IntroductionSelf-stigma plays a role in many areas of the patient’s life. Furthermore, it also discourages therapy. The aim of our study was to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups.MethodsThis cross-sectional study involved outpatients attending the Department of Psychiatry, University Hospital Olomouc, Czech Republic. The level of self-stigma was measured with the Internalized Stigma of Mental Illness and adherence with the Drug Attitude Inventory. The patients also anonymously filled out a demographic questionnaire which included a question asking whether they had discontinued their medication in the past.ResultsWe examined data from 332 patients from six basic diagnostic categories (substance abuse disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, and personality disorders). The study showed a statistically significant negative correlation between self-stigma and adherence to treatment in all diagnostic groups. Self-stigma correlated positively and adherence negatively with the severity of disorders. Another important factor affecting both variables was partnership. Self-stigma positively correlated with doses of antidepressants and adherence with doses of anxiolytics. Self-stigma also negatively correlated with education, and positively with a number of hospitalizations and number of psychiatrists visited. Adherence was further positively correlated with age and age of onset of disorders. Regression analysis showed that self-stigma was an important factor negatively influencing adherence to treatment and significantly contributing to voluntary discontinuation of drugs. The level of self-stigma did not differ between diagnostic categories. Patients suffering from schizophrenia had the lowest adherence to treatment.ConclusionThe study showed a significant correlation between self-stigma and adherence to treatment. High levels of self-stigma are associated with discontinuation of medications without a psychiatrist’s recommendation. This connection was present in all diagnostic groups.

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Manypsychiatric patients stigmatize themselves because of their mental disorder. Itis necessary to focus on both research and therapeutic options to alleviate theirburden resulting from self-stigma. The goal of this paper was to evaluate theCzech translation of the ISMI scale (the Internalized Stigma of Mental Illnessscale). The scale measures the level of self-stigma in psychiatric patients andconsists of 29 items divided in 5 subscales-Alienation, Stereotypeendorsement, Perceived discrimination, Social Withdrawal, and StigmaResistance. The research sample included 369 psychiatric patients. Theiraverage age was 41,5 + 13,3 years, and the majority were women (N = 210;56,6 %). The most common diagnoses were neurotic disorders (46,1 %), followedby mood disorders (18,4 %), substance use disorders (13,3 %), psychoses (10,8%), personality disorders (9,5 %), and organic disorders (1,6 %). Reliabilitywas assessed by Cronbach alpha (α = 0,91), split-half (Spearman-BrownCoefficient = 0,93), and test-retest with the second measurement 3 weeks afterthe first one (N = 17; r = 0,90, p < 0,05). We also performed exploratory factor analysisand the evaluation of validity based on correlations with two scales presentingphenomena connected to the concept of self-stigma (Beck Depression Scale-II andClinical Global Impression). Lastly, we created norms based on T-scores andstens for the overall scale and its subscales. The results showed that theCzech version of the ISMI scale has satisfactory psychometric properties.

IntroductionAdherence to treatment of mental disorders is one of the key factors influencing its success and, secondarily, the patients’ quality of life and social adaptation.AimsThe cross-sectional study of 90 outpatients diagnosed with psychotic disorders aimed at determining if there was a relationship between discontinuation of medication in the past, current adherence to treatment and self-stigma.MethodsThe assessment was made with the objective and subjective Clinical Global Impression – Severity scale, Drug Attitude Inventory, Internalized Stigma of Mental Illness (ISMI) scale and demographic data.ResultsThe questionnaires were filled out by 79 patients, of whom 5 handed in incomplete questionnaires. Complete sets of data were obtained from 74 patients. The data analysis showed that the levels of self-stigma as assessed by the total ISMI scores was not statistically significantly correlated with most of the demographic factors (age, age of illness onset, gender, education, marital status, employment, duration of the illness, number of hospitalizations and antipsychotic dosage). However, there was a significant negative correlation with current adherence to treatment.ConclusionsAdherence to treatment is one of the most important prerequisites for successful therapy. Adherence may be enhanced through better motivation and education of patients on the necessity of adhering to treatment recommendations and the consequences of non-adherent behavior. Important factors in adherence also seem to be patients’ stigmatization and self-stigma. Adherence may be increased by promising self-stigma-reducing strategies performed by systematic psychoeducation of patients or as a part of psychotherapeutic counseling.Disclosure of interestThe authors have not supplied their declaration of competing interest.