Gül KURNAZ BEREKETLİ, Şengül KOCAMER ŞAHİN, Gülçin ELBOĞA, Abdurrahman ALTINDAĞ, Feridun BÜLBÜL

Internalized stigmatization and quality of life in patients with bipolar disorders and schizophrenia

Aim: In this study the aim was to compare internalized stigmatization and quality of life between bipolar disorder and schizophreniapatients who were in remission.Material and Methods: Patients who were admitted to the psychiatry outpatient clinic of Gaziantep University Faculty with a diagnosisof bipolar disorder or schizophrenia according to DSM-5 were included in this cross sectional study. Assessment tools were theInternalized Stigma of Mental Illness Scale and the World Health Organization Quality of Life Measurement Instrument Short Form.Results: Schizophrenia and bipolar disorder groups were compared according to assessment tools. 58 bipolar disorder and 52schizophrenia patients were included in the study. The Quality of Life of patients with bipolar disorder was found to be higher thanpatients with schizophrenia according to mental domain (p = 0.006) and social relationships domain (p = 0.050). Internalized Stigmaof schizophrenia patients was higher than patients with bipolar disorder (p = 0.030). Internalized Stigma was higher in femalepatients with schizophrenia than female patients with bipolar disorder (p = 0.006). There were no significant differences betweenmale schizophrenia patients and patients with bipolar disorder according to quality of life.Conclusion: Internalized stigmatization is a problem that should be considered in schizophrenia patients, especially in femaleschizophrenia patients. Internalized stigmatization may result in decreased quality of life in schizophrenia.

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1. Association AP. Diagnostic and statistical manual of mental disorders. BMC Med 2013;17:133-7.
2. Hofer A, Mizuno Y, Wartelsteiner F, et al. Quality of life in schizophrenia and bipolar disorder: The impact of symptomatic remission and resilience. European Psychiatry 2017;46:42-7.
3. Şahin Ş, Elboğa G. Toplum ruh sağlığı merkezinden yararlanan hastaların yaşam kalitesi, tıbbi tedaviye uyumu, içgörü ve işlevsellikleri. Cukurova Medical J 2019;44:431-38.
4. Akvardar Y, Akdede BB, Özerdem A, et al. Assessment of quality of life with the WHOQOL-BREF in a group of Turkish psychiatric patients compared with diabetic and healthy subjects. Psychiatry Clin Neurosci 2006;60:693-9.
5. Corrigan PW. The impact of stigma on severe mental illness. Cogn Behav Pract 1998;5:201-22.
6. Corrigan P, Thompson V, Lambert D, et al. Perceptions of discrimination among persons with serious mental illness. Psychiatric Services 2003;54:1105-10.
7. Taşkın EO. İçselleştirilmiş damga ve damgalanma algısı. Stigma Ruhsal Hastalıklara Yönelik Tutumlar ve Damgalama: Meta Basım ve Matbaacılık, İzmir; 2007. p. 31-40.
8. Doğanavşargil GÖ. Şizofreni ve depresyonda içselleştirilmiş damgalanma ve yaşam kalitesi: DEÜ Sağlık Bilimleri Enstitüsü; 2010.
9. Üstündağ MF, Kesebir S. İki uçlu bozuklukta içselleştirilmiş damgalanma: Klinik özellikler, yaşam kalitesi ve tedaviye uyum ile ilişkisi. Türk Psikiyatri Dergisi 2013;24:1-9.
10. Vázquez G, Kapczinski F, Magalhaes P, et al. Stigma and functioning in patients with bipolar disorder. J Affect Disord 2011;130:323-7.
11. Karidi M, Vassilopoulou D, Savvidou E, et al. Bipolar disorder and self-stigma: A comparison with schizophrenia. J Affect Disord 2015;184:209-15.
12. Andreasen NC, Carpenter Jr WT, Kane JM, et al. Remission in schizophrenia: proposed criteria and rationale for consensus. AAm J Psychiatry 2005;162:441-9.
13. Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research 2003;121:31-49.
14. Ersoy MA, Varan A. Ruhsal hastalıklarda içselleştirilmiş damgalanma ölçeği Türkçe formu’nun güvenilirlik ve geçerlik çalışması. Türk Psikiyatri Dergisi 2007;18:163-71.
15. Group W. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine 1998;28:551-8.
16. Eser S, Saatli G, Eser E, et al. The reliability and validity of the Turkish version of the World Health Organization quality of life instrument-older adults module (WHOQOL-Old). Turk Psikiyatri Dergisi 2010;21:1.
17. Su C-T, Ng H-S, Yang A-L, et al. Psychometric evaluation of the Short Form 36 Health Survey (SF36) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for patients with schizophrenia. Psychol Assess 2014;26:980.
18. Ando S, Yamaguchi S, Aoki Y, Thornicroft G. Review of mental-health-related stigma in J apan. Psychiatry Clin Neurosci 2013;67:471-82.
19. Caplan S, Little TV, Garces-King J. Stigma about mental illness among multidisciplinary health care providers in the Dominican Republic. International Perspectives in Psychology: Research, Practice, Consultation 2016;5:192.
20. Vidović D, Brecić P, Vilibić M, et al. Insight and selfstigma in patients with schizophrenia. Acta Clin Croat 2016;55:23-8.
21. Camp D, Finlay W, Lyons E. Is low self-esteem an inevitable consequence of stigma? An example from women with chronic mental health problems. Social Science & Medicine 2002;55:823-34.
22. Chung L, Pan A-W, Hsiung P-C. Quality of life for patients with major depression in Taiwan: A modelbased study of predictive factors. Psychiatry Research 2009;168:153-62.
23. Mikhael T, Holden J, Link P, et al. SA119. Defeatist Attitudes and Self-Stigma Associations in Patients With Schizophrenia. Schizophrenia Bulletin 2017;43:155.
24. Koschorke M, Padmavati R, Kumar S, et al. Experiences of stigma and discrimination faced by family caregivers of people with schizophrenia in India. Social Science & Med 2017;178:66-77.
25. Utz F. Public attitudes towards depression and schizophrenia in an urban Turkish sample. Asian J Psychiatr 2019;45:1-6.
26. Levy B, Tsoy E, Brodt M, ET AL. Stigma, social anxiety, and illness severity in bipolar disorder: Implications for treatment. Ann Clin Psychiatry 2015;27:55-64.
27. Oliveira SE, Esteves F, Carvalho H. Clinical profiles of stigma experiences, self-esteem and social relationships among people with schizophrenia, depressive, and bipolar disorders. Psychiatry Res 2015;229:167-73.
28. Ritsher JB, Phelan JC. Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res 2004;129:257-65.
29. Loganathan S, Murthy RS. Living with schizophrenia in India: gender perspectives. Transcult Psychiatry 2011;48:569-84.
30. Thara R, Srinivasan T. How stigmatising is schizophrenia in India? Int J Soc Psychiatry 2000;46:135-41.
31. Kaya T. Gelin-Kaynana İletişiminin Niteliğini Belirleyen Kültürel Etmenler. 2019.
32. Zhang Z, Zhang L, Zhang G, et al. The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and metaanalysis. BMC Psychiatry 2018;18:50.
33. Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull 2006;33:192-9.
34. Silva RDdC, Albuquerque SG, Muniz AdV, et al. Reducing the schizophrenia stigma: A new approach based on augmented reality. Comput Intell Neurosci 2017;2017:2721846.
35. Üçok A, Karadayı G, Emiroğlu B, et al. Anticipated discrimination is related to symptom severity, functionality and quality of life in schizophrenia. Psychiatry Res 2013;209:333-9.
36. Fernando SM, Deane FP, McLeod HJ, et al. A carer burden and stigma in schizophrenia and affective disorders: Experiences from Sri Lanka. Asian J Psychiatr 2017;26:77-81.
37. Oliveira SE, Carvalho H, Esteves F. Internalized stigma and quality of life domains among people with mental illness: the mediating role of self-esteem. J Ment Health 2016;25:55-61.
38. Kim EY, Jang MH. The Mediating Effects of SelfEsteem and Resilience on the Relationship Between Internalized Stigma and Quality of Life in People with Schizophrenia. Asian Nurs Res 2019;13:257-63.
39. Horsselenberg EM, van Busschbach JT, Aleman A, et al. Self-Stigma and Its Relationship with Victimization, Psychotic Symptoms and Self-Esteem among People with Schizophrenia Spectrum Disorders. PloS one 2016;11:e0149763.
40. Caqueo-Urízar A, Urzúa A, Habib J, et al. Relationships between social stigma, stigma experience and selfstigma and impaired quality of life in schizophrenia across three Latin-American countries. Eur Arch Psychiatry Clin Neurosci 2019:1-8.