Stigma and access to care in first‐episode psychosis

Abstract

Aim: Mental health-related stigma is considered a significant barrier to help-seeking and accessing care in those experiencing mental illness. Long duration of untreated psychosis is associated with poorer outcomes. The impact of stigma on the duration of untreated psychosis, in firstepisode psychosis remains unexplored. To examine the association between mental healthrelated stigma and access to care in people experiencing first-episode psychosis in Birmingham, UK. Methods:We collected data on a prospective cohort of first-episode psychosis. The StigmaScale was used as a measure of mental health-related stigma, and duration of untreated psychosis as a measure of delay in accessing care. We performed logistic and linear regression analyses to explore the relationship between mental health-related stigma and duration of untreated psychosis, adjusting for sex, age, educational level, religion and ethnicity.Results: On the 89 participants included in this study, linear regression analysis revealed that overall stigma and the discrimination sub-factor were significant predictors of longer duration of untreated psychosis, whereas logistic regression identified the disclosure sub-factor to be a significant predictor of longer duration of untreated psychosis.Conclusions: These findings demonstrate that stigmatizing views of mental illness from the patient's perspectives can result in delayed access to care. This emphasizes the importance of tackling mental health-related stigma to ensure early treatment and improved outcomes for people experiencing first-episode psychosis. K E Y W O R D Searly intervention, first-episode psychosis, help-seeking, psychosis, stigma

Clinical and demographic correlates of stigma in first‐episode psychosis: the impact of duration of untreated psychosis

“…As would be expected when compared to individuals with multiple episodes of mental illness, this level of perceived stigma is somewhat lower than the average level of stigma in the sample of 193 service users (27% schizophrenia–schizoaffective disorder) reported on for the development of the Stigma Scale , for which the average score for the total Stigma Scale was 2.23 (on a 5‐point scale, ranging 0–4) and for the 6‐item abbreviated scale was 2.43, between the ‘neither agree nor disagree’ (2) and ‘agree’ (3) anchors. The level of perceived stigma in this study also appears slightly higher than that reported in the Kular et al study of 89 persons with FEP, where the average rating on the 5‐point Stigma Scale was 1.7, between the ‘disagree’ (1) and ‘neither agree nor disagree’ (2) anchors. Interestingly, the DUP of participants in the RAISE‐ETP study was somewhat longer (median = 74 weeks) than in the Kular et al study (median = about 52 weeks), which could account for some of the higher rate of perceived stigma in this study.…”

“…A recent quantitative study by Kular et al did show that perceived stigma (using the full version of the Stigma Scale used in this study) was significantly associated with a longer DUP in a sample of 89 persons beginning treatment for FEP, although data on symptoms were not reported. The present study extends the findings of Kular et al by demonstrating that perceived stigma is predictive of a longer DUP after controlling for symptom severity.…”

“…Perceptions of stigma have been reported to be associated with a delay in seeking treatment for individuals with a first episode of psychosis and are moderately correlated with internalized negative beliefs about mental illness or self‐stigma in this population . In addition, people who have developed psychosis often experience significant social anxiety and shame about their disorder, and feelings of social marginalization that can contaminate their social interactions with others .…”

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

“…Such delay can be related to several factors. These certainly include reduced access to care due to stigma and self‐stigma surrounding mental illness 25‐27 , but stigma‐derived or data‐based concerns about the safety of psychotropic medications in children and adolescents are also relevant 28‐34 .…”

Group cognitive behavioural therapy can reduce stigma and improve treatment compliance in major depressive disorder patients

“…Patients with higher levels of stigma-related negative feelings will have a higher tendency to avoid receiving treatment. When attitudes of acceptance towards MDD are high, it becomes easier for MDD sufferers to receive medication and psychotherapy (Carrara & Ventura, 2018;Latalova, Kamaradova, & Prasko, 2014;Tucker et al, 2013), especially in the early phase of the disorder (Firmin et al, 2018;Kular et al, 2018); that is, the feelings of stigma affect the outcome of the disorder by affecting the treatment compliance of MDD patients. The possible mechanism underlying this tendency is shown in Figure 1.…”