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. 2018 Apr 3:12:14.
doi: 10.1186/s13033-018-0192-4. eCollection 2018.

"My bitterness is deeper than the ocean": understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers

Yin-Ling Irene Wong  1 , Dexia Kong  1 , Lufei Tu  1 , Rosemary Frasso  2
Affiliations

"My bitterness is deeper than the ocean": understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers

Yin-Ling Irene Wong et al. Int J Ment Health Syst. .

Abstract

Background: It is estimated that 8 million of the Chinese adult population had a diagnosis of schizophrenia. Stigma associated with mental illness, which is pervasive in the Chinese cultural context, impacts both persons with schizophrenia and their family caregivers. However, a review of the literature found a dearth of research that explored internalized stigma from the perspectives of both patients and their caregivers.

Methods: We integrated data from standardized scales and narratives from semi-structured interviews obtained from eight family-dyads. Interview narratives about stigma were analyzed using directed content analysis and compared with responses from Chinese versions of the Internalized Stigma of Mental Illness Scale and Affiliated Stigma Scale. Scores from the two scales and number of text fragments were compared to identify consistency of responses using the two methods. Profiles from three family-dyads were analyzed to highlight the interactive aspect of stigma in a dyadic relationship.

Results: Our analyses suggested that persons with schizophrenia and their caregivers both internalized negative valuation from their social networks and reduced engagement in the community. Participants with schizophrenia expressed a sense of shame and inferiority, spoke about being a burden to their family, and expressed self-disappointment as a result of having a psychiatric diagnosis. Caregivers expressed high level of emotional distress because of mental illness in the family. Family dyads varied in the extent that internalized stigma were experienced by patients and caregivers.

Conclusions: Family plays a central role in caring for persons with mental illness in China. Given the increasingly community-based nature of mental health services delivery, understanding internalized stigma as a family unit is important to guide the development of cultural-informed treatments. This pilot study provides a method that can be used to collect data that take into consideration the cultural nuances of Chinese societies.

Keywords: China; Family caregiving; Internalized stigma; Schizophrenia.

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Figures

Fig. 1
Fig. 1
Comparison between number of text fragments and ISMI scores for IPs
Fig. 2
Fig. 2
Comparison between number of text fragments and ASS scores for FCs
Fig. 3
Fig. 3
Internalized stigma score of the study sample by family dyads
See this image and copyright information in PMC

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