Abstracting and Indexing

  • Google Scholar
  • CrossRef
  • WorldCat
  • ResearchGate
  • Academic Keys
  • DRJI
  • Microsoft Academic
  • Academia.edu
  • OpenAIRE

Self-Esteem Prevalence Amongst Acute Psychiatric Inpatients; Socio-Demographic Correlates and Association with Internalized Stigma and User Satisfaction

Article Information

Frias VM1, García-Estela A2, Colom F3*, Fortuny JR4, Bulbena A5, Perez-Sola V6

1Víctor-Manuel Frías; Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar/ IMIM/ CIBERSAM/ Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain

2Aitana García-Estela; IMIM, Barcelona, Spain

3Francesc Colom; Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar/ IMIM/ CIBERSAM/ Department of Health & Clinical Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain

4Joan-Ramon Fortuny; Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar, Barcelona, Spain

5Antoni Bulbena; Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar/ IMIM/ CIBERSAM/ Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain

6Víctor Pérez-Sola; Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar/ IMIM/ CIBERSAM/ Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain

*Corresponding Author: Francesc Colom, Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar/ IMIM/ CIBERSAM/ Department of Health & Clinical Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain

Received: 07 November 2019; Accepted: 21 November 2019; Published: 27 November 2019

Citation: Frias VM, García-Estela A, Colom F, Fortuny JR, Bulbena A, Perez-Sola V. Self-Esteem Prevalence Amongst Acute Psychiatric Inpatients; Socio-Demographic Correlates and Association with Internalized Stigma and User Satisfaction. Journal of Psychiatry and Psychiatric Disorders 3 (2019): 262-273.

View / Download Pdf Share at Facebook

Abstract

Objective: A field research on the prevalence of self-esteem among discharged patients from acute mental health wards was performed, including its socio-demographic correlates and the association with internalized stigma and user satisfaction.

Method: Discharged patients from psychiatric acute units were recruited (N=311). Participants were asked to complete questionnaires including the Rosenberg Self-Esteem Scale (RSES), the Internalized Stigma of Mental Illness (ISMI) scale and the Satispsy-22-E.

Results: Length of stay over 30 days (OR=0.422, p<0.01), voluntary admission (OR=0.295, p<0.0001), diagnosis of bipolar disorder (OR=3.926, p<0.01) and diagnosis of schizophrenia (OR=2.333, p-value<0.05) were significantly associated to preserved self-esteem. Subjects with higher self-esteem reported lower internalised stigma.

Conclusion: The combination of stigma and low self-esteem usually leads to a lack of illness insight and, consequently, to a poorer psychological and pharmacological treatment adherence. Therefore, these factors might lead to worse outcomes. Stigma and self-esteem should be targeted as early goals when developing treatment plan regardless the patient’s diagnosis.

Keywords

Self-esteem; Inpatients; Mental health; Stigma; User satisfaction

Self-esteem articles, Inpatients articles, Mental health articles, Stigma articles, User satisfaction articles

Article Details

1. Introduction

Over the last few years, self-esteem has been suggested as a variable that may explain some behaviours regarding major public health issues including non-suicidal self-injury [1] and suicidal ideation [2, 3]. Low self-esteem is of considerable interest, not only as a possible consequence of stigmatization and internalized stigma [4] but also, according to some authors, as a potential cause of psychiatric symptoms [5]. Low self-esteem and depression seem to be strongly related, however the causal direction of this relationship –if any- has not been demonstrated yet [6]. Low self-esteem has been also related to eating disorders and substance abuse [7]. In addition, it has been involved in psychotic disorders both in the development of delusions [8] and the maintenance of psychotic symptoms.

Low self-esteem has been associated with suicide risk in population with schizophrenia. In particular, low self-esteem was significantly associated with the existence of previous suicide attempts, even after controlling for depression and perceived stigma [9]. On the other hand, significantly higher self-esteem has been positively related to age, educational achievement and income.

Female patients had a significantly lower self-esteem compared to male patients [10]. Interestingly, the literature on non-affected population does not strongly support this finding; women show more or less (or equal) self-esteem than men depending on the self-esteem domain [11]. Finally, self-esteem acts as a protective factor and, at the same time, can be influenced by different factors involved in mental illnesses. Discharge from acute inpatient mental health settings usually constitutes a significant moment in the patient's recovery and little is known about the self-esteem levels of these discharged patients. Hereby, we present a field study on the prevalence of self-esteem among discharged patients from acute mental health wards, its socio-demographic correlates and association with internalized stigma and user satisfaction.

2. Material and Methods

2.1 Study design and participants

The present study was carried out in the inpatient psychiatric unit of the Institute of Neuropsychiatry and Addictions (INAD) of Parc de Salut Mar. The INAD provides psychiatric services to a catchment area of almost 600,000 adult people. The sample of the current study was obtained from several wards of INAD’s trust between May and October 2016. The final sample consisted of 311 discharged patients (N=311). Sample characteristics are shown in Table 1. Patients were invited to enter the study by the treating staff and signed informed consent was obtained from all participants. Scales were administered by the nursing staff. The study was approved by the Ethics Committee of Clinical Research of the Parc de Salut Mar (2015/6531/l).

2.2 Measures and instruments

Socio-demographic and clinical data were obtained from medical records. Self-esteem was assessed by means of the Rosenberg Self- Esteem Scale (RSES) [12]. This is a 10-item self-report instrument that is answered using a 4-pointsLikert scale format ranging from strongly agree to strongly disagree. The validated Spanish version of the RSES was used for this study [13].

Internalized stigma and stigma resistance were measured by means of the Internalized Stigma of Mental Illness Scale (ISMI), which is a 29-item scale that assesses self-stigma across 5 subscales: alienation, stereotype endorsement, perceived discrimination, social withdrawal and stigma resistance. All items are answered using a 4-points Likert scale format ranging from strongly disagree to strongly agree. The ISMI produces a resulting score for each subscale, as well as a total score. Research has suggested that the Stigma Resistance subscale is conceptually different to the other subscales. For this reason, stigma resistance (SR) is considered as a separate construct to self-stigma [14, 15].

Patient satisfaction was assessed using the Satispsy-22-E questionnaire. It is a specific and self-administered scale based on the psychiatric patients’ perspective and provides a multidimensional profile in relation to satisfaction during hospitalization. It contains 22 items describing 6 dimensions related to hospitalization: satisfaction with the staff, quality of care, personal experience, information, activity and food. Satispsy-22 also includes a total index score. Both the different dimensions and the total index scores range from 0 to 100 [16]. The Spanish version used in this study was validated by Frías et al. [17].

2.3 Statistical analysis

Descriptive statistics of the sample included frequencies and percentages of categorical variables, means and standard deviations of continuous variables. In addition, self-esteem was transformed into a dichotomous variable according to its mean scores: 0 for mean scores equal or lower than 25 (low level), and 1 for mean scores higher than 25 (high-mid level). Descriptive analyses were conducted to study the sample characteristics. Pearson’s correlation coefficients were used to describe relationships between self-esteem and internalized stigma (and its subscales), as well as stigma resistance and hospitalized patient’ satisfaction (and its subscales). This was followed by an analysis of variance (ANOVA) to compare means and detect differences between internalized stigma, stigma resistance and hospitalized patient’ satisfaction, and the two self-esteem levels: high-mid and low. With the aim of establishing variables associated with self-esteem, our dependent variable, logistic regression models were applied to the following independent variables: (1) ISMI and (2) its four subscales; (3) Stigma resistance; (4) Satispsy-22-E and (5) the six subscales of Satispsy-22-E. For all the analyses, the level of statistical significance was defined as a less than 0.05. Data analyses were performed using the R statistical software.

3. Results

3.1. Socio-demographic and clinical characteristics

Socio-demographic and clinical features of the study sample are reported in Table 1. Participants had a mean age of 45 years and 45% were women. All patients were Caucasian. The percentage of voluntary admissions for inpatient treatment was 42.7 and 61.4% were readmissions. According to length of hospitalization, 28.2% of patients stayed longer than 30 days. As for diagnoses, 30.8% presented with schizophrenia spectrum disorders and 23.4% with bipolar disorder. The prevalence of low self-esteem was 24.4%.

Variable

 n

%

self-esteem

N (%)

     

High-mid

Low

Overall

311

 

235 (75.56)

76 (24.44)

Gender

Male

171

55

137 (80.12%)

34 (19.88%)

Female

140

45

98 (70%)

42 (30%)

Age Mean (SD)

311

 

45.47 (14.78)

44.63 (14.31)

Marital Status

Married

59

19

41 (69.49%)

18 (30.51%)

Not Married

252

81

194 (76.98%)

58 (23.02%)

Education Level

Basic

199

64

152 (76.38%)

47 (23.62%)

Secondary/University

112

36

83 (74.11%)

29 (25.89%)

Economic Income

Yes (employed/pensioner)

203

65

156 (76.85%)

47 (23.15%)

No (unemployed)

108

35

79 (73.15%)

29 (26.85%)

Diagnosisa

Bipolar Disorder

73

23

64 (87.67%)

9 (12.33%)

Depression

40

13

21 (52.5%)

19 (47.5%)

Schizophrenia

96

31

76 (79.17%)

20 (20.83%)

Other non-organic Psychosis

38

12

30 (78.95%)

8 (21.05%)

Other Diagnosisb

64

21

44 (68.75%)

20 (31.25%)

Drug Abuse

Yes

143

46

112 (78.32%)

31 (21.68%)

No

168

54

123 (73.21%)

45 (26.79%)

Readmission

Yes

191

61

137 (71.73%)

54 (28.27%)

No

120

39

98 (81.67%)

22 (18.33%)

Type of Admission

Voluntary

133

43

81 (60.9%)

52 (39.1%)

Involuntary

178

57

154 (86.52%)

24 (13.48%)

Length of Stay

<30 days

223

72

180 (80.72%)

43 (19.28%)

≥30 days

88

28

55 (62.5%)

33 (37.5%)

aPsychiatric diagnosis defined by the International Classification of Diseases (ICD-9); bPersonality disorder, Anxiety, Drug dependence, Nondependent abuse, Adjustment reaction, Disturbance of conduct.

Table 1: Socio-demographic and clinical characteristics by level of self-esteem.

3.2. Correlates of self esteem

Logistic regression analysis of socio-demographic and clinical features revealed that gender (female), age, length of stay (≥30 days), diagnosis (bipolar disorder and schizophrenia) and type of admission (voluntary), were significantly associated to self-esteem (Table 2).

95% Conficence Interval(CI)

Odds Ratio

Lower CI

Upper CI

P-value

Woman

0,523

0,279

0,981

0,043*

Age

1,029

1,004

1,055

0,021*

Length of Stay (≥30)

0,422

0,226

0,788

0,007*

Educational Level (Secondary/University)

0,890

0,479

1,654

0,713

Economic Income (No)

0,710

0,369

1,365

0,305

Not Married

1,350

0,624

2,921

0,446

Readmission (Yes)

0,514

0,263

1,001

0,050

Bipolar Disorder

3,926

1,494

10,315

0,006*

Depressive Disorder

0,804

0,311

2,076

0,652

Schizophrenia

2,333

1,022

5,326

0,044*

Other non-organic psychosis

1,519

0,539

4,282

0,430

Drug Abuse

1,000

0,521

1,920

1,000

Voluntary Admission

0,295

0,154

0,564

0,000**

Constant

2,451

0,494

12,151

0,273

* <0.05; **<0.001

Table 2: Socio-demographic and clinical correlates of self-esteem.

3.3. Correlation of self-esteem with internalised stigma, stigma resistance and inpatients satisfaction

As presented in the results of correlation analysis (Table 3), self-esteem was negatively correlated with internalised stigma and all four subscales of ISMI. Also, self-esteem was positively correlated with stigma resistance. The satispsy-22-E scale does not correlate with self-esteem.

Scales/dimensions

RSES

Alienation

Stereotype Endorsement

Discrimination Experience

Social Withdrawal

ISMI Total score

Stigma_resistance

ISMI

             

Alienation

-0.69 **

           

Stereotype endorsement

-0.568 **

 0.653 **

         

Discrimination experience

-0.423 **

 0.602 **

0.563 **

       

Social withdrawal

-0.556 **

 0.734 **

0.682 **

0.633 **

     

ISMI Total score

-0.663 **

 0.888 **

0.846 **

0.795 **

0.894 **

   

Stigma Resistance

 0.438 **

-0.328 **

-0.46 **

-0.153 *

-0.315 **

-0.373 **

 

Satispsy-22-E Total score

-0.036

0.048

0.008

 -0.142 *

0.057

0.002

0.017

* <0.05

             

**<0.001

             

RSES: Rosemberg self-Esteem Scale.

           

Alienation, Stereotype Endorsement, Discrimination Experience, Social Withdrawal and Stigma resistance are subscales of the ISMI.

   

ISMI was calculated using the following subscales: Alienation, Stereotype Endorsement, Discrimination Experience and Social Withdrawal.

 

Table 3: Correlations between self-esteem, internalized stigma, stigma resistance and satisfaction.

3.4. Anova of internalised stigma, stigma resistance and hospitalisation satisfaction by self-esteem

The mean scores of internalised stigma and all subscales were significantly different between participants with low and high self-esteem. Results showed that those with high self-esteem reported lower internalised stigma, while patients with low self-esteem reported higher scores (Table 4).

Variable

Self-esteem

High-Mid*

Low**

F

P

ISMI

       

Alienation

1.797(0.545)

2.682(0.627)

2038.64

<0.01

Stereotype Endorsement_

1.611(0.427)

2.056(0.564)

2164.44

<0.01

Discrimination_Experience_

1.997(0.557)

2.418(0.587)

2168.57

<0.01

Social_Withdrawal_

1.842(0.554)

2.401(0.579)

1965.7

<0.01

Total_Score_without_Stigma_Resistance

1.796(0.435)

2.374(0.473)

2999.56

<0.01

Stigma_Resistance

2.99(0.569)

2.658(0.594)

3990.34

<0.01

SATISPSY-22-E

     

Staff

87.28(13.973)

86.264(20.067)

4140.56

<0.01

Qualiy of care

82.635(16.322)

80(19.685)

30.48.96

<0.01

Personal experience

50.216(26.759)

48.942(27.898)

456.62

<0.01

Information

69.951(27.177)

65.769(29.338)

829.74

<0.01

Activity

57.574(35.001)

62.308(30.014)

488.73

<0.01

Food

73.768(24.969)

72.115(26.587)

1120.92

<0.01

Total Score

70.237(14.867)

69.233(18.09)

2662.39

<0.01

* self-esteem high-mid >25 RSES; **self-esteem low <=25 RSES

Table 4: Score of interalised stigma, stigma resistance and hospitalization satisfaction [mean (SD)] by level of self-esteem.

3.5 Internalised stigma, stigma resistance and hospitalization satisfaction as predictors of self-esteem

Separate logistic regression revealed that while ISMI total score and Alienation were negatively associated with self-esteem, stigma resistance was positively associated (Table 5).

Odds Ratio

Lower CI (95%)

Upper CI(95%)

P-Value

AIC

ISMI

         

Alienation

0.084

0.036

0.183

<0.001

249.547

Stereotype Endorsement

0.646

0.256

1.581

0.346

 

Discrimination Experience

1.212

0.575

2.636

0.618

 

Social Withdrawal

1.165

0.492

2.803

0.73

 

Total Score without Stigma Resistance

0.061

0.027

0.123

<0.001

269.086

Stigma Resistance

2.612

1.667

4.177

<0.001

331.84

SATISPSY-22-E

       

Staff

0.997

0.974

1.02

0.821

305.39

Quality of care

1.011

0.99

1.032

0.298

 

Personal experience

1.003

0.991

1.015

0.648

 

Information

1.006

0.995

1.017

0.262

 

Activity

0.989

0.978

1

0.059

 

Food

1.004

0.991

1.016

0.558

 

Total Score

1.004

0.986

1.022

0.653

300.735

Table 5: Associations between self-esteem and internalised stigma, stigma resistance and hospitalization satisfaction.

5. Discussion

The socio-demographic characteristics show women are less likely to have high or mid self-esteem levels. Gender patterns are often reported in self-esteem studies. However, the evidence for an inner-relationship between female gender and low self-esteem in the general population is weak, and most of the existing articles point to gender differences in some self-esteem domains, in all possible directions, rather than a strong and direct association between poor self-esteem and female gender. Interestingly, morale and ethics self-esteem-related domains are higher amongst women [11]. Those domains could be more likely to change with the appraisal of a mental condition and, of course, with the occurrence of a psychiatric admission. Interestingly enough, women suffering from psychotic disorders reported a high prevalence of sexual trauma [18] which is known as a risk factor for low self-esteem. Actually, the sense of this association has led to several speculations, with some groups defending than (pre)psychotic women may constitute a sort of propitiatory victim [19] and others that sexual trauma leads to or worsens psychosis [20, 21].

We found out that bipolar and schizophrenic patients were more likely to have self-esteem completely preserved. This outcome in a population with bipolar disorder is consistent with other studies reporting higher self-esteem in bipolar patients compared to other conditions [22]. Several studies pointed out distinctive features of self-esteem during the course of remission in bipolar disorder: continuous mood and perception shifting include fluctuations in self-esteem [23, 24]. However, other studies suggest that despite self-esteem fluctuates in patients with bipolar disorder or remitting bipolar disorder, who seem to have higher self-esteem, it tends to be low overall [25].

Different studies have been published about the relation between psychotic symptoms and self-esteem, showing a relatively strong association between self-esteem and self-stigma in people with schizophrenia. Moreover, it has been suggested that premorbid functioning is an important aspect in the development of self-esteem.

Some authors have reported an association of lower self-esteem in schizophrenic subjects with poor evolution signs including increased negative symptoms and attention problems [26]. Interestingly, this would nicely fit with our finding of a higher self-esteem associated to recovery signs in schizophrenia. Future studies should consider examining its fluctuations across the course of illness.

In our sample, self-esteem was negatively correlated with internalized stigma and all of its subscales. This is in line with recent studies reporting that, in fact, self-esteem is significantly and negatively associated with internalized stigma amongst psychiatric outpatients [27]. Yanos et al. (2008) described how internalized stigma reduced sense of hope and self-esteem, which in turn resulted in negative outcomes related to recovery including social avoidance, depressive symptoms and a preference for using avoidant coping style. Stigma and low self-esteem might be on the origins of lack of self-awareness and lack of illness insight-. This presentation may enhance treatment adherence problems [28]). Stigma and self-esteem should become therapeutic goals in every integrative prophylactic intervention [27-29].

Our findings from logistic regression analyses revealed that only internalized stigma and alienation were significantly associated with self-esteem; participants with high internalized stigma or alienation were less likely to develop high-mid self-esteem respectively. The strong association between the alienation subscale and self-esteem is not surprising and confirms that this aspect of self-stigma is the strongest predictor of self-esteem as suggested in previous studies [30, 31]. This could support theories about self-esteem pointing at the importance of interpersonal appraisals in the value of self [32]. The feeling of alienation can be increased by other factors like admission to restrictive wards.

Self-esteem was positively correlated with stigma resistance, which is higher in individuals with high-mid self-esteem than in those with low self-esteem. Some people with mental illness who internalize stereotypes, negative beliefs of dangerousness, prejudice and discrimination suffer from significant self-esteem and self-efficacy slumps, which may undermine goal pursuit related to aspects of living independently, such as employment [33]. On the other hand, it seems that those people who developed skills to fight against self-stigma and increase self-esteem may become, somehow, resilient to stigma [34], which would be in line with results from previous studies.

This is a study focussing a major interest subject, caring for the final client subjective feelings about him /herself and collecting quite a significant sample. However, the present study shows a number of limitations that should be taken into consideration. Firstly, all participants were inpatients and their level of self-esteem is likely to differ from outpatients’ due to the different severity of mental illness. Furthermore, it is important to acknowledge the heterogeneity of the current sample which comprised participants with different diagnoses. On the other hand, low self-esteem could be some by-product of symptoms, so it’s needed to clarify its variation or stability along the illness evolution. Experience sampling method might be a way of investigating whether self-esteem precedes symptoms or symptoms are preceded by self-esteem, especially since many studies suggest that self-esteem fluctuates on a daily basis in response to negative and positive events [35].

We did not collect non-suicidal self-injuries. Safety procedures of psychiatric wards are, of course, designed to avoid users harming themselves or others so it makes little sense to try collecting such an uncommon event. However, non-suicidal self-injuries are related to low self-esteem in both clinical and non-clinical populations [1], so they constitute an excellent predictive hint that we could not validate in our study. Finally, since our study was conducted in a clinic setting, all participants were already seeking treatment for their mental illness when the recruitment took place, so it is possible the self-esteem levels reported have not reflected the actual levels of people with mental conditions.

5. Conclusions

The combination of stigma and low self-esteem usually leads to a lack of illness insight and, consequently, to a poorer psychological and pharmacological treatment adherence. Therefore, these factors might lead to worse outcomes. Stigma and self-esteem should be targeted as early goals when developing treatment plan regardless the patient’s diagnosis.

More research targeting the subjective feelings, emotions and uncovered needs of the mental health final client should be performed, as this is the only way to build a more human an ethic health provision.

Acknowledgement

Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement de la Generalitat de Catalunya GOVERNMENT OF CATALONIA (2017_SGR_134). This research is supported by the Quality Program of Parc de Salut Mar, Barcelona, Spain

Conflicts of Interest

The authors declare that have no competing interest with respect to the authorship and/or publication of this article.

References

  1. Forrester RL, Slater H, Jomar K, et al. Self-esteem and non-suicidal self-injury in adulthood: A systematic review. J Affect Disord 221 (2017): 172-183.
  2. Huang L-B, Tsai Y-F, Liu C-Y et al. Influencing and protective factors of suicidal ideation among older adults. Int J Ment Health Nurs 26 (2017): 191-219.
  3. Carpiniello B, Pinna F. The reciprocal relationship between suicidality and stigma. Front Psychiatry 8 (2017): 1-9.
  4. Lysaker PH, Yanos PT, Outcalt J, et al. Association of stigma, self-esteem, and symptoms with concurrent and prospective assessment of social anxiety in schizophrenia. Clin Schizophr Relat Psychoses 4 (2010): 41-48.
  5. Karatzias T, Gumley A, Power K, et al. Illness appraisals and self-esteem as correlates of anxiety and affective comorbid disorders in schizophrenia. Compr Psychiatry 48 (2007): 371-375.
  6. Sowislo JF, Orth U. Does Low Self-Esteem Predict Depression and Anxiety? A Meta-Analysis of Longitudinal Studies. Psychol Bull 139 (2013): 213-240.
  7. Silverstone PH, Salsali M. Low self-esteem and psychiatric patients: Part I – The relationship between low self-esteem and psychiatric diagnosis. Ann Gen Hosp Psychiatry 2 (2003): 2.
  8. Barrowclough C, Tarrier N, Humphreys L, et al. Self-esteem in schizophrenia: Relationships between self-evaluation, family attitudes, and symptomatology. J Abnorm Psychol 112 (2003): 92-99.
  9. Yoo T, Kim S, Kim S, et al. Relationship between Suicidality and Low Self-esteem in Patients with Schizophrenia. Front Hum Neurosci 13 (2015): 296-301.
  10. Salsali M, Silverstone PH. Low self-esteem and psychiatric patients: Part II – The relationship between self-esteem and demographic factors and psychosocial stressors in psychiatric patients. Ann Gen Hosp Psychiatry 2 (2003): 3.
  11. Gentile B, Grabe SJ, Dolan-Pascoe B, et al. Gender Differences in Domain-Specific Self-Esteem: A Meta-Analysis. Vol. 13, Review of General Psychology 13 (2009): 34-45.
  12. Rosenberg M. Society and the Adolescent Self-Image. Princenton University Press. New Jersey, USA (1965).
  13. Vázquez Morejón AJ, Vázquez-Morejón Jiménez R, Bellido Zanin G. Fiabilidad y validez de la Escala de Autoestima de Rosenberg (EAR) en pacientes con diagnóstico de psicosis. Apunt Psicol 31 (2013): 37-43.
  14. Brohan E, Gauci D, Sartorius N, et al. Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: the GAMIAN-Europe study. J Affect Disord 129 (2011): 56-63.
  15. Boyd JE, Adler EP, Otilingam PG, et al. Internalized Stigma of Mental Illness (ISMI) Scale: A multinational review. Compr Psychiatry 55 (2014): 221-231.
  16. Zendjidjian XY, Auquier P, Lançon C, et al. The SATISPSY-22: Development and validation of a French hospitalized patients’ satisfaction questionnaire in psychiatry. Eur Psychiatry 30 (2015) (1): 172-178.
  17. Frias VM, Colom F, Bulbena A, et al. Spanish translation and analysis of the metric properties of inpatient satisfaction scale in psychiatry: The Satispsy-22-E. Psychiatry Res 268 (2018): 8-14.
  18. Goodman LA, Rosenberg SD, Mueser KT, et al. Physical and sexual assault history in women with serious mental illness: prevalence, correlates, treatment, and future research directions. Schizophr Bull 23 (1997): 685-696.
  19. Haahr UH, Larsen TK, Simonsen E, et al. Relation between premorbid adjustment, duration of untreated psychosis and close interpersonal trauma in first-episode psychosis. Early Interv Psychiatry 12 (2018): 316-323.
  20. Rossler W, Ajdacic-Gross V, Rodgers S, et al. Childhood trauma as a risk factor for the onset of subclinical psychotic experiences: Exploring the mediating effect of stress sensitivity in a cross-sectional epidemiological community study. Schizophr Res 172 (2016): 46-53.
  21. Comacchio C, Howard LM, Bonetto C, et al. The impact of gender and childhood abuse on age of psychosis onset, psychopathology and needs for care in psychosis patients. Schizophr Res 210 (2019): 164-171.
  22. Pardoen D, Bauwens F, Tracy A, et al. Self-esteem in recovered bipolar and unipolar outpatients. Br J Psychiatry 163 (1993): 755-762.
  23. Knowles R, Tai S, Jones SH, et al. Stability of self-esteem in bipolar disorder: comparisons among remitted bipolar patients, remitted unipolar patients and healthy controls. Bipolar Disord 9 (2007): 490-495.
  24. Nowakowska C, Strong CM, Santosa CM, et al. Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls. J Affect Disord 85 (2005): 207-215.
  25. Nilsson KK, Jorgensen CR, Craig TKJ, et al. Self-esteem in remitted bipolar disorder patients: a meta-analysis. Bipolar Disord 12 (2010): 585-592.
  26. Lysaker PH, Vohs JL, Tsai J. Negative symptoms and concordant impairments in attention in schizophrenia: associations with social functioning, hope, self-esteem and internalized stigma. Schizophr Res 110 (2009): 165-172.
  27. Picco L, Pang S, Lau YW, et al. Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem. Psychiatry Res 246 (2016): 500-506.
  28. Adewuya AO, Owoeye OA, Erinfolami AR, et al. Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria. Gen Hosp Psychiatry 31 (2009): 167-174.
  29. Yanos PT, Roe D, Markus K, et al. Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatr Serv 59 (2008): 1437-1442.
  30. Ritsher JB, Phelan JC. Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res 129 (2004): 257-265.
  31. Werner P, Aviv A, Barak Y. Self-stigma, self-esteem and age in persons with schizophrenia. Int psychogeriatrics. 20 (2008): 174-187.
  32. Leary MR, Gallagher B, Fors E, et al. The Invalidity of disclaimers about the effects of social feedback on self-esteem. Pers Soc Psychol Bull 29 (2003): 623-636.
  33. Corrigan PW, Kosyluk KA, Rüsch N. Reducing self-stigma by coming out proud. Am J Public Health 103 (2013): 794-800.
  34. Van Zels C, Van Nierop M, Oorschot M, et al. Stereotype awareness, self-esteem and psychopathology in people with psychosis. PLoS One 9 (2014): 1-6.
  35. Greenier KD, Kernis MH, McNamara CW, et al. Individual differences in reactivity to daily events: examining the roles of stability and level of self-esteem. J Pers 67 (1999): 185-208.

    Editor In Chief

    Michael Maes

  • Molecular Biology and Neuroscience
    Deakin University
    Victoria, Australia

© 2016-2021, Copyrights Fortune Journals. All Rights Reserved!