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Investigating the Stigma Around Mental Health and When People Seek Professional Advice to Control Early Psychiatric Symptoms

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    Acta Psychiatrica Scandinavica

    Clinical and demographic correlates of stigma in first-episode psychosis: the impact of duration of untreated psychosis
    Mueser KT, et al.
    Acta Psychiatr Scand 2019; 1–10
    “Clinical and demographic correlates of stigma in first-episode Psychosis (FEP): the impact of duration of untreated psychosis (DUP)… The findings suggest that independent of symptom severity, perceived stigma may contribute to delay in seeking treatment for FEP, and this delay may amplify the deleterious effects of stigma on psychological functioning. The results point to the importance of reducing DUP and validating interventions targeting the psychological effects of stigma in people with FEP.”

    We often use the term ‘stigma’ to refer to any attribute, trait or disorder that marks an individual as being unacceptably different from “normal” people. The effects of the stigma of patients with psychiatric disorders are profound and widespread1.
    Often people with a severe mental illness report experiencing discrimination related to their psychiatric condition, which is associated with1:

    reduced employment

    lower housing opportunities

    fewer social opportunities

    poorer treatment of medical problems

    Crucially, the stigma surrounding mental illness has a profound impact on individuals seeking treatment and a delay in pursuing help can exacerbate the situation. The consequences of increasing the duration of untreated psychosis (DUP) are especially dire; the longer the DUP, the worse the outcome2. Furthermore, if left untreated for longer, all standard treatments have been found to have less impact3.
    To further understand the correlates of stigma with engagement in treatment and functioning following a first episode of psychosis (FEP), a large-scale study in the US was conducted in 399 participants from 34 community health centres across 21 states aged between 16 and 49 years.1
    Researchers used standardized instruments to assess diagnosis (Structured Clinical Interview for Axis I DSM-IV disorders [SCID-IV]), symptoms (Positive and Negative Syndrome Scale [PANSS]), psychosocial functioning (Quality of Life Scale [QLS]), perceived stigma (The Stigma Scale), psychosocial wellbeing (Scales of Psychosocial Wellbeing [SPWB]), and subjective recovery (Mental Health Recovery Measure [MHRM]). The study was based on baseline data collected in the Recovery After Schizophrenia Episode-Early Treatment Program (RAISE-ETP) project. Trained interviewers conducted all diagnostic and symptom assessments.
    The results showed that stigma was significantly related to marital status, with those who had ever been married reporting more stigma than those who had never married. Those living at home reported less stigma than those who did not.  Perceived stigma was marginally significantly related to employment status, with those unemployed having higher stigma scores than those not in employment. Stigma was not significantly related to any other demographic characteristics, including age, gender, race, ethnicity, and education level, nor status as a student.
    Also, it was reported that higher levels of perceived stigma were associated with a significantly longer DUP when controlling for psychiatric symptoms. Clinically, perceived stigma was related to depression, wellbeing and recovery independent of symptom severity, but not to other symptoms of functioning. When participants were further stratified based on high/low stigma and short/long DUP, it was observed that participants with high stigma and long DUP were associated with more severe depression and worse wellbeing and recovery compared to those with high stigma and short DUP. Conversely, participants with low stigma tended to have less severe depression and better wellbeing and recovery scores, regardless of length of DUP.
    The study also demonstrated that perceived stigma was related to:

    Schizoaffective disorder diagnosis, a disorder of the mind that affects thoughts and emotions, and possibly individual actions4

    More severe symptoms

    Lower subjective wellbeing

    Less perceived recovery

    The overall findings from this study underscore the correlation between perceived stigma and DUP in persons with a FEP, controlling for symptom severity in a large cohort of participants. In addition, the results indicate that the effects of stigma on psychosocial function are cumulative during the time of symptom onset to treatment initiation. Although the study was limited in that only one measure of perceived stigma was used, and self-stigma was not directly assessed, it is clear that further research is required on interventions targeting the effects of stigma on wellbeing and psychosocial functioning in this particular population.


    1. Mueser KT, et al. Clinical and demographic correlates of stigma in first-episode psychosis: the impact of duration of untreated psychosis. Acta Psychiatr Scand 2019: 1–10
    2. Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: A critical review and metaanalysis. Am J Psychiatry. 2005;162:1785–1804.
    3. Ho RWH, Chang W-C, Kwong VWY, et al. Prediction of self-stigma in early psychosis: 3-year follow-up of the randomized- controlled trial on extended early intervention. Schizophr Res 2018;195:463–468.
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