Comparison of self-stigma and subjective recovery status of patients receiving Community Mental Health Service and outpatient psychiatry policlinic

Objectives: The aim of this study is to investigate the efficacy of Community Mental Health Center (CMHC) services on self stigmatization and subjective recovery feeling of schizophrenia diagnosed individuals and to determine the factors that affecting the subjective recovery. Methods: The study included 145 individuals with a diagnosis of schizophrenia or schizoaffective disorder. Of them, 64 treated in the psychiatry policlinics and 81 who received service from the CMHC. Socio-demographic and disease/ treatment data forms, Self Stigma İnventory for Patients (SSI-P) and Subjective Recovery Assesment Scale (SRAS) were used to collect data. Patients were divided in two groups according to followed up at CBMHC or psychiatry policlinics. To compare the mean SSI-P and SRAS scores of groups independent samples t test was used. Results: According to results, the mean SSI-P points of CMHC and policlinic groups were 45.33±16.0 and 41.23±16.35 and there were no significant difference between groups. Mean SRAS points of CMHC and policlinic groups was 54.84±17.17 ve 45.97±17.63 and the mean SRAS points were significantly higher in CMHC group (p


1. Link BG, Phelan JC. Conceptualizing stigma. Ann Rev Sociol 2001;27:363–85.

2. Yıldız M, Özten E, Işık S, Özyıldırım İ, Karayun D, Cerit C. Self-stigmatization among patients with schizophrenia, their relatives and patients with major depressive disorder. Anatolian J Pyschiatry 2012;13:1–7.

3. Lloyd C, King R, Moore L. Subjective and objective indicators of recovery in severe mental illness: a cross-sectional study. Int J Soc Psychiatry 2010;56:220–9.

4. Angermeyer MC, Matschinger H. Labeling--stereotype--discrimination. An investigation of the stigma process. Soc Psychiatry Psychiatr Epidemiol 2005;40:391–5. 5. Corrigan PW. The impact of stigma on severe mental illness. Cogn Behav Pract 1998;5:201–22.

6. Stuart H, Arboleda-Flórez J, Sartorius N. Paradigms Lost Fighting Stigma and The Lessons Learned. New York, NY: Oxford University Press; 2012.

7. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. Br J Psychiatry 2000;177:4–7.

8. Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 2003;121:31–49.

9. Yanos PT, Roe D, Markus K, Lysaker PH. Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatr Serv 2008;59:1437–42.

10. Brohan E, Elgie R, Sartorius N, Thornicroft G; GAMIAN-Europe Study Group. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 2010;122:232–8.

11. Caqueo-Urízar A, Boyer L, Urzúa A, Williams DR. Self-stigma in patients with schizophrenia: a multicentric study from three Latin-America countries. Soc Psychiatry Psychiatr Epidemiol 2019;54:905–9.

12. Tang IC, Wu HC. Quality of life and self-stigma in individuals with schizophrenia. Psychiatr Q 2012;83:497–507.

13. Dikeç G, Kutlu Y. Determination of treatment compliance and influencing factors in a group of schizophrenia patients. Journal of Psychiatric Nursing 2014;5:143−8.

14. Fung KMT, Tsang HWH, Corrigan PW. Self-stigma of people with schizophrenia as predictor of their adherence to psychosocial treatment. Psychiatr Rehabil J 2008;32:95−104.

15. Schrank B, Amering M, Hay AG, Weber M, Sibitz I. Insight, positive and negative symptoms, hope, depression and self-stigma: a comprehensive model of mutual influences in schizophrenia spectrum disorders. Epidemiol Psychiatr Sci 2014;23:271−9.

16. Tel H, Ertekin-Pınar Ş. Internalized stigma and self-esteem in psychiatric outpatients. Journal of Psychiatric Nursing 2012;3:61−6.

17. Lysaker PH, Tsai J, Yanos P, Roe D. Associations of multiple domains of self-esteem with four dimensions of stigma in schizophrenia. Schizophr Res 2008;98:194−200.

18. Assefa D, Shibre T, Asher L, Fekadu A. Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study. BMC Psychiatry 2012;12:239.

19. Johnson J, Gooding P, Tarrier N. Suicide risk in schizophrenia: explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychol Psychother 2008;81:55−77.

20. Vass V, Morrison AP, Law H, Dudley J, Taylor P, Bennett KM, et al. How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatry Res 2015;230:487−95.

21. Yanos PT, Roe D, Lysaker PH. The impact of illness identity on recovery from severe mental illness. Am J Psychiatr Rehabil 2010;13:73−93.

22. Morgades-Bamba CI, Fuster-Ruizdeapodaca MJ, Molero F. The impact of internalized stigma on the well-being of people with Schizophrenia. Psychiatry Res 2019;271:621−7.

23. Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005;162:441−9.

24. Comission on mental health Achieving the Promise: Transforming Mental Health Care in America. Executive Summary; DHHS Pub. No: SMA-03-3831. Rockville: DHHS; 2003.

25. Andresen R, Oades L, Caputi P. The experience of recovery from schizophrenia: towards an empirically validated stage model. Aust N Z J Psychiatry 2003;37:586−94.

26. Bowersox NW, Lai Z, Kilbourne AM. Integrated care, recovery-consistent care features, and quality of life for patients with serious mental illness. Psychiatr Serv 2012;63:1142−5.

27. Roe D, Mashiach-Eizenberg M, Lysaker PH. The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophr Res 2011;131:133−8.

28. Hofer A, Post F, Pardeller S, Frajo-Apor B, Hoertnagl CM, Kemmler G, Fleischhacker WW. Self-stigma versus stigma resistance in schizophrenia: Associations with resilience, premorbid adjustment, and clinical symptoms. Psychiatry Res 2019;271:396−401.

29. Strauss GP, Sandt AR, Catalano LT, Allen DN. Negative symptoms and depression predict lower psychological well-being in individuals with schizophrenia. Compr Psychiatry 2012;53:1137−44.

30. Ralph RO, Lambert D, Kidder KA. The Recovery Perspective and Evidence-Based Practice for People With Serious Mental Illness. Illinois: Behavoral Health Recovery Management Project; 2002.

31. Norman RM, Windell D, Lynch J, Manchanda R. Correlates of subjective recovery in an early intervention program for psy- choses. Early Interv Psychiatry 2013;7:278−84.

32. Jenkins JH, Strauss ME, Carpenter EA, Miller D, Floersch J, Sajatovic M. Subjective experience of recovery from schizophrenia-related disorders and atypical antipsychotics. Int J Soc Psychiatry 2005;51:211−27.

33. Barak Y, Aizenberg D. Clinical and psychosocial remission in schizophrenia: correlations with antipsychotic treatment. BMC Psychiatry 2012;12:108.

34. Burns M. Turkey evaluations and recommendations on mental health system: Mental health action plan proposal. Reviews, Cases and Hypotheses in Psychiatry 2007;1−80.

35. Directive on Community Mental Health Centers; No: 9453. T.C. Official Newspaper 2014.

36. Yıldırım T. The relationship between ınternalized stigma and loneliness in schizophrenia patients. [Unpublished Master Thesis]. İnönü University Institute of Health Sciences; 2018.

37. Bozan M. Examination of Internalized Stigmatization and Social Functioning of Community Mental Health Center Service Users: Eskisehir Example. [Unpublished Master Thesis]. Ankara: Hacettepe University Institute of Social Sciences; 2019.

38. Yıldız M, Kiras F, İncedere A, Abut FB. Development of self-stigma inventory for patients with schizophrenia (SSI-P): reliability and validity study. Psychiatry and Clinical Psychopharmacology 2018; 4:640−9.

39. Yildiz M, Erim R, Soygur H, Tural U, Kiras F, Gules E. Development and validation of the Subjective Recovery Assessment Scale for patients with schizophrenia. Psychiatry and Clinical Psychopharmacology 2018;28:163−9.

40. Mestdagh A, Hansen B. Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies. Soc Psychiatry Psychiatr Epidemiol 2014;49:79−87.

41. Liégeois A, Van Audenhove C. Ethical dilemmas in community mental health care. J Med Ethics 2005;31:452−6.

42. Yanos PT, Lucksted A, Drapalski AL, Roe D, Lysaker P. Interventions targeting mental health self-stigma: A review and comparison. Psychiatr Rehabil J 2015;38:171−8.

43. Li J, Huang YG, Ran MS, Fan Y, Chen W, Evans-Lacko S, et al. Community-based comprehensive intervention for people with schizophrenia in Guangzhou, China: Effects on clinical symptoms, social functioning, internalized stigma and discrimination. Asian J Psychiatr 2018;34:21−30.

44. Ersoy MA, Varan A. Reliability and validity study of the Turkish version of the internalized stigmatization scale in mental illnesses. Turkish Journal of Psychiatry 2007;18:163−71.

45. Sibitz I, Amering M, Gössler R, Unger A, Katschnig H. Patients' perspectives on what works in psychoeducational groups for schizophrenia: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 2007;42:909−15.

46. Bechdolf A, Knost B, Nelson B, Schneider N, Veith V, Yung AR, et al. Randomized comparison of group cognitive behaviour therapy and group psychoeducation in acute patients with schizophrenia: effects on subjective quality of life. Aust N Z J Psychiatry 2010;44:144−50.

47. Şahin Ş, Elboğa G. Quality of life, compliance with medical treatment, insight and functionality of patients using community mental health centers. Cukurova Med J 2019;44:431−8.

48. Ensari H, Gültekin BK, Karaman D, Koç A, Beşkardeş AF. The effects of the service of community mental health center on the schizophrenia patients -evaluation of quality of life, disabilities, general and social functioning- a summary of one year follow-up. Anatolian J Psychiatry 2013;14:108−14.

49. Söğütlü L, Özen Ş, Varlık C, Güler A. Application and results of mental social skills training for schizophrenia patients in community mental health center. Anatolian J Psychiatry 2017;18:121−8.

50. Arslan M, Yazıcı A, Yılmaz T, Coşkun S, Kurt E. Long-term effects of the rehabilitation program on the clinic, social functionality and quality of life of patients with schizophrenia: Monitoring work. Anatolian J Psychiatry 2015;16:238−46.

51. Elboğa G, Kocamer-Şahin Ş, Altındağ A. Contribution of skills training in a community mental health center to daily living activities and cognitive functions. Current Approaches in Psychiatry 2019;11(Suppl 1):1−8

52. Rouillon F, Eriksson L, Burba B, Raboch J, Kaprinis G, Schreiner A. Functional recovery results from the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE). Acta Neuropsychiatr 2013;25:297−306.

53. İpçi K, İncedere A, Kiras F, Yıldız M. An examination of the relationship between subjective recovery and cognitive insight in patients with schizophrenia. Journal of Health Sciences of Kocaeli University 2018;4:1−4.

54. Van Eck RM, Burger TJ, Vellinga A, Schirmbeck F, de Haan L. The Relationship Between Clinical and Personal Recovery in Patients With Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis. Schizophr Bull 2018;44:631−42.

55. Kukla M, Lysaker PH, Roe D. Strong subjective recovery as a protective factor against the effects of positive symptoms on quality of life outcomes in schizophrenia. Compr Psychiatry 2014;55:1363−8.

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