Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic

RationaleMental health-related stigma and discrimination not only affect persons living with schizophrenia but also their whole families. Stigma and discrimination reduction is key to respond to the unmet needs of persons with mental illness. The local context is of particular importance in this endeavor, as stigma and its manifestations depend on the specific conditions of the target population and across cultures and settings. Evidence on effective approaches to reduce stigma is sparse and lacking from Central and Eastern Europe, including from the Czech Republic.ObjectiveOur aim was to inform a far-reaching anti-stigma campaign related to a national mental health reform that was being deployed.MethodsWe conducted a qualitative study based on semi-structured in-depth interviews with relatives of patients diagnosed with schizophrenia in the Czech Republic. Initial respondents were identified through local mental health services and users' organizations with a consecutive chain-referral sampling. Transcribed narratives were thematically analyzed within a pre-developed four-level thematic framework to comprehensively identify experiences of stigma and discrimination in all areas of the respondents' lives.ResultsStigma experiences of 25 diverse family members of persons living with schizophrenia spanned four levels of respondents' lives (macro-, meso-, micro-, and intro-level). The overarching issues were: (1) general lack of understanding and misconceptions about mental illness; (2) structural discrimination and paucity of governmental and public support system; (3) burden of “pervasive and unlimited” care and inability of independent living.ConclusionsWe identified several features of mental health related stigma and the ensuing discrimination in Czech Republic experienced by persons with severe mental illness and their relatives. We developed a set of recommendations for policy-makers aimed at reducing ignorance and prejudice amongst the public and professionals, improving health and social services—including employment, housing and community integration—and the provision of family support

Norman Sartorius: psychiatry's living legend

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The Role of Insight in Moderating the Association Between Depressive Symptoms in People With Schizophrenia and Stigma Among Their Nearest Relatives: A Pilot Study

Background: There is evidence of a positive association between insight and depression among patients with schizophrenia. Self-stigma was shown to play a mediating role in this association. We attempted to broaden this concept by investigating insight as a potential moderator of the association between depressive symptoms amongst people with schizophrenia and stigmatizing views towards people with mental disorders in their close social environment. Method: In the initial sample of 120 pairs, data were gathered from 96 patients with a diagnosis of “paranoid schizophrenia” and 96 of their nearest relatives (80 response rate). In this cross-sectional study data were collected by clinical interview using the following questionnaires: “The Scale to Assess Unawareness of Mental Disorder,” “Calgary Depression Scale for Schizophrenia,” and “Brief Psychiatric Rating Scale.” The stigmatizing views of patients’ nearest relatives towards people with mental disorders were assessed with the “Mental Health in Public Conscience” scale. Results: Among patients with schizophrenia depressive symptom severity was positively associated with the intensity of nearest relatives’ stigmatizing beliefs (“Nonbiological vision of mental illness,” τ = 0.24; P < .001). The association was moderated by the level of patients’ awareness of presence of mental disorder while controlling for age, sex, duration of illness and psychopathological symptoms. Conclusions: The results support the hypothesis that the positive association between patients’ depression and their nearest relatives’ stigmatizing views is moderated by patients’ insight. Directions for further research and practical implications are discussed

Satisfaction with psychiatric in-patient care across 11 countries: Final report of the IDEA-study (inpatient discharge: experiences and analysis)

IntroductionSatisfaction of patients with in-patient care is a relatively rare focus of research in mental health.ObjectivesThe IDEA-study (inpatient discharge: experiences and analysis) was initiated to shed the light on the issue internationally.AimThe IDEA project aimed to:– develop a collaborative network of young psychiatrists;– use this network to explore satisfaction of people treated in psychiatric in-patient facilities in a range of high-, middle- and low-income countries.MethodsStudy was conducted in 25 hospitals across 11 countries. We measured satisfaction with in-patient care using the 5-item study-specific questionnaire. Individual and institution level correlates of “low satisfaction” were examined by comparisons of binary and multivariate associations in multilevel regression models.ResultsA final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards positive responses. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio.ConclusionWe could successfully establish a collaborative network of early career psychiatrists from different parts of the world and collect data in regards to the study aims. The positive skew of satisfaction scores need to be carefully considered in the context of literature and study limitations. In particularly, we suggest further studies on patients’ satisfaction to pay more attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients’ disempowerment, power imbalance.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

QUALITATIVE RESEARCH IN MEDICINE AND PUBLIC HEALTH

In this paper we present definition, classification and main characteristics of qualitative research as well as its advantages and disadvantages. We also compare the main features of qualitative and quantitative study designs. Examples are given to demonstrate practical steps in qualitative inquiry to demonstrate that qualitative research can sufficiently contribute to evidence generation in medicine and public health complementing quantitative research with answers on questions "why" and "how", which cannot be answered by quantitative research. The paper presents basic information on qualitative studies and does not substitute specialized literature.</jats:p