Facility based cross-sectional study of self stigma among people with mental illness: towards patient empowerment approach

Background: Self stigma among people with mental illness results
from multiple cognitive and environmental factors and processes. It
can negatively affect adherence to psychiatric services, self
esteem, hope, social integration and quality of life of people with
mental illness. The purpose of this study was to measure the level
of self stigma and its correlates among people with mental illness
at Jimma University Specialized Hospital, Psychiatry clinic in
southwest Ethiopia. Methods: Facility based cross-sectional study
was conducted on 422 consecutive samples of people with mental
illness using interviewer administered and pretested internalized
stigma of mental illness (ISMI) scale. Data was entered using
EPI-DATA and analysis was done using STATA software. Bivariate and
multivariate linear regressions were done to identify correlates of
self stigma. Results: On a scale ranging from 1 to 4, the mean self
stigma score was 2.32 (SD = 0.30). Females had higher self stigma
(std. beta = 0.11, P < 0.05) than males. Patients with a history
of traditional treatment had higher self stigma (std. beta = 0.11,
P < 0.05). There was an inverse relationship between level of
education and self-stigma (std. beta = -0.17, P < 0.01).
Perceived signs (std. beta = 0.13, P < 0.05) and supernatural
causes of mental illness ( std. beta = 0.16, P < 0.01) were
positively correlated with self stigma. Higher number of drug side
effects were positively correlated (std. beta = 0.15, P < 0.05)
while higher self esteem was negatively correlated (std. beta =
-0.14, P < 0.01) with self stigma. Conclusions: High feeling of
inferiority (alienation) but less agreement with common stereotypes
(stereotype endorsement) was found. Female showed higher self
stigma than male. History of traditional treatment and higher
perceived supernatural explanation of mental illness were
associated with higher self stigma. Drug side effects and perceived
signs of mental illness were correlated with increased self stigma
while education and self esteem decreased self stigma among people
with mental illness. Patient empowerment psychosocial interventions
and strategies to reduce drug side effects can be helpful in
reducing self stigma among people with mental illnesses.