Psychoeducation reduces internalised stigmatisation in bipolar patients

By Afsaneh Gray, medwireNews Reporter

A psychoeducation program designed to reduce internalised stigmatisation in patients with bipolar disease resulted in a significant decrease in total mean scores on the Internalized Stigmatization Scale of Mental Illness (ISSMI) compared with a control group, a Turkish study shows.

“Internalized stigmatization is a condition experienced extensively by one in three people with severe mental illness,” write Döndü Çuhadar (Gaziantep University) and M Olcay Çam in the Archives of Psychiatric Nursing. They add that this can lead to impairment in functioning.

Forty-seven patients with bipolar disorder completed the study, of whom 24 were assigned to the experimental group and 23 were in the control group. Patients were in remission and were receiving outpatient treatment.

At the beginning and end of the study, participants were asked to complete the ISSMI, which has five subscales: alienation, approval of stereotypes, perceived discrimination, social withdrawal and resistance against stigmatisation. Participants were also assessed with the bipolar disorder functioning questionnaire (BDFQ).

The effectiveness of the psychoeducation programme was not followed up beyond the end of the intervention.

Çuhadar and Çam found significant correlations between patients’ ISSMI scores before psychoeducation and their BDFQ functionality subscale scores for emotional functioning, mental functioning, feeling of stigmatisation, relationship with friends, participation in social activities and taking initiative and using one’s potential.

Patients in the intervention group received seven weekly sessions in groups of three to six patients, and were required to complete them all. Sessions covered topics such as information about bipolar disorder and the disease process, and information about social and internal stigmatisation, as well as coping skills.

At the end of the sessions the experimental group achieved a significant decrease in the total ISSMI mean scores, as well as in some of the ISSMI subscale mean scores, including alienation, approval of stereotypes, perceived discrimination and social withdrawal. By contrast, controls had only a significant reduction for perceived discrimination. For the BDFQ, the mean score of the domestic relationship subscale was significantly increased in the intervention group but unchanged in controls.

“In light of these observations, it is suggested that psychoeducation activities intended to decrease internalized stigmatization should be designed to include all patients and should be incorporated into post-discharge education and included in treatment guidelines,” the researchers conclude.

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