Internalized stigma among people with severe mental illness : a study in rural China

Abstract

Background and purpose: In China, as society has transformed and developed, mental health has been considered as a momentous public health issue. Mental health related stigma is also problematic and pervasive in Chinese societies, including the discrimination and devaluation from the public and self-congruence of stigmatizing notions amongst people living with mental illness. However, no prior study has explored the internalized stigma among individuals with severe mental illness (SMI) in a rural Chinese community. The objective of this study is to comprehensively canvass internalized stigma, which comprises the investigation of prevalence, examination of associated factors, and exploration of subjective experience from the perspective of people with SMI. Data sources and methods: This study used quantitative and qualitative data from two projects, conducted in 2015 and 2016, respectively. In the quantitative section, data from 453 people with schizophrenia, major depressive disorder, or bipolar disorder were derived from the research participants of Chengdu Mental Health Project (CMHP). Sociodemographic data and illness characteristics were recorded, and the participants completed measurements of internalized stigma, social support, and social functioning. With respect to the qualitative section, narratives of 16 people with schizophrenia obtained using the method of photo-elicitation interviewing from a project entitled Community In-Alliance for Recovery: Challenging Stigma of Mental Illness in Rural China (CIFR) were extracted for this study. A directed content analysis approach was adopted for analyzing the qualitative data. Results: Quantitative data indicated that internalized stigma attached to mental illness is pervasive in a rural Chinese community, with 44.8% of participants reported to suffer from high levels of internalized stigma. In addition, internalized stigma was significantly different among people with various psychiatric diagnoses. The results of the quantitative data also showed that lower levels of family income, poorer working ability, economic capacity, worsened current mental status, weakened social support, and impaired social functioning increased the likelihood of higher levels of internalized stigma. Moreover, social support and social functioning were the mediators of the relationship between current mental status and internalized stigma among people suffering from SMI. Qualitative data further delineated the experience of internalized stigma. The main source of stigma identified in the narratives pertains to perceived discrimination from several aspects of the social system, such as family, workplace, and community. In addition, participants endorsed negative public stereotypes and formed adverse self- image. The findings of the qualitative study also showed that participants adopted negative behavior responses to their stigmatized status, including social withdrawal, passive and selective disclosure of mental illness, and label avoidance. Discussions and implications: The current study enriches the previous literature on internalized stigma attached to mental illness in a rural Chinese community by using both quantitative and qualitative data. Despite several limitations, this study provides contextualized information for penetrating mental illness stigma and tailoring stigma reduction programs in Chinese societies. To facilitate the recovery of people with SMI, it is necessary not only to tailor interventions for stigma reduction among them but also to ameliorate attitudes toward mental illness amongst the general public.