The Relationship Between Stigma And Medication Adherence Of People With Schizophrenia

Many studies in western countries have approved that stigma and medication-induced stigma against people with schizophrenia were universal which will affect the medication adherence. However, the study of Xuhui, in China, found that the sense of shame with schizophrenia patients was not strong and the stigma was not the predictor of medication adherence.Objective:To describe the status of stigma and medication-induced stigma of people with schizophrenia and analyze the relationship between the stigma and medication adherence in China.Method:97 patients with schizophrenia recruited the study of Xuhui (sample 1) were surveyed by phone at 12 and 18 months after discharge and were classified as fully adherence, partial adherence and non-adherence on the basis of self-reported. Convenient sampling was used to recruit 125 inpatients who were getting well to discharge from a psychiatric hospital in Beijing (sample 2). Link Stigma Scales and Medication-induced Stigma Scale were administered to assess the stigma of sample 2 patients. The medication adherence of patients was surveyed by phone and the medication-induced sitgma was assessed again by mail at 1,3 and 6 months after discharge.Results:(1) Correlation analysis found that lower medication adherence was associated with the patients'feeling of understood by others (r=-0.253, P<0.05). Ordinal regression analysis showed that the medication adherence at 12 months after discharge was affected by patients'desire of secrecy and feeling of understood (R Square is 0.161). (2) The mean of the perceived devaluation-discrimination scale was 2.42±0.41, significantly lower than the 2.5 midpoint. The means of five coping dimensions-secrecy, withdrawal, education, challenging, and distancing were significantly higher than the midpoint, indicating that respondents endorsed these coping orientations with some regularity, and the most frequent way to cope with stigma was to challenge it (2.94±0.42). The majority of subjects felt that people were unable to understand their situation (2.77±0.44), but the sense of difference and ashamed was (2.30±0.47) significantly lower than the average 2.50. The means of medication-related stigma before discharge, at 1,3 and 6 month after discharge were 2.46±0.40,2.61±0.41,2.64±0.50, and 2.65±0.48. ANOVA analysis of repeated measures showed that four time point of medication-induced stigma were significantly different (F=13.12, P< 0.01). (3) Lower medication adherence was associated with higher medication-induced stigma (P< 0.01). "Patients' medication-induced stigma", "desire of challenge", and "perception of discrimination" were the influencing factors of medication adherence at 1 month after discharge (R Square:0.168). The predictor of adherence to antipsychotic drug therapy at 3 month after discharge was "medication-induced stigma at 1 month after discharge".Conclusion:Stigma and medication-induced stigma are ubiquitous among people with schizophrenia. Medication adherence of people with schizophrenia was predicted by patients' medication-induced stigma, desire of challenge and secrecy, perception of discrimination", and "feeling of understood by others" in this study……...