Stigma as social death: Mental health outcomes in Chinese Americans with schizophrenia.

摘要

Mental illness stigma has been identified as one of the most important barriers to the recovery and social reintegration of persons with severe and chronic psychiatric disorders like schizophrenia. Chinese Americans with psychotic disorders are particularly susceptible to treatment barriers due to cultural, linguistic, and structural factors, including stigma. Because family members also play a key role in consumers' care in this group, understanding stigma among consumers and their caregivers may shed light on mental health outcomes. The following study aimed to understand mental health and psychosocial outcomes in relation to stigma levels and attribution of illness. Methods: Fifty-two consumer-family dyads were recruited from two Asian inpatient psychiatric hospitals at baseline, with 29 consumers (56%) at 9-month follow-up. An additional archival dataset (n=64) was utilized to compare baseline stigma levels across other ethnicities to better understand the experience of stigma across cultures. Stigma (Devaluation-Discrimination Scale and Consumer Experience of Stigma Questionnaire) in consumers and families and attribution of illness (Causal Models Questionnaire for Schizophrenia) were evaluated for longitudinal association with mental health outcomes (treatment adherence, symptoms, and re-hospitalization) and psychosocial outcomes (social network, self-esteem, and employment). Results: Consumer stigma was associated with reduced social network size, and family stigma was associated with consumers' lower self-esteem, reduced non-relative social network, and reduced symptomology. Stigma did not predict other mental health or psychosocial outcomes. Using indigenous beliefs to explain cause of illness, particularly Excessive Thinking or "thinking too much", was associated with reduced re-hospitalization. The present study's findings suggest that for a group mostly representing Chinese immigrants to New York City, perception of stigma is higher than that of Whites and African Americans in New York, but not Hispanics. Limitations include moderate follow-up rate and small sample size. Conclusions: Mental illness stigma is high in Chinese Americans compared to other ethnic groups, and has a significant negative effect on Chinese Americans with schizophrenia. Findings suggest anti-stigma interventions for family and consumers may be warranted to improve outcomes. Given the limitations in sample size, future studies may investigate these trends further to better understand how stigma affects outcomes in Chinese Americans with schizophrenia.