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Self-stigma and affiliate stigma in first-episode psychosis patients and their caregivers

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Stigma is a major factor causing delayed help-seeking and poor treatment adherence in patients with psychotic disorders. Previous research has mostly focused on chronic samples and the impact of culturally-relevant variables on both patients’ and their caregivers’ stigmatization is understudied. This study aimed to examine the relationships between various forms of stigma, “face concern”, and clinical characteristics in a group of Chinese first-episode psychosis (FEP) patients and their caregivers.

Methods

Forty-four Hong Kong Chinese aged 15–54 years presenting with FEP to psychiatric services and their caregivers were recruited. Assessments on self-stigma, affiliate stigma, perceived public stigma, “face concern”, symptom severity and subjective quality of life (QoL) were conducted.

Results

Self-stigma of FEP patients was correlated with perceived public stigma, “face concern”, insight and psychological health of QoL. Multiple regression analysis revealed that perceived public stigma and “face concern” independently predicted self-stigma. Mediation analysis further suggested that “face concern” partially mediated the relationship between perceived public stigma and self-stigma. Caregivers’ affiliate stigma was significantly associated with higher levels of stress, and symptoms of depression and anxiety. Affiliate stigma did not correlate with perceived public stigma and “face concern”.

Conclusion

Our results indicate a critical role of perceived public stigma and fear of losing face in determining self-stigma in Chinese patients with FEP. Caregivers with greater degree of affiliate stigma experience increased stress and emotional distress. Our findings highlight the importance to examine culturally specific factors that may contribute to the development of self-stigma in first-episode populations of different ethnicities.

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Acknowledgments

The authors would like to thank all coordinating clinicians and staff from the participating hospitals, clinics and medical records departments for their kind assistance.

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Authors and Affiliations

  1. Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong

    Emily S. M. Chen, Wing Chung Chang, Christy L. M. Hui, Sherry K. W. Chan, Edwin Ho Ming Lee & Eric Y. H. Chen

  2. The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong

    Wing Chung Chang & Eric Y. H. Chen

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  1. Emily S. M. Chen
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  2. Wing Chung Chang
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  3. Christy L. M. Hui
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  4. Sherry K. W. Chan
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Corresponding author

Correspondence to Wing Chung Chang.

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Conflict of interest

E.Y.H.C. has participated in the paid advisory board for Otsuka, has received educational grant support from Janssen-Cilag, and has received research funding from Astra-Zeneca, Janssen-Cilag, Eli Lilly, Sanofi-Aventis and Otsuka. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Chen, E.S.M., Chang, W.C., Hui, C.L.M. et al. Self-stigma and affiliate stigma in first-episode psychosis patients and their caregivers. Soc Psychiatry Psychiatr Epidemiol 51, 1225–1231 (2016). https://doi.org/10.1007/s00127-016-1221-8

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  • DOI: https://doi.org/10.1007/s00127-016-1221-8

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