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Accessible SummaryWhat is known on the subject? Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs’ quality of life and caregiving capacity. Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. What does the paper add to existing knowledge? Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. What are the implications for practice? Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients’ adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs’ internalized stigma can be delivered by healthcare providers or by peer caregivers. AbstractIntroductionInternalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue.AimThe aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China.MethodsA consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors.ResultsNearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients’ characteristics (severity of illness) and FGs’ characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication).Discussion and implications for practiceInformative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support.

AimTo develop and psychometrically test the distress thermometer for caregivers (DT‐C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia.DesignA validation diagnostic accuracy study and descriptive cross‐sectional survey.MethodsDT‐C was adopted based on Harverman's distress thermometer for parents. The cut‐off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale‐21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018.ResultsOne‐item DT of DT‐C indicated a good retest reliability (r = 0.86) and one‐item DT and the Problem List (PL) indicated good convergent validity (r = 0.67–0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70–0.90). Setting seven as the cut‐off score, the values of sensitivity (0.72–0.81), specificity (0.86–0.90), Youden's index (0.61–0.70), positive predictive value (0.67–0.74), and negative predictive value (0.84–0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88–0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut‐off. Caregivers above the cut‐off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains.ConclusionThe DT‐C, with six domains containing 35 items in Problem List and with the cut‐off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers’ distress.ImpactThis study adapted a reliable DT‐C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals.