Relationship between self-stigma of people with psychotic disorders and their adherence to psychosocial treatment

Abstract

Background: Psychosocial treatment noncompliance is one of the main reasons for therapeutic failure. Recent research has shown that mental health consumers may internalize negative stereotypes, become self-stigmatized, and thus avoid engaging in appropriate helping-seeking behaviors. This study aimed at uncovering the relationship between psychosocial treatment compliance and self-stigma, and identifying possible mediators in undermining treatment compliance. Method: Some 108 mental health consumers were recruited in this cross-sectional observation study. In Phase One study, the Psychosocial Treatment Compliance Scale was developed, and the Self-stigma of Mental Illness Scale, the Rosenberg Self-esteem Scale, the Self-efficacy Scale and the Scale to Assess Unawareness of Mental Disorder were translated into Chinese and validated. The relationship between psychosocial treatment compliance and the identified variables were examined by using statistical regression of forward selection in Phase Two study. Results: The psychometric properties of all instruments were well established. As revealed by exploratory factor analysis, "Participation" and "Attendance" were identified as the main factors of psychosocial treatment compliance. Poor participation was related to lower self-esteem, diminished social self-efficacy, and poor retrospective insight of having mental illness. Poor attendance was related to higher self-concurrence of self-stigma, poor current awareness to the achieved effects of medication, and living with others. Conclusion: Psychosocial treatment compliance would be impeded by self-stigma and certain mediating factors. A better understanding of those barriers enables us to formulate appropriate interventional strategies to reduce self-stigma and meanwhile enhance compliance.