Stages of change, self-stigma, and treatment compliance among Chinese adults with severe mental illness

Abstract

The two-phased study aimed at exploring the relationship between self-stigma, readiness for change, and psychosocial treatment compliance and developing a self-stigma reduction program among individuals with schizophrenia. 105 adults with schizophrenia were recruited in Phase One. Participants' level of self-stigma, readiness for change, insight, general self-efficacy, treatment compliance, psychopathology, and global functioning were assessed. Regression analyses suggested that individuals with higher global functioning, better readiness for action, and lower level of self-stigma demonstrated better treatment participation. Female participants and those with less severity of psychiatric symptoms had better treatment attendance. Path analysis supported the direct and indirect (i.e., mediated by insight and stages of change) effects of self-stigma on reducing treatment compliance. Psychopathology was also found to have a direct effect on undermining compliance. In Phase Two, a 16-session integrated self-stigma reduction program was developed. Sixty-six self-stigmatized individuals with schizophrenia were recruited and randomly allocated to the self-stigma reduction program (N= 34; experimental protocol) or the newspaper reading group (N=32; comparison protocol). Measures on participants' level of self-stigma, readiness for change, insight, general self-efficacy, and treatment compliance were taken for six assessment intervals. The findings suggested that the self-stigma reduction program was effective in promoting the readiness for changing own problematic behaviors and reducing self-stigmatization although the effect was not long lasting. Further recommendations for promoting the effectiveness of the program are suggested.