Skip to main content

Advertisement

SpringerLink
Log in

Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this review is to identify consistent themes among the qualitative literature on stigma as experienced by patients with schizophrenia receiving community mental health care. With the treatment focus of schizophrenia nowadays shifting more and more towards community-based mental health care, professionals need to be aware of the increased vulnerability of their clients in their social environment as a result of stigma towards their disease. In-depth knowledge on stigma is critical in order to offer a dignifying community mental health care.

Methods

A systematic search of the qualitative literature in Web of Science, PubMed, PsycINFO and Francis was performed to review the subjective experiences and ideas on stigma in outpatients with schizophrenia.

Results

Three major themes were identified in 18 studies and need to be taken into consideration when implementing an adequate community mental health care: (i) the continuing existence of stigma inherent in the health care setting, (ii) the importance of relational aspects of stigma encounters in daily life and (iii) the significance of the behavioural aspects related to previous stigma experiences and beliefs among patients.

Conclusions

Despite much effort in community treatment, patients still experience stigma and discrimination. Community mental health care professionals should not only be aware of structural problems in mental health care, but should also pay considerable attention towards the relational and behavioural aspects in their clients’ life concerning stigma. Furthermore, they have the crucial role in the community to raise awareness about stigma in order to increase their clients’ acceptance in society.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Picchioni MM, Murray RM (2007) Schizophrenia. BMJ 335(7610):91–95. doi:10.1136/bmj.39227.616447.BE (England)

    Article  PubMed  Google Scholar 

  2. van Os J, Kapur S (2009) Schizophrenia. Lancet 374(9690):635–645. doi:10.1016/s0140-6736(09)60995-8 (England)

    Article  PubMed  Google Scholar 

  3. Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M (2009) Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373(9661):408–415. doi:10.1016/S0140-6736(08)61817-6

    Article  PubMed  Google Scholar 

  4. Corrigan PW (2000) Mental health stigma as social attribution: implications for research methods and attitude change. Clin Psychol Sci Pract 7(1):48–67. doi:10.1093/clipsy/7.1.48

    Article  Google Scholar 

  5. World Health Organisation (2005) Mental health declaration for Europe. WHO regional office for Europe, Copenhagen

    Google Scholar 

  6. Semrau M, Barley EA, Law A, Thornicroft G (2011) Lessons learned in developing community mental health care in Europe. World Psychiatry 10(3):217–225

    PubMed Central  PubMed  Google Scholar 

  7. World Health Organisation (2005) Mental health action plan for Europe. WHO regional office for Europe, Copenhagen

    Google Scholar 

  8. World Health Organisation (2005) Mental health: facing the challenges, building solutions. Report from the WHO ministerial conference. WHO regional office for Europe, Copenhagen

    Google Scholar 

  9. Dixon-Woods M, Fitzpatrick R, Roberts K (2001) Including qualitative research in systematic reviews: opportunities and problems. J Eval Clin Pract 7(2):125–133 (pii jep257)

    Article  CAS  PubMed  Google Scholar 

  10. Dierckx de Casterlé B, Gastmans C, Bryon E, Denier Y (2011) QUAGOL: a guide for qualitative data analysis. Int J Nurs Stud. doi:10.1016/j.ijnurstu.2011.09.012

    PubMed  Google Scholar 

  11. Critical Appraisal Skills Program (CASP) (2003) 10 questions to help you make sense of qualitative research, Oxford. http://www.sph.nhs.uk/sph-files/casp-appraisaltools/Qualitative%20Appraisal%20Tool.pdf. Accessed 28 Feb 2012

  12. Schulze B, Angermeyer MC (2003) Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med (1982) 56(2):299–312

    Article  Google Scholar 

  13. Lloyd C, Sullivan D, Williams PL (2005) Perceptions of social stigma and its effect on interpersonal relationships of young males who experience a psychotic disorder. Aust Occup Ther J 52(3):243–250. doi:10.1111/j.1440-1630.2005.00504.x

    Article  Google Scholar 

  14. Buizza C, Schulze B, Bertocchi E, Rossi G, Ghilardi A, Pioli R (2007) The stigma of schizophrenia from patients’ and relatives’ view: a pilot study in an Italian rehabilitation residential care unit. Clin Pract Epidemiol Ment Health 3:23. doi:10.1186/1745-0179-3-23

    Article  PubMed Central  PubMed  Google Scholar 

  15. Gonzalez-Torres MA, Oraa R, Aristegui M, Fernandez-Rivas A, Guimon J (2007) Stigma and discrimination towards people with schizophrenia and their family members—a qualitative study with focus groups. Soc Psychiatry Psychiatr Epidemiol 42(1):14–23. doi:10.1007/s00127-006-0126-3

    Article  PubMed  Google Scholar 

  16. Jenkins JH, Carpenter-Song EA (2008) Stigma despite recovery: strategies for living in the aftermath of psychosis. Med Anthropol Q 22(4):381–409

    Article  PubMed  Google Scholar 

  17. Jenkins JH, Carpenter-Song EA (2009) Awareness of stigma among persons with schizophrenia marking the contexts of lived experience. J Nerv Ment Dis 197(7):520–529. doi:10.1097/NMD.0b013e3181aad5e9

    Article  PubMed  Google Scholar 

  18. Rose D, Willis R, Brohan E, Sartorius N, Villares C, Wahlbeck K, Thornicroft G (2011) Reported stigma and discrimination by people with a diagnosis of schizophrenia. Epidemiol Psychiatr Sci 20(2):193–204. doi:10.1017/S2045796011000254

    Article  CAS  PubMed  Google Scholar 

  19. Chernomas WM, Clarke DE, Chisholm FA (2000) Perspectives of women living with schizophrenia. Psychiatr Serv 51(12):1517–1521. doi:10.1176/appi.ps.51.12.1517

    Article  CAS  PubMed  Google Scholar 

  20. Jenkins JH, Carpenter-Song E (2005) The new paradigm of recovery from schizophrenia: cultural conundrums of improvement without cure. Cult Med Psychiatry 29(4):379–413. doi:10.1007/s11013-006-9000-8

    Article  PubMed  Google Scholar 

  21. Barker S, Lavender T, Morant N (2001) Client and family narratives on schizophrenia. J Ment Health 10(2):199–212. doi:10.1080/09638230123705

    Article  Google Scholar 

  22. Lester H, Tritter JQ, England E (2003) Satisfaction with primary care: the perspectives of people with schizophrenia. Fam Pract 20(5):1–11. doi:10.1093/fampra/cmg502

    Article  Google Scholar 

  23. Perry BM, Taylor D, Shaw SK (2007) You’ve got to have a positive state of mind: an interpretative phenomenological analysis of hope and first episode psychosis. J Ment Health 16(6):781–793. doi:10.1080/09638230701496360

    Article  Google Scholar 

  24. Nithsdale V, Davies J, Croucher P (2008) Psychosis and the experience of employment. J Occup Rehabil 18(2):175–182. doi:10.1007/s10926-008-9131-6

    Article  PubMed  Google Scholar 

  25. Judge AM, Estroff SE, Perkins DO, Penn DL (2008) Recognizing and responding to early psychosis: a qualitative analysis of individual narratives. Psychiatr Serv 59(1):96–99. doi:10.1176/appi.ps.59.1.96

    Article  PubMed  Google Scholar 

  26. Forrester-Jones R, Barnes A (2008) On being a girlfriend not a patient: the quest for an acceptable identity amongst people diagnosed with a severe mental illness. J Ment Health 17(2):153–172. doi:10.1080/09638230701498341

    Article  Google Scholar 

  27. Tidefors I, Olin E (2011) A need for “good eyes”: experiences told by patients diagnosed with psychosis. Int J Qual Stud Health Well Being 6(1) doi:10.3402/qhw.v6i1.5243

  28. Redmond C, Larkin M, Harrop C (2010) The personal meaning of romantic relationships for young people with psychosis. Clin Child Psychol Psychiatry 15(2):151–170. doi:10.1177/1359104509341447

    Article  PubMed  Google Scholar 

  29. McCann E (2010) Investigating mental health service user views regarding sexual and relationship issues. J Psychiatr Ment Health Nurs 17(3):251–259. doi:10.1111/j.1365-2850.2009.01509.x

    Article  CAS  PubMed  Google Scholar 

  30. Harrison J, Gill A (2010) The experience and consequences of people with mental health problems, the impact of stigma upon people with schizophrenia: a way forward. J Psychiatr Ment Health Nurs 17(3):242–250. doi:10.1111/j.1365-2850.2009.01506.x

    Article  CAS  PubMed  Google Scholar 

  31. Liegeois A, Van Audenhove C (2005) Ethical dilemmas in community mental health care. J Med Ethics 31(8):452–456. doi:10.1136/jme.2003.006999

    Article  CAS  PubMed  Google Scholar 

  32. Corcoran C, Malaspina D, Hercher L (2005) Prodromal interventions for schizophrenia vulnerability: the risks of being “at risk”. Schizophr Res 73(2–3):173–184. doi:10.1016/j.schres.2004.05.021 (The Netherlands)

    Article  PubMed Central  PubMed  Google Scholar 

  33. Thornicroft G, Rose D, Kassam A (2007) Discrimination in health care against people with mental illness. Int Rev Psychiatry 19(2):113–122. doi:10.1080/09540260701278937

    Article  PubMed  Google Scholar 

  34. Beauchamp TL, Childress JF (2009) Principles of biomedical ethics, 6th edn. Oxford University Press, New York

    Google Scholar 

  35. Grisso T, Appelbaum PS (1995) The MacArthur treatment competence study III: abilities of patients to consent to psychiatric and medical treatments. Law Hum Behav 19(2):149–174

    Article  PubMed  Google Scholar 

  36. Jeste DV, Depp CA, Palmer BW (2006) Magnitude of impairment in decisional capacity in people with schizophrenia compared to normal subjects: an overview. Schizophr Bull 32(1):121–128 10.1093/schbul/sbj001

    Article  PubMed  Google Scholar 

  37. Woltmann EM, Whitley R (2010) Shared decision making in public mental health care: perspectives from consumers living with severe mental illness. Psychiatr Rehabil J 34(1):29–36. doi:10.2975/34.1.2010.29.36

    Article  PubMed  Google Scholar 

  38. Quirk A, Chaplin R, Hamilton S, Lelliott P, Seale C (2013) Communication about adherence to long-term antipsychotic prescribing: an observational study of psychiatric practice. Soc Psychiatry Psychiatr Epidemiol 48(4):639–647. doi:10.1007/s00127-012-0581-y

    Article  PubMed  Google Scholar 

  39. Nguyen E, Chen TF, O’Reilly CL (2012) Evaluating the impact of direct and indirect contact on the mental health stigma of pharmacy students. Soc Psychiatry Psychiatr Epidemiol 47(7):1087–1098. doi:10.1007/s00127-011-0413-5

    Article  PubMed  Google Scholar 

  40. O’Reilly CL, Bell JS, Chen TF (2012) Mental health consumers and caregivers as instructors for health professional students: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 47(4):607–613. doi:10.1007/s00127-011-0364-x

    Article  PubMed  Google Scholar 

  41. Markowitz FE (2011) Mental illness, crime, and violence: risk, context, and social control. Aggress Viol Behav 16(1):36–44. doi:10.1016/j.avb.2010.10.003

    Article  Google Scholar 

  42. van Zelst C (2009) Stigmatization as an environmental risk in schizophrenia: a user perspective. Schizophr Bull 35(2):293–296. doi:10.1093/schbul/sbn184 (United States)

    Article  PubMed  Google Scholar 

  43. Elbogen EB, Johnson SC (2009) The intricate link between violence and mental disorder. Arch Gen Psychiatry 66(2):152–161

    Article  PubMed  Google Scholar 

  44. Ucok A, Brohan E, Rose D, Sartorius N, Leese M, Yoon CK, Plooy A, Ertekin BA, Milev R, Thornicroft G, Indigo Study Group (2012) Anticipated discrimination among people with schizophrenia. Acta Psychiatr Scand 125(1):77–83. doi:10.1111/j.1600-0447.2011.01772.x

    Article  CAS  PubMed  Google Scholar 

  45. Moriarty A, Jolley S, Callanan MM, Garety P (2012) Understanding reduced activity in psychosis: the roles of stigma and illness appraisals. Soc Psychiatry Psychiatr Epidemiol 47(10):1685–1693. doi:10.1007/s00127-012-0475-z

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The research for this review was performed in the context of the Erasmus Mundus Master in Bioethics that was attended by A.M. with supporting scholarship of the European Commission. The authors would like to thank the participating universities of the EMMB programme for their valuable support in this research project; KU Leuven in Belgium, RU Nijmegen in The Netherlands and UNIPD Padova in Italy.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Faculty of Medicine, LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium

    Annelien Mestdagh

  2. Faculty of Medicine, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium

    Bart Hansen

Authors
  1. Annelien Mestdagh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bart Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bart Hansen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mestdagh, A., Hansen, B. Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies. Soc Psychiatry Psychiatr Epidemiol 49, 79–87 (2014). https://doi.org/10.1007/s00127-013-0729-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0729-4

Keywords

Search

Navigation