A multicomponent intervention to reduce internalized stigma in persons with a diagnosis of severe mental disorder: protocol of a pilot randomized mixed trial

Authors

  • Dany Fernández Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
  • Pamela Grandón Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
  • Claudio Bustos Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile

DOI:

https://doi.org/10.18203/2349-3259.ijct20230050

Keywords:

Protocol, Multicomponent intervention, Internalized stigma, Mental disorder, Severe mental disorder, Psychiatric diagnosis

Abstract

Background: People with mental disorders face stigma as a social obstacle in multiple areas of their lives. Therefore, stigma toward this population is a priority for global public health due to its numerous consequences for those affected. One of its manifestations is internalized stigma, which also has severe implications for people with mental disorders. This study presents the protocol of a multicomponent intervention aimed at reducing internalized stigma in people with severe mental disorders.

Methods: The intervention is based on a mixed-method experimental design. The main design is an external randomized pilot trial with two arms, parallel, double-blind, equally randomized, and single-center. Qualitative data before and after the completion of the intervention are included as a secondary component of the main design. The study will be carried out in health service of the secondary level of care in Gran Concepción, Biobío Region, Chile. Twelve people will participate in the qualitative pre-intervention stage and 34 in the intervention stage, 17 in the experimental group, and 17 in the control group. The experimental group will receive the intervention plus the usual treatment, and the control group will only receive the usual treatment. The intervention is carried out in 10 sessions lasting 90 minutes each and is administered by a health service professional.

Conclusions: The study will provide evidence on the acceptability and feasibility of the intervention in the Chilean context, advancing knowledge and understanding in the field.

Trial Registration: The study has been registered with trial registration no. ACTRN12622000919718.

References

Mascayano F, Lips W, Mena C, Manchego C. Estigma hacia los trastornos mentales: características e intervenciones. Salud Ment. 2015;38:53-8.

Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 2010;71(12):2150-61.

Yanos PT, Roe D, Lysaker PH. Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness. Int J Group Psychother. 2011;61(4):577-95.

Caqueo-Urízar A, Boyer L, Urzúa A, Williams DR. Self-stigma in patients with schizophrenia: a multicentric study from three Latin-America countries. Soc Psychiatry Psychiatr Epidemiol. 2019;54(8):905-9.

Caqueo-Urízar A, Urzúa A, Habib J, Loundou A, Boucekine M, Boyer L, Fond G. Relationships between social stigma, stigma experience and self-stigma and impaired quality of life in schizophrenia across three Latin-American countries. Eur Arch Psychiatry Clin Neurosci. 2020;270(5):513-20.

Vaccari P, Ramírez-Vielma R, Saldivia S, Cova F, Vielma-Aguilera A, Victoriano V, Ulloa-Vidal N, Grandón P. Stigma towards people with a diagnosis of severe mental disorder in primary healthcare centers: perspectives of service users and health teams in Chile. Int J Ment Health Syst. 2020;14:6.

Corrigan PW, Larson JE, Michaels PJ, Buchholz BA, Rossi RD, Fontecchio MJ, Castro D, Gause M, Krzyżanowski R, Rüsch N. Diminishing the self-stigma of mental illness by coming out proud. Psychiatry Res. 2015;229(1-2):148-54.

González-Domínguez S, González-Sanguino C, Muñoz M. Efficacy of a combined intervention program for the reduction of internalized stigma in people with severe mental illness. Schizophr Res. 2019;211:56-62.

Yanos PT, Lysaker PH, Silverstein SM, Vayshenker B, Gonzales L, West ML, Roe D. A randomized-controlled trial of treatment for self-stigma among persons diagnosed with schizophrenia-spectrum disorders. Soc Psychiatry Psychiatr Epidemiol. 2019;54(11):1363-78.

Alonso M, Guillén AI, Muñoz M. Interventions to Reduce Internalized Stigma in individuals with Mental Illness: A Systematic Review. Spanish J Psychol. 2019;22:1-14.

Büchter RB, Messer M. Interventions for reducing self-stigma in people with mental illnesses: A systematic review of randomized controlled trials. GMS Ger Med Sci. 2017;15:1-12.

Wood L, Byrne R, Varese F, Morrison AP. Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis. Schizophr Res. 2016;176(2-3):291-303.

Mascayano F, Toso-Salman J, Ho YCS, Dev S, Tapia T, Thornicroft G, Cabassa LJ, Khenti A, Sapag J, Bobbili SJ, Alvarado R, Yang LH, Susser E. Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries. Transcult Psychiatry. 2020;57(1):140-60.

Yang LH, Kleinman A, Link BG, Phelan JC, Lee S, Good B. Culture and stigma: adding moral experience to stigma theory. Soc Sci Med. 2007;64(7):1524-35.

Bos AER, Pryor JB, Reeder GD, Stutterheim SE. Stigma: Advances in Theory and Research. Basic Appl Soc Psychol. 2013;35:1-9.

Markowitz FE. Labeling Theory and Mental Illness. In Labeling Theory: Empirical Tests. Editors, Farrington DP, Murray J. 2014;45-62.

Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061.

Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45(5):626-9.

O’Cathain A, Hoddinott P, Lewin S, Thomas KJ, Young B, Adamson J, et al. Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: guidance for researchers. Pilot Feasibility Studies. 2015;1:1-13.

Minoletti A, Soto-Brandt G, Sepúlveda R, Toro O, Irarrázaval M. Capacidad de respuesta de la atención primaria en salud mental en Chile: una contribución a Alma-Ata. Rev Panam Salud Publica. 2018;42:e136.

Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA; PAFS consensus group. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016;2:64.

Ledesma JM, Gutierrez M. Estudios experimentales. Ensayo clínico aleatorizado. Form Act Pediatr Aten Prim. 2013;6:123-32.

Creswell JW, Plano Clark VL. Designing and Conducting Mixed Methods Research. SAGE Publications, Inc. 2018.

Organización Mundial de la Salud. CIE-11. Clasificación Internacional de Enfermedades para Estadísticas de Mortalidad y Morbilidad. Guía de Referencia. 2019.

Onwuegbuzie AJ, Collins KMT. A Typology of Mixed Methods Sampling Designs in Social Science Research. Qualitative Rep. 2007;12:281-316.

Dishy G, Blasco D, Filgueira C, Sun M, et al. ‘What Matters Most’: Internalized Mental Illness Stigma and the Role of Women in Chilean Society. American Psychological Association. 2019.

Gyamfi S, Hegadoren K, Park T. Individual factors that influence experiences and perceptions of stigma and discrimination towards people with mental illness in Ghana. Int J Ment Health Nurs. 2017;27:368-77.

Tzouvara V, Papadopoulos C, Randhawa G. Self-Stigma Experiences Among Older Adults with Mental Health Problems Residing in Long-Term Care Facilities: A Qualitative Study. Issues Ment Health Nurs. 2017;39:403-10.

Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016;25(3):1057-73.

Tsang HW, Ching SC, Tang KH, Lam HT, Law PY, Wan CN. Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophr Res. 2016;173(1-2):45-53.

Yanos PT, DeLuca JS, Roe D, Lysaker PH. The impact of illness identity on recovery from severe mental illness: A review of the evidence. Psychiatry Res. 2020;288:112950.

Corrigan PW, Watson, A. C. The Paradox of Self-Stigma and Mental Illness. Clin Psychol. 2002;9:35-53.

Scheff TJ. Being Mentally Ill: A Sociological Theory. Aldine de Gruyter, 1966.

Thoits P. A. Self-Labeling Processes in Mental Illness: The Role of Emotional Deviance. AJS. 1985;91:221-49.

Link BG. Understanding Labeling Effects in the Area of Mental Disorders: An Assessment of the Effects of Expectations of Rejection. Am Sociol Rev. 1987;52:96-112.

Cooley CH. Human Nature and the Social Order. Scribner’s Sons. 1902.

Firmin RL, Lauren L, Lysaker PH, Minor KS, McGrew JH, Cornwell MN, et al. Stigma Resistance at the Personal, Peer, and Public Levels: A New Conceptual Model. Stigma Health. 2017;2:182-94.

Simon B. Identity in Modern Society: A Social Psychological Perspective. Blackwell Publishing Ltd. 2004.

O’Cathain A. A Practical Guide to Using Qualitative Research With Randomized Controlled Trials. Oxford University Press. 2018.

Toomey E, Matthews J, Hurley DA. Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain. BMJ Open. 2017;7:e015452.

Boyd Ritsher JE, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121:31-49.

Caqueo-Urízar A, Urzúa A, Loundon A, Boucekine M, Fond G, Boyer L. The Latin American version of the internalized stigma of mental illness scale (LA-ISMI): a multicentric validation study from three Latin American countries. Health Qual Life Outcomes. 2019;17(1):175.

Rosenberg M. Society and the Adolescent Self-Image. Princeton University Press, 1965.

Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: The Hopelessness Scale. J Consult Clin Psychol. 1974;42:861-5.

Alamo C, Baader T, Antúnez Z, Bagladi V, Bejer T. Escala de desesperanza de Beck como instrumento útil para detectar riesgo de suicidio en universitarios chilenos. Revista Chilena de Neuro-psiquiatría. 2019;57:167-75.

Corrigan PW, Salzer M, Ralph RO, Sangster Y, Keck L. Examining the Factor Structure of the Recovery Assessment Scale. Schizophr Bull. 2004;30:1035-41.

Zalazar V, Valdez JC, Mascayano F, Vera N, Scorza P, Agrest M. Feasibility and Psychometric Properties of the Recovery Assessment Scale (RAS) in People with Mental Illness for Its Use in Argentina. J Psychosoc Rehabil Ment Health. 2017;4:179-88.

Rogers E, Chamberlin J, Ellison M, Crean T. A Consumer-Constructed Scale to Measure Empowerment Among Users of Mental Health Services. Psychiatr Serv. 1997;48:1042-7.

Ballester MA. Efectos de la participación sobre el empoderamiento en dos muestras de personas con trastorno mental grave que reciben tratamiento rehabilitador. Universitat Jaume I. 2015.

Marcussen K, Gallagher M, Ritter C. Stigma Resistance and Well-Being in the Context of the Mental Illness Identity. J Health Soc Behav. 2021;1-18.

Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health. 2019;11:589-97.

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3:77-101.

Braun V, Clarke V. Thematic Analysis: A Practical Guide. SAGE Publications, Inc., 2021.

Mascayano F, Toso-Salman J, Ruiz B, Warman K, Jofre Escalona A, Alvarado Muñoz R, Sia KJ, Yang LH. What matters most': stigma towards severe mental disorders in Chile, a theory-driven, qualitative approach. Rev Fac Cien Med Univ Nac Cordoba. 2015;72(4):250-60.

Yang LH, Valencia E, Alvarado R, Link B, Huynh N, Nguyen K, Morita K, Saavedra M, Wong C, Galea S, Susser E. A theoretical and empirical framework for constructing culture-specific stigma instruments for Chile. Cad Saude Colet. 2013;21(1):71-9.

VERBI Software. MAXQDA. 2022. Available at: https://www.maxqda.com/new-maxqda-2022. Accessed on 21 October 2022.

Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004;10:307-12.

Elkins MR, Moseley AM. Intention-to-treat analysis. J Physiother. 2015;61:165-7.

IBM Corp. IBM SPSS Statistics. 2021.

Emanuel, E. J., Wendler, D. & Grady, C. What makes clinical research ethical? JAMA. 2000;283:2701-11.

McGregor SLT. Understanding and Evaluating Research: A Critical Guide. SAGE Publications, Inc. 2018.

Park K, MinHwa L, Seo M. The impact of self-stigma on self-esteem among persons with different mental disorders. Int J Soc Psychiatry. 2019;65(7-8):558-65.

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Published

2023-01-23