| Stigma among patients with mental disorders is increasingly recognized as a global public health problem. Public discrimination against patients with mental disorder is very common, which leads to the stigma in most psychiatric patients. Stigma has a severe impact on the patient’s psychological status, social function, compliance with treatment, and recovery. In Chinese culture, psychiatric patients suffer from social discrimination, so perceived stigma has become an important issue to be studied on.Objectives:1. To describe the public (relatives of the psychiatric patients, nurses, students) discrimination against patients with mental disorders, and to explore its influencing factors and strategies of reducing discrimination.2. To describe the stigma levels perceived by patients with mental disorders, to analyze the influencing factors such as social demographic factors, clinical factors, social support, general self-efficacy, and coping style etc. on the patient’s stigma, and to explore the strategies of reducing stigma.3. To investigate the influence by perceived stigma on quality of life of the patients with mental disorders. To explore the strategies used to improve patients’ quality of life.This study will provide a scientific basis for reducing the public’s prejudice and discrimination towards the psychiatric patients, reducing the patients’stigma, improving quality of life of the patients, formulating mental health work policies by the government, in order to promote physiological, psychological, and social aspects of rehabilitation of patients with mental disorders.Methods:1. The survey of the publicThis study is a descriptive study, used questionnaire method and convenience sample survey. A total of1864public received the survey, including relatives of patients with mental disorders, students (secondary professional school students, associate degree program students, undergraduate), nurses (psychiatric hospital nurses, nurses in comprehensive hospitals). The survey instruments include:general information questionnaire and assessment scale of discrimination against patients with mental disorders. For the latter scale, higher scores may indicate more serious discrimination against the patients.2. The investigation of the patients with mental disordersThe survey was carried out at psychiatric departments of3hospitals in Guangzhou. By using convenience sampling method, the patients meeting the inclusion criteria were recruited in the survey. Patients’diagnosis was schizophrenia and affective disorder. The instruments used in the survey were:general information questionnaire, Link stigma series scale, social support assessment scale, schizophrenic quality of life scale, general self-efficacy scale, simplified coping style questionnaire. Patients suffering from mental disorders in the survey were given written informed consent after being fully informed about the study procedures. A total of430copies of questionnaires were given to the patients, and effective questionnaires were406, so efficiency was94.42%.Results:1. The public discrimination against patients with mental disorders and its influencing factors.(1) The public discrimination against patients with mental disordersTwo independent sample t test showed no significant difference (P=1.000) between the total scores of the scale of discrimination against patient with mental disorders in this research and that of scale editor Zeng Qingzhi’s finding. Scores of isolation dimensions and ability dimension were significantly lower than Zeng Qingzhi’s findings (P<0.001), but score of dangerous dimensions was significantly higher than Zeng Qingzhi’s survey results (P<0.001).The scores of the scale of discrimination against patients with mental disorders were compared among the subjects of patients’relatives, nurses and students. In addition to the ability dimension scores, the three groups total scores of the scale, isolation dimension score and risk dimension score had significant difference (P<0.001). Multiple comparison showed that as compare to the patient’s relatives, total scores of the scale, isolation dimension scores, dangerous dimension scores were significantly higher in nurses and students (P<0.001). Isolation dimension score of nurses was significantly higher than that of the students (P<0.001). However, there were no significantly differences in total scores of the scale, dangerous dimension scores and ability dimension scores between nurses and students (P>0.05). There were no significant difference in total scores of the scale and ability dimension scores between nurses in psychiatric hospitals and comprehensive hospitals (P=0.391,0.404). The isolation dimension scores of psychiatric hospital nurses were significantly higher than that of nurses in comprehensive hospitals (P<0.001), but the dangerous dimension scores were significantly lower than that of the nurses in comprehensive hospital (P<0.001).There was no significant differences in total scores of the scale, isolation dimension scores and dangerous dimension scores between associate degree program students majoring in science and nursing (P>0.05), but ability dimension score of the students majoring in science was significantly higher than that of the students majoring in nursing (P<0.001).In addition to the ability dimension, there were significant differences in total scores of the scale, isolation dimension scores and dangerous dimension scores among nursing students in certificate program, associate degree program and bachelor’s degree program (P<0.001). Multiple comparisons showed that the total scores of the scale, isolation dimension score of nursing students in bachelor’s degree program was significantly lower than that of the nursing students in certificate program and associate degree program. The isolation dimension score of the nursing students in certificate program was significantly lower than that of the nursing students in associate degree program; but the dangerous dimension score was significantly higher than that of the nursing students in associate degree program and bachelor’s degree program.The total score of the scale and isolation dimension score of nursing students in bachelor’s degree program was significantly higher than that of the students majoring in clinical medicine (P=0.030,0.003), but there was no significant difference in dangerous dimension score and ability dimension score between the two students groups (P=0.141,0.828).(2) Factors that influence the public discrimination against patient with mental disordersMultiple regression analysis showed:factors influence the total score of the scale were type of investigation objects, gender, age, educational background, attended psychiatric/psychological lectures or not, contact degree and life connection degree to the patients with mental disorders. Nurses and students’ total scores of the scale were higher than those of family members of the patients. Male’s total score of the scale was lower than that of females. The older of the age, the higher total score of the scale would be. The public with higher educational background attended psychiatric/psychological lectures, with higher contact degree, and with higher life connection degree would have lower total scores of the scale, which indicate lower degree of discrimination against the patients.2. Perceived stigma of psychiatric patients and its influencing factors(1) Perceived stigma of patients with mental disorders, influence of social demographic factors, clinical factors on patient’s stigma.There was significant difference in the scores of Link stigma series scale between the patients with mental disorders and the norm (mid point2.5)(P<0.05). Except different/shame dimension score was significantly higher than the norm, scores of other dimensions were significantly lower than the norm (P<0.01).As to the Link stigma series scale of the patients with mental disorders, the average scores of item6,7,9,11,12,44,46were higher than midpoint2.5. The average scores of item16and45were equal to the midpoint2.5. Other37items’ average scores were lower than the midpoint2.5. In addition to item16,22,25,28,37,45, the average scores of other40items had significant difference as compare to the midpoint2.5(P<0.05). Comparison of the scores of Link stigma series scale between patients with schizophrenia and affective disorder:scores of perceived devaluation-discrimination, education, challenge and misunderstanding dimensions in the patients with schizophrenia were significantly higher than that of the patients with affective disorders (P<0.05). Score of different/sham dimension of patients with schizophrenia was significantly lower than that of the patients with affective disorders. But scores of confidentiality, withdrawal, separation dimensions showed no significant difference between the two kinds of mental disorders (P>0.05).Analysis of variance showed:there were significant differences in total scores of the scale and score of withdrawal dimension among patients with mental disorders whose hospitalization time were within3months,3to6months,6months to1year and more than1year respectively (P=0.049,0.033), however scores of other dimensions showed no significant difference among the patients with4different length hospitalization time (P>0.05). Comparing patients whose hospitalization time is within3months and more than3months, we found that the former patients’total score of the scale and score of withdrawal dimension were significantly higher than that of the latter patients (P=0.013,0.021), and there were no significant difference in other dimensions between patients whose length of hospitalization time was within3months and more than3months.Regression analysis showed, general speaking, to patients with mental disorders, the older age, not living with family members before hospitalization, the higher score of stigma scale the patient would have. The longer of hospitalization time, the lower score of stigma scale the patients would have. Regression analysis of patients with schizophrenia showed, female, married, not living with family members before hospitalization would have higher total scores of stigma scale; as for the patients with affective disorders, regression analysis showed that no independent social demographic risk factors were found.(2) Patients’social support, general self-efficacy, coping style and its influence on the stigma①Social support:There was significant difference in the total score of social support scale between the patients with mental disorders and that of the national norm (P<0.001). Patients with mental disorder got lower social support than normal persons. There were significant differences in total score of social support scale and scores of each dimension between patients with schizophrenia and affective disorders (P<0.05). Total scores of social support scale of patients with schizophrenia, scores of objective support, subjective support and utilization of social support were significantly lower than that of patients with affective disorders (P<0.05).②General self-efficacy:Two independent sample t test showed that the score of general self-efficacy scale in patients with mental disorders was significantly lower than national norm (P<0.001). There was no significant difference in the scores of self-efficacy between patients with schizophrenia and patients with affective disorders (P=0.562).③Coping style:As compare to the norm, there was no significant difference in the average score of positive coping style dimension in patients with mental disorders (P=0.785), but significantly lower in the average score of negative coping style dimension than the national norm (P<0.001). Average score of positive coping style in patients with schizophrenia was significantly lower than that of patients with affective disorders (P=0.049), but there was no significant difference in negative coping style of the two kinds of mental disorders (P=0.408).④Influencing of social support, general self-efficacy, coping style on the stigma:Correlation analysis showed that stigma had significant negative correlation with total score of social support, utilization of social support, general self-efficacy (P<0.05), stigma had positive correlation with negative coping style (P<0.01). Multiple linear stepwise regression showed, negative coping style was the significant influence factor to the stigma (P<0.05). The more negative coping style adopted by the patients, the more serious stigma the patient would perceive.(3) Quality of Life (QOL) and its influencing factors on the patients with mental disordersThere were no significant difference in the total scores of QOL and the scores of each dimension between patients with schizophrenia and affective disorders (P>0.05).Stepwise linear regression analysis revealed the following factors has significant influence on the QOL of patients with mental disorders:age, gender, place of residence, being work or not before hospitalization, marriage status, living with family or not before hospitalization, insight. Patient with younger age, female, living in city, not at work before hospitalization, separate from spouses, not living with the family before hospitalization, and with poor insight had higher total score of QOL, which means poor QOL. The influencing factors that influence the QOL of the patients with schizophrenia and affective disorders were different. As for the patients with schizophrenia who were female, separated from spouses had higher total score of QOL, namely had poor QOL. As for the patients with affective disorders, those with younger age, lower family income had higher total score of QOL, namely had poor QOL.Correlation analysis showed:Total score of QOL had significant positive correlation with score of perceived devaluation-discrimination dimension (P<0.01); had significant negative correlation with total score of social support, score of objective support, utilization of social support, general self-efficacy and positive coping style (P<0.01). Stepwise regression revealed that social support, general self-efficacy and negative coping style were significant influencing factors on patients’QOL (P<0.05). Patients with higher general self-efficacy, more social support would have lower total score of QOL, namely better QOL. Patients adopted more negative coping style, would have poor QOL.Conclusion:1. Study on public discrimination against patient with mental disorder and its influencing factors(1) Discrimination against patients with mental disorders by the public (relatives of psychiatric patients, nurses, and students) indeed existed. The degree of discrimination, and discrimination dimensions (isolation, dangerous, ability dimension) were different in different investigation objects.(2) Factors influence discrimination degree against patients with mental disorders were types of investigation objects, gender, age, educational background, participated in psychiatric/psychological lectures or not, degree of contact and life connection with the patients. The discrimination attitude of nurses and students was more serious than that of the relatives of the patients; male’s discrimination against patients with mental illness is less serious than females; the older of the patients’age, the more serious discrimination against the patients. Patients with higher level of education, having attended the psychiatric/psychological lectures, with higher degree of contact, and with close life connection to the patients, would have less discrimination against the patients with mental disorders.(3) Because the public’s discrimination against patients with mental disorders are popular, government should pay more attention to it, and effective intervention should be taken to reduce or eliminate the discrimination toward the patients, in order to reduce or eliminate the patients stigma, as the result to promote recovery of the patients. 2. Study on psychiatric patients’stigma, quality of life and its influencing factors(1)406patients with mental disorders had perceived stigma, but less serious than psychiatric patients in western countries. Schizophrenic patients’stigma was more serious than that of patients with affective disorders. The patients’social support, general self-efficacy, negative coping style were significantly lower than that of the national norm. Factors influence the psychiatric patients’stigma were age, living with the family or not, coping style, length of hospitalization time. Those with older age, not living with the family before hospitalization, adopted more negative coping styles would perceive more serious stigma; those with longer hospitalization time, would perceive less serious stigma. Further more, patients’stigma had significant negative correlation with social support and general self-efficacy. Factors influence schizophrenic patients’stigma:those who were female, married, not living with the family before hospitalization would have more serious stigma. As for the patients with affective disorder, no independent social demographic risk factors that influence the stigma were found.(2) Factors influence psychiatric patients’QOL were age, gender, being work or not before hospitalization, place of residence, marriage status, living with the family or not before hospitalization, insight, coping style, social support and general self efficacy. Psychiatric patients who were younger, female, not being work before hospitalization, living in city, divoice or died of the spouse or being separated from the spouses, not living with family before hospitalization, with worse insight, and adopted more negative coping styles would have poor QOL. Psychiatric patients with good social support, general self-efficacy would have better QOL.(3) Stigma had no significant influence on psychiatric patient’s QOL, but there was correlation between them. Score of perceived devaluation-discrimination dimension of the stigma scale had significant positive correlation with QOL of psychiatric patient. The higher score of perceived devaluation-discrimination dimension of stigma scale, the poor QOL the patient would have.(4) Because psychiatric patient had perceived stigma, and social demographic factors, clinical factors, social and psychological factors could influence patient’s perceived stigma, effective intervention should be taken to reduce patients’stigma, in order to promote their physiological, psychological, social aspects of recovery. |
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