Interventions to reduce internalized stigma in individuals with mental illnessA systematic review

  1. Marta Alonso 1
  2. Ana Isabel Guillén 1
  3. Manuel Muñoz 1
  1. 1 Universidad Complutense de Madrid
    info

    Universidad Complutense de Madrid

    Madrid, España

    ROR 02p0gd045

Revista:
The Spanish Journal of Psychology

ISSN: 1138-7416

Año de publicación: 2019

Número: 22

Páginas: 1-14

Tipo: Artículo

DOI: 10.1017/SJP.2019.9 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: The Spanish Journal of Psychology

Resumen

Internalized stigma has a high prevalence in people with mental health problems and is associated with negative consequences in different areas: work, social, personal, etc. Therefore, it is relevant to systematically study the characteristics and effectiveness of the different psychological and psychosocial interventions aimed at reducing it. Through the databases MEDLINE and PsycINFO, among others, controlled studies on specific interventions to reduce internalized stigma in people with severe mental disorders published between 2008 and 2018 were selected and reviewed. Results showed that the interventions can be grouped into four blocks: (a) psychoeducational interventions about stigma; (b) cognitive-behavioral interventions, mainly aimed at modifying self-stigmatizing beliefs; (c) interventions focused on the revelation of mental illness; and (d) multicomponent interventions that combine several of the above. The interventions had an average of 10 sessions and were predominantly applied in group format. In 9 of the 14 studies reviewed, significant results were obtained in the reduction of internalized stigma with small or moderate effect sizes. There were also significant improvements in other variables, such as subjective recovery or coping. The main methodological limitation of the studies reviewed was the absence of information on the rejection rate. We conclude that there are effective interventions aimed at reducing internalized stigma, with psychoeducational interventions on stigma and multicomponent interventions showing the best results. Cognitive-behavioral interventions and interventions based on disclosure have been studied to a lesser extent and their results are inconclusive. Future research should focus on establishing optimal interventions according to characteristics and objectives of individuals.

Referencias bibliográficas

  • Al-Khouja M. A., & Corrigan P. (2017). Self-stigma, identity, and co-occurring disorders. The Israel Journal of Psychiatry and Related Sciences, 54 (1), 56-61.
  • Angermeyer M. C., & Schomerus G. (2017). State of the art of population-based attitude research on mental health: A systematic review. Epidemiology and Psychiatric Sciences, 26, 252-264. https://doi.org/10.1017/S2045796016000627 10.1017/S2045796016000627 S2045796016000627
  • Brohan E., Elgie R., Sartorius N., & Thornicroft G. (2010). Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: The GAMIAN-Europe study. Schizophrenia Research, 122, 232-238. https://doi.org/10.1016/j.schres.2010.02.1065 10.1016/j.schres.2010.02.1065
  • Büchter R. B., & Messer M. (2017). Interventions for reducing self-stigma in people with mental illnesses: A systematic review of randomized controlled trials. GMS German Medical Science, 15, Doc07. https://doi.org/10.3205/000248
  • Campbell M., & Wilson C. (2017). Service users' experiences of participation in clinical psychology training. The Journal of Mental Health Training, Education and Practice, 12, 337-349. https://doi.org/10.1108/jmhtep-03-2017-0018 10.1108/JMHTEP-03-2017-0018
  • Cechnicki A., Angermeyer M. C., & Bielańska A. (2011). Anticipated and experienced stigma among people with schizophrenia: Its nature and correlates. Social Psychiatry and Psychiatric Epidemiology, 46, 643-650. https://doi.org/10.1007/s00127-010-0230-2 10.1007/s00127-010-0230-2
  • Comunidad de Madrid (2003). Plan de atención social a personas con enfermedad grave y crónica 2003-2007 [Social care plan for people with severe and chronic illness 2003-2007]. Madrid, Spain: Comunidad de Madrid, Consejeriá de Servicios Sociales.
  • Conejo S., Moreno P., Morales J. M., Alot A., Garciá-Herrera J. M., González M. J.,. & Moreno Küstner B. (2014). Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave: Un estudio cualitativo [Opinions of healthcare professionals about the definition of severe mental disorder: A qualitative study]. Anales del Sistema Sanitario de Navarra, 37 (2), 223-233. 10.4321/S1137-66272014000200005
  • Conner K. O., McKinnon S. A., Ward C. J., Reynolds C. F., & Brown C. (2015). Peer education as a strategy for reducing internalized stigma among depressed older adults. Psychiatric Rehabilitation Journal, 38, 186-193. https://doi.org/10.1037/prj0000109 10.1037/prj0000109
  • Corrigan P. W., Bink A. B., Schmidt A., Jones N. & Rüsch N. (2016). What is the impact of self-stigma Loss of self-respect and the "why try" effect. Journal of Mental Health, 25, 10-15. https://doi.org/10.3109/09638237.2015.1021902 10.3109/09638237.2015.1021902
  • ∗ Corrigan P. W., Larson J. E., Michaels P. J., Buchholz B. A., Del Rossi R., Fontecchio M. J., Rüsch N. (2015). Diminishing the self-stigma of mental illness by coming out proud. Psychiatry Research, 229, 148-154. https://doi.org/10.1016/j.psychres.2015.07.053 10.1016/j.psychres.2015.07.053
  • Crespo M., Pérez-Santos E., Munõz M., & Guillén A. I. (2008). Descriptive study of stigma associated with severe and persistent mental illness among the general population of Madrid (Spain). Community Mental Health Journal, 44, 393-403. https://doi.org/10.1007/s10597-008-9142-y 10.1007/s10597-008-9142-y
  • ∗ Çuhadar D., & Cąm M. O. (2014). Effectiveness of psychoeducation in reducing internalized stigmatization in patients with bipolar disorder. Archives of Psychiatric Nursing, 28, 62-66. https://doi.org/10.1016/j.apnu.2013.10.008 10.1016/j.apnu.2013.10.008
  • Diáz-Mandado O. (2015). Estigma internalizado en el trastorno mental grave: Predictores cognitivos de la eficacia de un programa de intervención [Internalized stigma in severe mental disorder: Cognitive predictors of the effectiveness of an intervention program]. Toledo, Spain: Fundación Sociosanitaria de Castilla-La Mancha.
  • Evans-Lacko S., Brohan E., Mojtabai R., & Thornicroft G. (2012). Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine, 42, 1741-1752. https://doi.org/10.1017/S0033291711002558 10.1017/S0033291711002558 S0033291711002558
  • Farrelly S., Clement S., Gabbidon J., Jeffery D., Dockery L., Lassman F., Thornicroft G. (2014). Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: A cross sectional study. BMC Psychiatry, 14, 157. https://doi.org/10.1186/1471-244X-14-157 10.1186/1471-244X-14-157
  • ∗ Fung K. M. T., Tsang H. W. H., & Cheung W. (2011). Randomized controlled trial of the self-stigma reduction program among individuals with schizophrenia. Psychiatry Research, 189, 208-214. https://doi.org/10.1016/j.psychres.2011.02.013 10.1016/j.psychres.2011.02.013
  • Gerlinger G., Hauser M., De Hert M., Lacluyse K., Wampers M., & Correll C. U. (2013). Personal stigma in schizophrenia spectrum disorders: A systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry, 12, 155-164. https://doi.org/10.1002/wps.20040 10.1002/wps.20040
  • Guinea R. (Coord.) (2007). Modelo de atención a personas con enfermedad mental grave [Model of care for people with serious mental illness] Madrid, Spain: Ministerio de Trabajo y Asuntos Sociales.
  • ∗ Hansson L., Lexén A., & Holmén J. (2017). The effectiveness of narrative enhancement and cognitive therapy: A randomized controlled study of a self-stigma intervention. Social Psychiatry and Psychiatric Epidemiology, 52, 1415-1423. https://doi.org/10.1007/s00127-017-1385-x 10.1007/s00127-017-1385-x
  • ∗ Ivezić S. S., Sesar M. A., & MuÅ3/4inić L. (2017). Effects of a group psychoeducation program on self-stigma, empowerment and perceived discrimination of persons with schizophrenia. Psychiatria Danubina, 29 (1), 66-73. 10.24869/psyd.2017.66
  • ∗ Lucksted A., Drapalski A. L., Brown C. H., Wilson C., Charlotte M., Mullane A., & Fang L. J. (2017). Outcomes of a psychoeducational intervention to reduce internalized stigma among psychosocial rehabilitation clients. Psychiatric Services, 68, 360-367. https://doi.org/10.1176/appi.ps.201600037 10.1176/appi.ps.201600037
  • Mascayano F., Lips W., Mena C., & Manchego C. (2015). Estigma hacia los trastornos mentales: Características e intervenciones [Stigma towards mental disorders: Characteristics and interventions]. Salud Mental, 38, 53-58. https://doi.org/10.17711/SM.0185-3325.2015.007 10.17711/SM.0185-3325.2015.007
  • ∗ Michaels P., Corrigan P. W., Buchholz B., Brown J., Arthur T., Netter C., & Macdonald-Wilson K. L. (2014). Changing stigma through a consumer-based stigma reduction program. Community Mental Health Journal, 50, 395-401. https://doi.org/10.1007/s10597-013-9628-0 10.1007/s10597-013-9628-0
  • Michaels P. J., López M., Rüsch N., & Corrigan P. W. (2012). Constructs and concepts comprising the stigma of mental illness. Psychology, Society, & Education, 4, 183-194. https://doi.org/10.25115/psye.v4i2.490
  • ∗ Morrison A. P., Burke E., Murphy E., Pyle M., Bowe S., Varese F., Wood L. J. (2016). Cognitive therapy for internalised stigma in people experiencing psychosis: A pilot randomised controlled trial. Psychiatry Research, 240, 96-102. https://doi.org/10.1016/j.psychres.2016.04.024 10.1016/j.psychres.2016.04.024
  • Munõz M., Sanz M., Pérez-Santos E., & Quiroga M. A. (2011). Proposal of a socio-cognitive-behavioral structural equation model of internalized stigma in people with severe and persistent mental illness. Psychiatry Research, 186, 402-408. https://doi.org/10.1016/j.psychres.2010.06.019 10.1016/j.psychres.2010.06.019
  • Parcesepe A. M., & Cabassa L. J. (2013). Public stigma of mental illness in the United States: A systematic literature review. Administration and Policy in Mental Health and Mental Health Services Research, 40, 384-399. https://doi.org/10.1007/s10488-012-0430-z 10.1007/s10488-012-0430-z
  • Picco L., Pang S., Lau Y. W., Jeyagurunathan A., Satghare P., Abdin E.,. Subramaniam M. (2016). Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem. Psychiatry Research, 246, 500-506. https://doi.org/10.1016/j.psychres.2016.10.041 10.1016/j.psychres.2016.10.041
  • ∗ Roe D., Hasson-Ohayon I., Mashiach-Eizenberg M., Derhy O., Lysaker P. H., & Yanos P. T. (2014). Narrative Enhancement and Cognitive Therapy (NECT) effectiveness: A quasi-experimental study. Journal of Clinical Psychology, 70, 303-312. https://doi.org/10.1002/jclp.22050 10.1002/jclp.22050
  • Ruggeri M., Leese M., Thornicroft G., Bisoffi G., & Tansella M. (2000). Definition and prevalence of severe and persistent mental illness. The British Journal of Psychiatry, 177 (2), 149-155. 10.1192/bjp.177.2.149
  • Ruiz M. A., Montes J. M., Correas Lauffer J., Álvarez C., Maurinõ J., & De Dios Perrino C. (2012). Opiniones y creencias sobre las enfermedades mentales graves (esquizofrenia y trastorno bipolar) en la sociedad espanõla [Opinions and beliefs about serious mental illnesses (schizophrenia and bipolar disorder) in Spanish society]. Revista de Psiquiatriá y Salud Mental, 5, 98-106. https://doi.org/10.1016/j.rpsm.2012.01.002 10.1016/j.rpsm.2012.01.002
  • ∗ Rüsch N., Abbruzzese E., Hagedorn E., Hartenhauer D., Kaufmann I., Curschellas J.,... Corrigan P. W. (2014). Efficacy of Coming Out Proud to reduce stigma's impact among people with mental illnes: Pilot randomised controlled trial. The British Journal of Psychiatry, 204, 391-397. https://doi.org/10.1192/bjp.bp.113.135772 10.1192/bjp.bp.113.135772
  • Rüsch N., Angermeyer M. C., & Corrigan P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20, 529-536. https://doi.org/10.1016/j.eurpsy.2005.04.004 10.1016/j.eurpsy.2005.04.004
  • ∗ Russinova Z., Rogers E. S., Gagne C., Bloch P., Drake K. M., & Mueser K. T. (2014). A randomized controlled trial of a peer-run antistigma photovoice intervention. Psychiatric Services, 65, 242-246. https://doi.org/10.1176/appi.ps.201200572 10.1176/appi.ps.201200572
  • Tsang H. W. H., Ching S. C., Tang K. H., Lam H. T., Law P. Y. Y., & Wan C. N. (2016). Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophrenia Research, 173, 45-53. https://doi.org/10.1016/j.schres.2016.02.013 10.1016/j.schres.2016.02.013
  • ∗ Uchino T., Maeda M., & Uchimura N. (2012). Psychoeducation may reduce self-stigma of people with schizophrenia and schizoaffective disorder. The Kurume Medical Journal, 59, 25-31. https://doi.org/10.2739/kurumemedj.59.25 10.2739/kurumemedj.59.25
  • Urrútia G., & Bonfill X. (2010). Declaración PRISMA: Una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis [PRISMA statement: A proposal to improve the publication of systematic reviews and meta-analyzes]. Medicina Clínica, 135, 507-511. https://doi.org/10.1016/j.medcli.2010.01.015 10.1016/j.medcli.2010.01.015
  • ∗ Wood L., Byrne R., Enache G., & Morrison A. P. (2018). A brief cognitive therapy intervention for internalised stigma in acute inpatients who experience psychosis: A feasibility randomised controlled trial. Psychiatry Research, 262, 303-310. https://doi.org/10.1016/j.psychres.2017.12.030 10.1016/j.psychres.2017.12.030
  • Wood L., Byrne R., & Morrison A. P. (2017). An integrative cognitive model of internalized stigma in psychosis. Behavioural and Cognitive Psychotherapy, 45 (6), 545-560. https://doi.org/10.1017/S1352465817000224 10.1017/S1352465817000224 S1352465817000224
  • Wood L., Byrne R., Varese F., & Morrison A. P. (2016). Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis. Schizophrenia Research, 176, 291-303. https://doi.org/10.1016/j.schres.2016.05.001 10.1016/j.schres.2016.05.001
  • Yanos P. T., Lucksted A., Drapalski A. L., Roe D., & Lysaker P. (2015). Interventions targeting mental health self-stigma: A review and comparison. Psychiatric Rehabilitation Journal, 38, 171-178. https://doi.org/10.1037/prj0000100 10.1037/prj0000100
  • ∗ Yanos P. T., Roe D., West M. L., Smith S. M., & Lysaker P. (2012). Group-based treatment for internalized stigma among persons with severe mental illness: Findings from a randomized controlled trial. Psychological Services, 9, 248-258. https://doi.org/10.1037/a0028048 10.1037/a0028048
Fuente de los datos: Dialnet