran • According to holy Quran people suffering from a disease for example mental disorder should be treated with respect. Is there Less stigmatizing behaviour in Islamic societies ?
Self perception of stigma =Internalized Stigma • Self stigmatization: Perception of the difference/ deviance. • Importance of self-stigmatization = General stigmatization (stigmatization from people around him/her).
Concept of Internalized Stigma • The concept of Internalized stigma was developed by J.Ritsher et al (2003) . • Internalized stigma is the devaluation, shame, secrecy and withdrawal trigged by applying negative stereotypes to oneself.
Aim • To determine the experience of Internalized stigma in Mentally ill patients in Tehran, Iran. • To include stigma reduction as a verifiable treatment goal in addition to symptom reduction.
Questionnaire 6 items 7 items 5 items ISMIS, 29 items 6 items 5 items
Design • Study design: Cross-sectional study • Sampling method: Non-probability • Analysis of variance: Chi-square, ANOVA. • Followed by an open ended question asked by first author.
Subjects • Participants : • 130 diagnosed patients with depressivedisorders, Schizophrenia spectrum, Bipolar mood spectrum disorders. • From admitted and out patient clinic of : • Rasoul hospital • Navab hospital • Razi Mental Hospital • The participation were on voluntary basis.
Pilot study • ISMIS translated to Farsi and back translated to English. • Pilot study : 30 individuals, the internal consistency was 0.87. • Questions were comprehensive, only question 24was not easy understood in Farsi.
Reliability and validity Cronbach’s alpha Total 29 items Farsi version= 0.90 Cronbach’s alpha of different versions of ISMIS
Results • Mean age : 29 range of( 18-60). • 40% Female. • 57%single, 7% divorced or widowed. • Majority with high school diploma degree. • 80% Unemployed.
Examples of responses • ‘‘ Blind man crossing street recieves help, even cars have options for disables but nothing is provided for us’’. • ‘‘I wish my family could understand that psychiatric patients are like other patients, like those with cancer or cardiac disease’’.
Stigma and education • We found association between discrimination experience , social withdrawal and education. • Higher education = lesser experience of stigma. • No significant association between subscales and gender, marital status and occupation.
of stigma Prevalence • What is Normative , High level or Low level of stigma?
Lysaker , Roe et al model • <2 minimal stigma • 2-2.5 mild stigma • 2.5 -3 moderate stigma • >3 severe stigma 40% 21% 27% 12%
Conclusion • Comparing these findings, we can conclude that the level of stigma in patients suffering from mental illness is estimated HIGH (40%). • Same study performed on patients with Epilepsy findings show less stigma experience(23%) comparing to mentally ill.
Recommendations • Willingness of patients to talk about their situation gives us strong indication for further more qualitative studies. • It seems necessary to inform the public about the cause of psychiatric problems and possible effective treatments.
