A mini literature review report on mental health stigma towards schizophrenia

Introduction:

Mental health stigma refers to the stigmatisation and discrimination of people who suffer from mental health problems, such as the false belief that people with depression are merely being lazy or down (Lee et al., 2016; Webb et al., 2016). Despite much of this stigma being reduced through greater public knowledge of mental health disorders, the stigma against schizophrenia and those who suffer from it is still prevalent within societies (Gronholm et al., 2017). Further to this, there is empirical evidence that has demonstrated that mental health stigma has a detrimental impact on help-seeking behaviour and treatment adherence if treatment is sought (Clement et al., 2015; Corrigan, Druss and Perlick, 2014). Consequently, there is a need for a greater understanding of mental health stigma toward schizophrenia as a means by which to encourage help-seeking behaviour.

As a consequence of this prevailing stigmatisation of schizophrenia, the aim of this literature review was to explore the topic of mental health stigma, focusing particularly on schizophrenia. Due to this, the research question for this study was ‘what does the literature tell us about mental health stigma and schizophrenia?’. Lastly, the following report will describe, discuss and evaluate this mini literature review and so the report will consist of this introduction, a brief methodology, the literature review, the findings and discussion, and a conclusion.

Methodology:

Design:

For the present study, a secondary piece of qualitative research was deemed the most appropriate design by which to address and explore the research aim and research question (Coolican, 2017; Taylor, Bogdan and DeVault, 2015).

Method:

As a result of the research design, a mini literature review was selected as the most suitable form of secondary research that could explore the topic of mental health stigma toward schizophrenia. Such a research method was chosen as it would allow the researcher to gather a large amount of empirical research on the subject of mental health stigma and schizophrenia as well as review it so as to produce a highly comprehensive representation of the subject matter (Coolican, 2017; Silverman, 2016; Smith, 2015; Marks and Yardley, 2004). Moreover, such a comprehensive picture of the subject is something that could not be achieved through the use of a primary research method (Coolican, 2017; Silverman, 2016; Taylor, Bogdan and DeVault, 2015).

Procedure:

The 11 research studies were obtained through the use of a database search, using key words like ‘mental health stigma and schizophrenia’. A simplistic inclusion and exclusion criteria was used to select the most appropriate studies to be reviewed. This criteria consisted of research having been published within the last 25 years and must be concerned with mental health stigma and schizophrenia.

Literature Review:

Stigma and Schizophrenia:

There is a large amount of empirical research that has investigated mental health stigma and schizophrenia (Corrigan et al., 2014; Mestdagh and Hansen, 2014). For instance, a questionnaire study by Ye et al (2016) of 50 schizophrenic patients found that a large majority of the participants had experienced repeated instances of stigma and discrimination from friends, family and strangers, mainly consisting of social exclusion based on beliefs of dangerousness and that schizophrenia is a biological and subsequently contagious disease. A strength of this research is that the questionnaire consisted of quantitative and qualitative measures, meaning that the results produced were highly comprehensive, increasing the validity, reliability and usefulness of these results. Moreover, these results are consisted with other research studies on this subject (Gronholm et al., 2017; Lee et al., 2016; Link et al., 1999), suggested that this is a highly reliable finding within the literature. Moreover, such false beliefs of the general public have been shown to be a consequence of a lack of information and literature concerning schizophrenia being available to the general public (O’Keefe et al., 2016), though these findings were only based on findings from a sample of people from Ireland, which may mean that the generalisability and usefulness of this to a UK setting is limited. Therefore, it is clear to see that stigma towards schizophrenia is based on false beliefs that are a result of ignorant and/or a lack of knowledge concerning schizophrenia being a mental health disorder.

The Outcome/s of Stigma:

One of the main findings concerning the outcome of stigma towards schizophrenia is that of stigma discouraging help-seeking behaviour in people suffering from schizophrenia (Clement et al., 2015; Corrigan, Druss and Perlick, 2014). For example, a 6-month longitudinal questionnaire study by Vass et al (2015) examined the outcomes of mental health stigma, using a sample of 80 schizophrenic patients. It was found that stigma was correlated with low self-esteem as well as high levels of hopelessness and self-stigma, which in turn was associated with lower levels of help-seeking behaviours. A strength of this study is that of the sample size, which means that the sample representation and generalisability of the results of this research are likely to be high, though the extent to which this study showed changes over time is questionable as it was only conducted over a 6-month period as opposed to 12 or 24 months. Nonetheless, this is a very prevalent finding within the research literature (Clement et al., 2015), particularly in terms of concealing mental health problems as a means by which to cope with or avoid stigma (Wahl, 1999), suggesting that this is a consistent and reliable finding. Furthermore, a cross-section survey study of 3005 schizophrenic patients showed that more than half concealed their mental health problems from friends, family and healthcare professionals to avoid stigma and discrimination, which led to low help-seeking behaviours and intentions (Isaksson et al., 2017). Thus, from this evidence it can be argued that mental health stigma towards schizophrenia reduces help-seeking behaviour, which may be a consequence of stigma decreasing self-esteem and increasing hopelessness and possibly embarrassment and self-stigma as a means by which people with schizophrenia cope with their mental health issues.

Findings and Discussion:

Findings:

The aim of this literature review was to explore the topic of mental health stigma, focusing particularly on schizophrenia. Likewise, the research question for this study was ‘what does the literature tell us about mental health stigma and schizophrenia?’. From the findings of the literature review, it can be said that mental health stigma towards schizophrenia is based on the false belief that schizophrenia is a biological and contagious disease rather than that of a mental health disorder (Lee et al., 2016), which leads to social exclusion of people with schizophrenia (Ye et al., 2016). Furthermore, this stigma leads people with schizophrenia to avoid seeking help as a means by which to conceal their mental health problem and avoid stigma (Clement et al., 2015; Corrigan, Druss and Perlick, 2014). As such, this mini literature review did achieve its aim and explore the research question, though as it was a mini literature review, the extensiveness of the findings is questionable.

Limitations:

There are a few limitations associated with the present study that are worth mentioned here. For instance, as mentioned earlier, researcher bias may have influenced the themes and findings of this literature review, which would reduce the validity, reliability and overall usefulness of the findings of this review (Coolican, 2017; Silverman, 2016; Taylor, Bogdan and DeVault, 2015). In addition to this, a further problem with this study is that there was no control over reliability and validity issues associated with the research reviewed, meaning that the findings of this review may possess the same reliability and validity issues of the studies reviewed (Coolican, 2017; Taylor, Bogdan and DeVault, 2015). Yet, as the research reviewed was discussed in light of any strengths and limitations, the likelihood of such a limitation is low. Also, as this was a mini literature review, the description of the database search was not as extensive as it might have been, which could mean that it would be difficult for future research to replicate this study, thus reducing the external reliability of the findings of this study (Coolican, 2017; Marks and Yardley, 2004). Consequently, an improvement on this study would be to perform a more systematic literature review so as to increase the external reliability of the findings, but also further reduce the impact of any reliability and/or validity issues by excluding poor quality research from the review.

Recommendations and Implications for Future Research:

From the findings of this study, it is clear to see that stigma towards schizophrenia is based on ignorant and false beliefs concerning the causes of schizophrenia and its potential ‘contagiousness’ (Lee et al., 2016). As such, future interventions for reducing mental health stigma should focus on addressing these false beliefs and lack of knowledge by providing a greater level of information concerning schizophrenia to the general public (Gronholm et al., 2017; Lee et al., 2016).

Future research should continue to investigate mental health stigma and schizophrenia, particularly focusing on the causal factors and means by which to reduce such stigma. Moreover, future research would benefit from using mixed methods research designs in order to produce more detailed and comprehensive accounts of this topic (Coolican, 2017; Taylor, Bogdan and DeVault, 2015).

Conclusion:

In conclusion, the aim of this literature review was to explore the topic of mental health stigma against schizophrenia and those who suffer from it. The findings of this review suggested that stigma towards schizophrenia is based on the false belief that schizophrenia is a contagious biological disease, resulting in avoidance of people with schizophrenia and making such people avoid seeking help as a means by which to conceal their problems. In spite of this, though, there are methodological limitations associated with this literature review that means that a truly comprehensive representation of the subject matter may not have been achieved. To close, future research should continue to study this topic through the use of mixed method research designs, but also replicate this study but using a systematic review design.

References:

Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ... and Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11-27.

Coolican, H. (2017). Research methods and statistics in psychology. UK: Psychology Press.

Corrigan, P. W., Druss, B. G., and Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37-70.

Corrigan, P. W., Mittal, D., Reaves, C. M., Haynes, T. F., Han, X., Morris, S., and Sullivan, G. (2014). Mental health stigma and primary health care decisions. Psychiatry Research, 218(1), 35-38.

Gronholm, P. C., Thornicroft, G., Laurens, K. R., and Evans-Lacko, S. (2017). Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review. Psychological Medicine, 47(11), 1867-1879.

Isaksson, A., Corker, E., Cotney, J., Hamilton, S., Pinfold, V., Rose, D., ... and Evans-Lacko, S. (2017). Coping with stigma and discrimination: evidence from mental health service users in England. Epidemiology and Psychiatric Sciences, 1-12.

Lee, E. H. M., Hui, C. L. M., Ching, E. Y. N., Lin, J., Chang, W. C., Chan, S. K. W., and Chen, E. Y. H. (2016). Public stigma in China associated with schizophrenia, depression, attenuated psychosis syndrome, and psychosis-like experiences. Psychiatric Services, 67(7), 766-770.

Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., and Pescosolido, B. A. (1999). Public conceptions of mental illness: labels, causes, dangerousness, and social distance. American Journal of Public Health, 89(9), 1328-1333.

Marks, D. F., and Yardley, L. (2004). Research methods for clinical and health psychology. London: Sage.

Mestdagh, A., and Hansen, B. (2014). Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies. Social Psychiatry and Psychiatric Epidemiology, 49(1), 79-87.

O’Keeffe, D., Turner, N., Foley, S., Lawlor, E., Kinsella, A., O'Callaghan, E., and Clarke, M. (2016). The relationship between mental health literacy regarding schizophrenia and psychiatric stigma in the Republic of Ireland. Journal of Mental Health, 25(2), 100-108.

Silverman, D. (2016). Qualitative Research. London: Sage.

Smith, J. A. (2015). Qualitative psychology: A practical guide to research methods. London: Sage.

Taylor, S. J., Bogdan, R., and DeVault, M. (2015). Introduction to qualitative research methods: A

Vass, V., Morrison, A. P., Law, H., Dudley, J., Taylor, P., Bennett, K. M., and Bentall, R. P. (2015). How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatry Research, 230(2), 487-495.

Wahl, O. F. (1999). Mental health consumers' experience of stigma. Schizophrenia Bulletin, 25(3), 467-478.

Webb, M., Peterson, J., Willis, S. C., Rodney, H., Siebert, E., Carlile, J. A., and Stinar, L. (2016). The role of empathy and adult attachment in predicting stigma toward severe and persistent mental illness and other psychosocial or health conditions. Journal of Mental Health Counseling, 38(1), 62-78.

Ye, J., Chen, T. F., Paul, D., McCahon, R., Shankar, S., Rosen, A., and O’Reilly, C. L. (2016). Stigma and discrimination experienced by people living with severe and persistent mental illness in assertive community treatment settings. International Journal of Social Psychiatry, 62(6), 532-541.