The process of stigma experience in the families of people living with bipolar disorder: a grounded theory study

Abstract

Background One of the most challenging issues faced by families of people living with bipolar disorder is stigma. This study was conducted to explain the process of stigma experience in the families of people living with bipolar disorder using the grounded theory method. Methods Data for this study were collected through semi-structured interviews with participants in Razi Psychiatric Hospital in Tehran, Iran, via purposive sampling and field notetaking. The dependability, conformability, and transferability measures were included to support the data accuracy and robustness, and MAXQDA 2020 software was used to facilitate data coding. The Strauss–Corbin method was used to analyse the data. Results A total of 20 family members of people living with bipolar disorder, four people living with bipolar disorder, and three mental health professionals participated in this study. The analysis of participants’ experiences led to identifying 64 subcategories, 21 categories, and six main concepts, including social deprivation, being labelled, cultural deficiency and lack of awareness, economic challenges, forced acceptance of the existing situation, and social isolation. Conclusion Families of people living with bipolar disorder experience social deprivation, social isolation, and social rejection, which have irreparable consequences for them. Overcoming stigma in these families should be a priority of policymakers and planners in the field of psychosocial health.

Stigma in people living with bipolar disorder and their families: a systematic review

“…Studies have pointed out several consequences of stigma in these individuals, such as reduced participation, social deprivation, threats to mental health and reduced social adjustment emotional and sentimental excitement, objective and behavioral reflections, family solidarity threat, social exclusion, social isolation, restriction in social functions such as job performance and education, low self-esteem, poor quality of life, the prolongation of the treatment course, disease recurrence, hiding the disease, experiencing discrimination and injustice, and finally reduced life expectancy and resilience. These results were in line with previous studies of Bhattacharyya, Pal, Noak, Latifian, Perlick, Kumar, Sadighi, Au, Vazquez, Karidi, Post, Quenneville, Grover, Brohan and Mileva (Bhattacharyya et al 2019 ; Pal 2020 ; Noack et al 2016 ; Latifian et al 2022a , b , c ; Perlick et al 2001 , 2007 ; Kumar et al 2020 ; Sadighi et al 2015 ; Au et al 2019 ; Vázquez et al 2011 ; Karidi et al 2015 ; Post et al 2018 ; Quenneville et al 2020 ; Grover et al 2016 ; Brohan et al 2011 ; Mileva et al 2013 ).…”

“…Social stigma is the most devastating when the bipolar patients and their families accept it and internalized the negative views of the community, a phenomenon called internalized or emotional stigma. This is consistent with the findings of Bruni, Sharma, Wong, Bassirnia, Park, Grover, Ando and Leporil (Bruni et al 2018 ; Sharma et al, 2017 ; Wong et al 2009 ; Bassirnia et al 2015 ; Park et al, 2014 ; Latifian et al 2022a , b , c ; Grover et al 2019 ; Ando et al 2013 ; Richard-Lepouriel et al 2021 ).…”

“…Stigma impairs people’s quality of life and leads to their isolation and rejection of interpersonal relationships. The rejection from society and low self-esteem, following the fear of rejection, weakens living conditions, reduces income, and causes unemployment for people with bipolar disorders (Connell et al 2014 ; Latifian et al 2022a , b , c ).…”

“…Stigma is also common among families of people living with bipolar disorder. The parents of such patients, reprimanding by ordinary and professional people, look for the causes of the disease and experience issues such as guilt attribution and social exclusion due to having a family member with such disorder (Koschorke et al 2014 ; Latifian et al 2022a , b , c ; McCann et al 2011 ). Family stigma contributes to decreased self-esteem, sleep disorders, decreased psychological well-being, and reduced quality of life (Wong et al 2009 ).…”

“…The increasing experience of stigma in people living with bipolar disorders and their families, as well as the significant role of psychological and social interventions in reducing the stigma of this disease, make it more necessary to pay attention to the various dimensions of this phenomenon (Latifian et al 2022a , b , c ). So far, a number of review articles have been done in the field of stigma in bipolar disorder.…”