Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences

Dubreucq, Julien; Plasse, Julien; Franck, Nicolás

doi:10.1093/schbul/sbaa181

Cited by 176 publications

(154 citation statements)

References 214 publications

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“…Experienced stigma, anticipated stigma, and self-stigma were identified as barriers to intimacy in ASD ( 33 ). This concurs with findings in serious mental illness where self-stigma has been associated with reduced capacity for intimacy and more negative parenting experiences ( 61 ). Self-stigma has been found to affect one in five people with ASD ( 7 , 62 ).…”

Section: Discussionsupporting

confidence: 91%

“…Future research should further investigate perceived stigma, experienced stigma, anticipated stigma, and self-stigma in gender-diverse autistic individuals. Self-stigma reduction [e.g., narrative enhancement and cognitive therapy ( 65 ) or peer-delivered interventions ( 61 )] might improve the clinical and functional outcomes in autistic women, although this remains to be investigated. A longitudinal examination is needed to investigate the potential relationships between camouflage strategies, stigma-related issues, capacity for intimacy, and parenting experiences.…”

Section: Discussionmentioning

confidence: 99%

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Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

Dubreucq

2021

Front. Psychiatry

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Later age of diagnosis, better expressive behaviors, increased use of camouflage strategies but also increased psychiatric symptoms, more unmet needs, and a general lower quality of life are characteristics often associated with female gender in autism spectrum disorder (ASD). Psychiatric rehabilitation has shown small to moderate effectiveness in improving patients' outcomes in ASD. Few gender differences have been found in the response to psychiatric rehabilitation. This might be related to the predominance of males in research samples, but also to the lack of programs directly addressing women's unmet needs. The objectives of the present paper were: (i) to review the needs for care of autistic women in romantic relationships and reproductive health; (ii) to review the existing psychosocial treatments in these domains; and (iii) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed and PsycINFO), following PRISMA guidelines, was conducted on autistic women's needs for care relating to psychiatric rehabilitation in romantic relationships and reproductive health. Out of 27 articles, 22 reported on romantic relationships and 16 used a quantitative design. Most studies were cross-sectional (n = 21) and conducted in North America or Europe. Eight studies reported on interventions addressing romantic relationships; no published study reported on interventions on reproductive health or parenting. Most interventions did not include gender-sensitive content (i.e., gender variance and gender-related social norms, roles, and expectations). Autistic women and autistic gender-diverse individuals may face unique challenges in the domains of romantic relationships and reproductive health (high levels of stigma, high risk of sexual abuse, increased psychiatric symptoms, and more unmet needs). We discussed the potential implications for improving women's access to psychiatric and psychosocial treatment, for designing gender-sensitive recovery-oriented interventions, and for future research.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

Dubreucq

2021

Front. Psychiatry

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“…Previous research from the French national REHABase network showed that (i) most patients were dissatisfied with their interpersonal relationships at the time of admission and asked for interventions improving social function [36] and (ii) elevated self-stigma was frequent (31.2% of the 738 participants [37]) and was negatively associated with recovery-related outcomes. Self-stigma has been negatively associated with patient's longitudinal outcomes and to lower benefits from psychiatric rehabilitation [38]. Providing NECT to all participants aims at not excluding participants from interventions improving social function (e.g.…”

Section: Designmentioning

confidence: 99%

Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial

Dubreucq

Faraldo

Abbes

et al. 2021

Trials

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Background Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning. Methods This is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery. Discussion NECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice. Trial registration ClinicalTrials.gov NCT03972735. Trial registration date 31 May 2019.

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“…Many people with mental illness are not only aware of public prejudices, but turn them against themselves which is referred to as self-stigma (“I have a mental illness, therefore I must be lazy” [ 6 ]). Self-stigma is associated with a range of negative outcomes [ 7 ] and leads to impaired self-esteem and a sense of demoralization, the so-called why try effect (“Why should I even try to achieve my goals? I am not worthy or not able” [ 8 ]).…”

Section: Introductionmentioning

confidence: 99%

Honest, Open, Proud to support disclosure decisions and to decrease stigma’s impact among people with mental illness: conceptual review and meta-analysis of program efficacy

Rüsch

Kösters

2021

Soc Psychiatry Psychiatr Epidemiol

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Purpose Honest, Open, Proud (HOP; formerly “Coming Out Proud”/COP) is a peer-led group program to support people with mental illness in their disclosure decisions and in their coping with stigma. The aims of this study were to provide (i) a conceptual review of HOP, including versions for different target groups and issues related to outcome measurement and implementation; and (ii) a meta-analysis of program efficacy. Methods Conceptual and empirical literature on disclosure and the HOP program was reviewed. Controlled trials of HOP/COP were searched in literature databases. A meta-analysis of HOP efficacy in terms of key outcomes was conducted. Results HOP program adaptations for different target groups (e.g. parents of children with mental illness; veterans or active soldiers with mental illness) exist and await evaluation. Recruitment for trials and program implementation may be challenging. A meta-analysis of five HOP RCTs for adults or adolescents with mental illness or adult survivors of suicide attempts found significant positive effects on stigma stress (smd = − 0.50) as well as smaller, statistically non-significant effects on self-stigma (smd = − 0.17) and depression (smd = − 0.11) at the end of the HOP program. At 3- to 4-week follow-up, there was a modest, not statistically significant effect on stigma stress (smd = − 0.40, 95%-CI -0.83 to 0.04), while effects for self-stigma were small and significant (smd = − 0.24). Long-term effects of the HOP program are unknown. Conclusion There is initial evidence that HOP effectively supports people with mental illness in their disclosure decisions and in their coping with stigma. Implementation issues, future developments and public health implications are discussed.

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Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences

Cited by 176 publications

References 214 publications

Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial

Honest, Open, Proud to support disclosure decisions and to decrease stigma’s impact among people with mental illness: conceptual review and meta-analysis of program efficacy

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