Background Characteristics
From the total of 233 schizophrenia outpatients, 216 of them participated in the study and having response rate of 92.7%. The remaining participants failed to complete the interview because of the illness, in between the study, and questions were not fulfilled properly.
The majority of the Participants were males 153 (70.8%). The mean ages of the participants were 32.9 years. Out of the total study participants, 114(52.8%) of them could not read and write, Orthodox in religion 176(81.6%), single in marital status 129(59.7%), and within the age range of 25-34 years 91(42.1%).
Out of 216 participants, 187(86.6%) were unemployed, 119 (55.1%) were living in rural areas, and 179 (82.9%) were living with their family (Table 1).
Table 1: Socio demographic characteristics of the study participants (𝑛 = 216)
Variable
|
Categories
|
Frequency (N)
|
Percentage (%)
|
Sex
|
Male
|
153
|
70.8
|
Female
|
63
|
29.2
|
Age
|
18–24
|
38
|
17.6
|
25-34
|
91
|
42.1
|
35-44
|
64
|
29.6
|
≥45
|
23
|
10.7
|
Marital status
|
Single
|
129
|
59.7
|
Married
|
46
|
21.3
|
Divorced
|
30
|
13.9
|
Widowed
|
11
|
5.1
|
Educational status
|
Cannot read and write
|
114
|
52.8
|
Primary school
|
81
|
37.5
|
Secondary and above
|
21
|
9.7
|
Ethnicity
|
Tigray
|
202
|
93.5
|
Afar
|
11
|
5.1
|
Amhara
|
1
|
0.5
|
Others
|
2
|
0.9
|
Religion
|
Muslim
|
31
|
14.4
|
Orthodox
|
176
|
81.4
|
Protestant
|
4
|
1.9
|
Catholic
|
5
|
2.3
|
Employment status
|
Unemployed
|
187
|
86.6
|
Employed
|
29
|
13.4
|
Residence
|
Rural
|
119
|
55.1
|
Urban
|
97
|
44.9
|
Living arrangement
|
With family
|
179
|
82.9
|
Alone
|
37
|
17.1
|
Clinical Characteristics of the study participants
32.9% (71) of the participants had been for two to five years with schizophrenia. Though 18% (39) of participants had the illness of schizophrenia for eleven and above years, only 6.9% (15) persons had treatment since the illness onset. Out of the total of the study participants, 18.9 %( 39) and 30.6 %( 66) of them had difficulty of adherence to prescribed anti-psychotic medications and follow up appointments, respectively (table 2).
Table2: clinical characteristics of the study participants (𝑛 = 216)
Variable
|
Categories
|
Frequency (N)
|
Percentage (%)
|
Duration of illness
|
≤1 year
|
43
|
19.9
|
2-5 years
|
71
|
32.9
|
6-10 years
|
63
|
29.2
|
≥11 years
|
39
|
18
|
Duration of treatment
|
≤1 year
|
69
|
31.9
|
2-5 years
|
93
|
43.1
|
6-10 years
|
39
|
18.1
|
≥11 years
|
15
|
6.9
|
Adherence to prescribed drugs
|
Yes
|
177
|
81.9
|
No
|
39
|
18.9
|
Adherence to clinical follow up or appointment
|
Yes
|
150
|
69.4
|
No
|
66
|
30.6
|
Prevalence Self-stigma among the study participants
The study found that prevalence of self-stigma among schizophrenic outpatients was 67.1% (145) (figure 1).
Large proportion of schizophrenia patients with adherence to prescribed psychotropic drugs medication experience self-stigma (72.3%) as compared those patient with no psychotropic drugs adherence (43.6%). On the other hand, large proportion schizophrenic patients with more than eleven years illness duration before treatment reported self-stigma (84.6%) compared to those patients with up to one year untreated illness duration (48.8%). Large proportion of rural residents of schizophrenic patients reported self-stigma (79.8%) compared to urban resident counter parts (51.5%). While 80.7% of patients who cannot read and write reported self-stigma, 28.6% of patients with secondary and above educational status had self-stigma (Table3).
Table 3: Cross tab analysis factors versus self-stigma status
Factors
|
Category
|
Self-stigma status
|
No
|
Yes
|
p-value
|
Adherence to prescribed drugs
|
Yes
|
27.7%
|
72.3%
|
0.001
|
No
|
56.4%
|
43.6%
|
Adherence to clinical follow up or appointment
|
Yes
|
41.3%
|
58.7%
|
0.000
|
No
|
13.6%
|
86.4%
|
Duration of the illness before treatment
|
< or =1 year
|
51.2%
|
48.8%
|
0.004
|
2-5years
|
36.6%
|
63.4%
|
6-10years
|
27.0%
|
73.0%
|
>or=11years
|
15.4%
|
84.6%
|
Duration of treatment
|
≤1 year
|
18.8%
|
81.2%
|
0.001
|
2-5 years
|
32.3%
|
67.7%
|
6-10 years
|
48.7%
|
51.3%
|
≥11 years
|
60.0%
|
40.0%
|
Living arrangement
|
With family
|
37.4%
|
62.6%
|
0.002
|
Alone
|
10.8%
|
89.2%
|
Residence
|
Rural
|
20.2%
|
79.8%
|
0.000
|
Urban
|
48.5%
|
51.5%
|
Marital status
|
Single
|
25.6%
|
74.4%
|
0.000
|
Married
|
58.7%
|
41.3%
|
Divorced
|
36.4%
|
63.6%
|
Widowed
|
23.3%
|
76.7%
|
Educational status
|
Cannot read and write
|
19.3%
|
80.7%
|
0.000
|
Primary school
|
42.0%
|
58.0%
|
Secondary and above
|
71.4%
|
28.6%
|
Gender
|
Male
|
26.8%
|
73.2%
|
0.003
|
Female
|
47.6%
|
52.4%
|
Employment status
|
Unemployed
|
26.2%
|
73.8%
|
0.000
|
Employed
|
75.9%
|
24.1%
|
Religion
|
Muslim
|
32.3%
|
67.7%
|
0.972
|
Orthodox
|
33.0%
|
67.0%
|
Protestant
|
25.0%
|
75.0%
|
Catholic
|
40.0%
|
60.0%
|
Ethnicity
|
Tigray
|
33.2%
|
66.8%
|
0.364
|
Afar
|
27.3%
|
72.7%
|
Amhara
|
100.0%
|
0.0%
|
Others
|
0.0%
|
100.0%
|
Age
|
18–24
|
23.7%
|
76.3%
|
0.359
|
25-34
|
38.5%
|
61.5%
|
35-44
|
32.8%
|
67.2%
|
≥45
|
26.1%
|
73.9%
|
Variables Associated with High Self-stigma
In binary logistic regression analysis, factors such as being male (COR=2.5, 95% CI=1.35-4.57), single (COR=4.13, 95% CI= 2.04-8.39), widowed (COR=4.67, 955 CI= 1.67-13.10), rural resident (COR=3.72, 95% CI= 2.04-6.77), living alone (COR=4.94, 95% CI=1.67-14.55), cannot read and write (COR=10.46, 95% CI=3.64-30.0), having primary school educational level (COR=3.46, 95% CI= 1.22-9.82), being employed (COR=0.11, 95% CI=0.05-0.28), being with schizophrenia without treatment for eleven and above years (COR= 5.76, 95% CI=2.01-16.56), less than one year schizophrenia treatment (COR=6.46, 95% CI=1.95-21.37), two to five schizophrenia treatment (COR=3.15, 95% CI=1.03-9.66), no adherence to clinical follow appointments (COR=4.46, 95% CI=2.06-9.68), and being medication non-adherent (COR=3.38, 95% CI=1.66-6.90) significantly independently associated Self-stigma of outpatients with schizophrenia.
After controlling potential confounders by multivariate logistic regression, being single marital status (AOR=6.2, 95% CI= 1.83-21.21), rural resident (AOR=3.7, 95% CI= 1.47-9.14), being living alone (AOR=9.5, 95% CI= 1.59-56.40), cannot read and write (AOR=22.2, 95% CI= 3.5-15.85), primary school educational status and below (AOR= 13.4, 95% CI=2.1-13.16), staying with schizophrenia illness for eleven and above years without treatment (AOR=11.6, 95% CI=2.19-61.7), having less than a year schizophrenia treatment (AOR=49.1, 95% CI=5.1-15.46), two to five years of treatment of schizophrenia (AOR=10.2, 95% CI=1.23-9.25), non-adherence to clinical follow up (AOR=10.6, 95% CI=2.96-12.7), and being non-adherent to medications (AOR=3.7, 95% CI=1.10-12.37) was positively significantly associated with Self-stigma among persons with schizophrenia visiting outpatient clinic. However, being male, widowed didn’t significantly associate with schizophrenia outpatient Self-stigma condition. On the other hand, being unemployed (AOR=0.1, 95% CI= 0.02-0.29) negatively associated with Self-stigma of persons with schizophrenia treated at outpatient department.
The odds of developing Self-stigma was six times higher among single schizophrenic outpatients than that of married ones (AOR=6.2, 95% CI= 1.83-21.21). Besides, schizophrenic outpatients living in rural areas had almost four times odds of higher Self-stigma compared to those from urban areas (AOR=3.7, 95% CI= 1.47-9.14). The odds of Self-stigma was almost ten times higher among schizophrenic outpatients who lived alone than those who lived with their relatives (AOR=9.5, 95% CI= 1.59-56.40). On the other hand, schizophrenic outpatients who cannot read and write (AOR=22.2, 95% CI= 3.5-15.85) and primary school educational status and below (AOR= 13.4, 95% CI=2.1-13.16) had twenty two and more than thirteen times, respectively, of Self-stigma compared to schizophrenic outpatients with secondary school and above educational status. The odds of Self-stigma was more than eleven times higher among persons with schizophrenia outpatients who stayed with schizophrenia illness for eleven and above years without treatment (AOR=11.6, 95% CI=2.19-61.7) than that of persons with less than a year schizophrenia illness duration. Besides, persons with less than a year (AOR=49.1, 95% CI=5.1-15.46) and two to five years of schizophrenia treatment (AOR=10.2, 95% CI=1.23-9.25) in outpatient department had forty nine times and more than times, respectively, higher odds of Self-stigma compared to that of schizophrenic outpatients with eleven and above years of treatment duration. Moreover, the odds of Self-stigma was more than ten times higher among schizophrenic outpatients who were non-adherent to clinical follow up compared to those schizophrenic outpatients with good adherence to clinical follow up appointments (AOR=10.6, 95% CI=2.96-12.7). In addition to this, medication non-adherent schizophrenic outpatients had more than three times higher odds of Self-stigma than medication adherent outpatients with schizophrenia (AOR=3.7, 95% CI=1.10-12.37). Furthermore, the odds of Self-stigma was lower among unemployed schizophrenic outpatients as compared to that of employed ones (AOR=0.1, 95% CI= 0.02-0.29) (Table 4).
Table 4: Logistic regression analysis results on factors predicting Self-stigma among Schizophrenia outpatients
Variables
|
High perceived devaluation and Discrimination
|
COR (95% CI)
|
P-value
|
Adjusted OR (95% CI)
|
P-value
|
Age
|
18–24
|
76.3%
|
2.01(.85-4.75)
|
0.110
|
1.4(.38-4.83)
|
.64
|
25-34
|
61.5%
|
1.00
|
35-44
|
67.2%
|
1.3(0.65-2.50)
|
0.471
|
1.4(.46-4.42)
|
0.54
|
≥45
|
73.9%
|
1.77(0.64-4.9)
|
0.273
|
2.3(.47-11.13)
|
0.304
|
Gender
|
Male
|
73.2%
|
2.5(1.35-4.57)
|
0.003
|
2.1(.76-5.62)
|
0.16
|
Female
|
52.4%
|
1.00
|
Marital status
|
Single
|
74.4%
|
4.13(2.04-8.39)
|
<0.001
|
6.2(1.83-21.21)
|
0.003
|
Married
|
41.3%
|
1.00
|
|
Divorced
|
63.6%
|
2.49(0.64-9.70)
|
0.190
|
1.4(.17-11.66)
|
.75
|
Widowed
|
76.7%
|
4.67(1.67-13.10)
|
0.003
|
4.2(.85-20.54)
|
0.08
|
Residence area
|
Rural
|
79.8%
|
3.72(2.04-6.77)
|
<0.001
|
3.7(1.47-9.14)
|
0.005
|
Urban
|
51.5%
|
1.00
|
Living arrangement
|
With family
|
62.6%
|
1.00
|
Alone
|
89.2%
|
4.94(1.67-14.55)
|
0.004
|
9.5(1.59-56.40)
|
0.014
|
Educational status
|
Cannot read and write
|
80.7%
|
10.46(3.64-30.0)
|
<0.001
|
22.2(3.5-15.85)
|
0.001
|
Primary school
|
58.0%
|
3.46(1.22-9.82)
|
0.02
|
13.4(2.1-13.16)
|
0.007
|
Secondary and above
|
28.6%
|
1.00
|
Employment status
|
Unemployed
|
73.8%
|
0.11(0.05-0.28)
|
<0.001
|
0.1(0.02-0.29)
|
<0.001
|
Employed
|
24.1%
|
1.00
|
Duration of the illness before treatment
|
≤1 year
|
48.8%
|
1.00
|
2-5years
|
63.4%
|
1.81(0.84-3.91)
|
0.129
|
3.2(.95-10.61)
|
0.06
|
6-10years
|
73.0%
|
2.84(1.25-6.42)
|
0.012
|
2.9(.79-10.59)
|
0.10
|
≥11years
|
84.6%
|
5.76(2.01-16.56)
|
0.001
|
11.6(2.19-61.7)
|
0.004
|
Duration of treatment
|
≤1 year
|
81.2%
|
6.46(1.95-21.37)
|
0.002
|
49.1(5.1-15.46)
|
0.001
|
2-5 years
|
67.7%
|
3.15(1.03-9.66)
|
0.045
|
10.2(1.23-9.25)
|
0.031
|
6-10 years
|
51.3%
|
1.58(0.47-5.29)
|
0.459
|
7.9(.84-2.63)
|
0.071
|
≥11 years
|
40.0%
|
1.00
|
Clinical follow up adherence
|
Yes
|
58.7%
|
1.00
|
No
|
86.4%
|
4.46(2.06-9.68)
|
<0.001
|
10.6(2.96-12.7)
|
<0.001
|
Drug Adherence
|
No
|
72.3%
|
3.38(1.66-6.90)
|
0.001
|
3.7(1.10-12.37)
|
0.034
|
Yes
|
43.6%
|
1.00
|
Constant= -9.67, Wald= 27.03, Reference=1.00