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Exploring how a genetic attribution to disease relates to stigma experiences of Xhosa patients with schizophrenia in South Africa

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Abstract

Background

Over the past three decades, a range of international stakeholders have highlighted the possibility that genomic research may impact stigma associated with psychiatric disorders. Limited research has been conducted in Africa to investigate this relation.

Method

In the present study, using focus group discussions, we explored the relation between genetic attribution and stigma among 36 Xhosa people with schizophrenia. We addressed three main questions: (1) What causal beliefs do Xhosa people with schizophrenia use to explain their illness and to what extent do genetic explanations play a role in these beliefs? (2) What are the internalised stigma experiences of Xhosa people with schizophrenia? (3) How do genetic explanations relate to stigma experiences, if at all?

Results

Most participants were able to define genetics and some linked genetics to disease causation. Despite adequate knowledge of genetics and an emphasis on genetic explanations of schizophrenia in the study, most participants held a multitude of causal explanations including: psychosocial, environmental, and cultural. Moreover, participants rarely mentioned disease cause when describing their stigma experiences.

Discussion

For this population group, there was no straight-forward relation between a genetic attribution and stigma. Therefore, we did not find evidence that genetic attribution may significantly increase stigma. Although North American and European literature provides conflicting evidence regarding this relation, there is increased consensus that biomedical explanations for psychiatric disorders may reduce blame. This study found evidence supporting that consensus. This study provides an empirical foundation to inform ongoing work on the psychosocial implications of psychiatric genomics research in non-Western contexts.

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Acknowledgements

We would like to acknowledge and thank the Genomics of Schizophrenia in South African Xhosa project team, including Dr Adele Pretorius, Dr Goodman Sibeko, Bronwyn Malagas, Michael Mndini, Sibonile Mqulwana, Ziyanda Gemashe, Odwa Ntola, and Bubele Makeleni, who assisted with identifying patients and sites for recruitment of participants in this study.

Funding

This work was part of the “Stigma in African Genomics research on schizophrenia and rheumatic heart disease” – PI: Jantina de Vries, funded by the National Institutes of Health (Grant No: 1U01HG008226-01) and a member of the H3Africa Consortium (www.h3africa.org). The work also received funding from the National Research Foundation (Grant Number: 107664) and the Harry Crossley Foundation—PI: Olivia Matshabane.

Author information

Authors and Affiliations

  1. Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Olivia P. Matshabane, Marlyn C. Faure, Bongani M. Mayosi & Jantina de Vries

  2. Department of Psychology, Rhodes University, Grahamstown, South Africa

    Megan M. Campbell

  3. Department of Anthropology, Case Western University, Cleveland, USA

    Patricia A. Marshall

  4. SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa

    Dan J. Stein

  5. Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, USA

    Paul S. Appelbaum

Authors
  1. Olivia P. Matshabane
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  2. Megan M. Campbell
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  3. Marlyn C. Faure
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  4. Patricia A. Marshall
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  5. Bongani M. Mayosi
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  6. Dan J. Stein
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  7. Paul S. Appelbaum
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  8. Jantina de Vries
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Contributions

All eight authors contributed to the conceptualisation of the work. OM conducted the research. All authors commented on the findings and data analysis strategy. OM wrote the first draft and all authors commented. Revisions were made by OM and all the other authors agreed to the suitability of the final manuscript. JdV and MC provided supervision of the work.

Corresponding author

Correspondence to Olivia P. Matshabane.

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Conflict of interests

On behalf of all authors, the corresponding author states that there is no conflict of interest. All authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of the review.

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Matshabane, O.P., Campbell, M.M., Faure, M.C. et al. Exploring how a genetic attribution to disease relates to stigma experiences of Xhosa patients with schizophrenia in South Africa. Soc Psychiatry Psychiatr Epidemiol 55, 1679–1686 (2020). https://doi.org/10.1007/s00127-020-01875-z

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