MUSTAFA YILDIZ, EYLEM ÖZTEN, Sibel IŞIK, İlker ÖZYILDIRIM, Deniz KARAYÜN, CEM CERİT, Alp ÜÇOK

Şizofreni hastaları, hasta yakınları ve majör depresif bozukluk hastalarında kendini damgalama

Amaç: Şizofreni hastalarında, şizofreni hastalarının ailelerinde ve majör depresif bozukluk (MDB) hastalarındaki başkalarını ve kendini damgalamayı değerlendirmek ve damgalama ile ilişkili etkenleri incelemektir. Yöntem: Kendini Damgalamayı Değerlendirme Ölçeği kullanılarak 167 şizofreni hastası, 86 MDB hastası ve 45 şizofreni hastasının yakınıyla görüşüldü. Başkalarını ve kendini damgalama ile hastalığın şiddeti, hastalığın süresi ve nüfus özellikleri arasındaki ilişkiler her grup için çözümlendi. Hastalık şiddeti Klinik Genel İzlenim Ölçeği ile değerlen- dirildi. Bulgular: Başkalarını damgalama ve kendini damgalama açısından şizofreni hastaları ile MDB hastaları arasında istatistiksel olarak anlamlı düzeyde fark saptandı. Şizofreni hastalarının ailelerinde başkalarını damgala- ma yüksek oranda saptandı. Şizofreni hastaları ve hasta yakınlarında kendini ve başkalarını damgalama puanları ile sosyodemografik, nüfus ve klinik özellikler arasında anlamlı bir ilişki saptanmazken, MDB hastalarında klinik durumun şiddeti ile başkalarını ve kendini damgalama puanları arasında pozitif yönde anlamlı bir ilişki saptandı. MDB hastalarında kendini damgalama ile eğitim düzeyi arasında pozitif bir ilişki saptandı. Tartışma: Şizofreninin yeti yitimiyle giden doğası ve olumsuz toplumsal tutumlar, şizofreni hastalarında kendini damgalamada nedensel bir rol oynayabilir. Damgalamanın olumsuz sonuçlarını önlemek için klinisyenler hastaları ve aileleri tedavi eder- ken hastalarda ve ailelerde de görülebilen başkalarını ve kendini damgalamayı dikkate almalıdır. (Anadolu Psikiyatri Derg 2012; 13:1-7)

Self-stigmatization among patients with schizophrenia, their relatives and patients with major depressive disorder

Objective: The aims of this study were to assess stigma to others and self-stigma among outpatients with schizo- phrenia, their relatives, and patients with major depressive disorder and to examine the factors related to the stigmatization. Methods: Using the Self-Stigma Assessment Scale, 167 patients with schizophrenia, 45 relatives of the patients with schizophrenia and 86 patients with major depressive disorder were evaluated. The correlation between stigmatization to others and self-stigmatization and severity of illness, duration of illness, and demo- graphic characteristics were further examined for each group. Illness severity was evaluated using the clinical global impression scale. Results: There was a statistically significant difference between patients with schizo- phrenia and patients with major depressive disorder (MDD) with respect to stigmatization to others and self-stig- matization. Stigmatization to others was found to be higher in patients’ relatives. Although there were no corre- lation between stigmatization and demographic and clinical characteristics among patients with schizophrenia and their relatives, there was a positive correlation between severity of illness and stigmatization to others and self- stigmatization among patients with MDD. There was also a positive correlation between the level of education and self-stigmatization among patients with MDD. Conclusion: Disabling nature of the illness and negative public atti- tudes to the patients might be causative factors for self-stigmatization in schizophrenia. Clinicians should take the stigmatization to others and self-stigmatization which could be seen both patients and their relatives into con- sideration when treating patients with schizophrenia and their relatives in order to prevent negative consequences of the stigma. (Anatolian Journal of Psychiatry 2012; 13:1-7)

PDF

___

1. Link BG, Phelan JC. Conceptualizing stigma. Ann Rev Sociol 2001; 27:363-385.
2. Angermeyer MC, Matschinger H. The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatr Scand 2003; 108:304-309.
3. Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry 2002; 1:6-20.
4. Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry 2005; 20:529-539.
5. Corrigan PW. The impact of stigma on severe mental illness. Cogn Behav Prac 1998; 5:201-222.
6. Larson JE, Corrigan P. The stigma of families with mental illness. Acad Psychiatry 2008; 32:87-91.
7. Struening EL, Perlick DA, Link BG, Hellman F, Herman D, Sirey JA. The extent to which caregivers believe most people devalue consumers and their families. Psychiatr Serv 2001; 52:1633-1638.
8. Lee S, Lee MTY, Chiu MYL, Kleinman A. Experience of social stigma by people with schizophrenia in Hong Kong. Br J Psychiatry 2005; 186:153-157.
9. Wahl OF, Harman CR. Family views of stigma. Schizophr Bull 1989; 15:131-139.
10. Ostman M, Kjellin L. Stigma by association: psycho- logical factors in relatives of people with mental illness. Br J Psychiatry 2002; 181:494-498.
11. Magaña SM, García JIR, Hernández MG, Cortez R. Psychological distress among Latino family caregivers of adults with schizophrenia: the roles of burden and stigma. Psychiatr Serv 2007; 58:378-384.
12. Perlick DA, Miklowitz DJ, Link BG, Struening E, Kaczynski R, Gonzalez J, et al. Perceived stigma and depression among caregivers of patients with bipolar disorder. Br J Psychiatr 2007; 190:535-536.
13. Yanos PT, Roe D, Markus K, Lysaker PH. Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psych Serv 2008; 59:1437-1442.
14. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. Br J Psychiatry 2000; 177:4-7.
15. Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health 1999; 89:1328-1333.
16. Üçok A. Diğer insanlar damgalar. Peki ya biz? Zihin sağlığı çalışanlarının şizofreni hastalarına karşı tutum- ları. Nöropsikiyatri Arşivi 2007; 44:108-116.
17. American Psychiatric Association. Diagnostic and Statis- tical Manual of Mental Disorders, fourth ed. Washington, DC, American Psychiatric Association, 1994.
18. Guy W. ECDEU Assessment Manual for Psychopharma- cology. Rockville, MD, US Department of Health and Human Services Publication (ADM), 1976, p.218-222.
19. Corrigan PW, Lundin RK. Don't Call Me Nuts: Coping with the Stigma of Mental Illness. Tinley Park, Ill, Recovery Press, 2001.
20. Pyne JM, Kuc EJ, Schroeder PJ, Fortney JC, Edlund M, Sullivan G. Relationship between perceived stigma and depression severity. J Nerv Ment Dis 2004; 192:278- 283.
21. Raguram R, Weiss MG, Channabasavanna SM, Devins GM. Stigma, depression, and somatization in South India. Am J Psychiatry 1996; 153:1043-1049.
22. Freidl M, Piralic Spitzl S, Aigner M. How depressive symptoms correlate with stigma perception of mental illness. Int Rev Psychiatry 2008; 20:510-514.
23. Yen C-F, Chen C-C, Lee Y, Tang T-C, Yen J-Y, Ko C-H. Self-Stigma and Its Correlates Among Outpatients With Depressive Disorders. Psychiatr Serv 2005; 56:599-601.
24. Holzinger A, Beck M, Munk I, Weithaas S, Angermeyer MC. Stigma aus der perspektive schizophren und depressiv erkrankter. (Stigma as perceived by schizo- phrenics and deppressives). Psychiatrische Praxis 2003; 30:395-401.
25. Mak WWS, Wu CFM. Cognitive Insight and Causal Attribution in the Development of Self-Stigma Among Individuals With Schizophrenia. Psychiatr Serv 2006; 57:1800-1802.
26. Rüsch N, Lieb K, Bohus M, Corrigan PW. Self-stigma, empowerment, and perceived legitimacy of discrimina- tion among women with mental illness. Psychiatr Serv 2006; 57:399-402.
27. Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan JC, Link BG. "A disease like any other"? a decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry 2010; doi: 10.1176/appi.ajp. 2010.09121743.
28. Sibitz I, Unger A, Woppmann A, Zidek T, Amering M. Stigma resistance in patients with schizophrenia. Schizophr Bull 2011; 37:316-323.