Relationship Between Illness Perceptions and Stigma in Patients With Schizophrenia in Community

Background:Despite the benefits of maintenance treatment with antipsychotic drugs for patients with schizophrenia, non-adherence impedes the treatment effect and results in reduced functioning and increased relapses, hospitalization, and healthcare costs. Nonadherence has been studied from biomedical and behavioral perspectives; however, patients’ subjective perceptions of their illnesses and treatments and their association with health outcomes have been increasingly highlighted for knowledge development (Kucukarslan, 2012). Illness perception has been supported its mediated effect on patients’ adherence to antipsychotics in Western studies (Rungruangsiripan, Sitthimongkol, Maneesriwongul, Talley, & Vorapongsathorn, 2011). Furthermore, stigma has been reported to have a negative impact on adherence (Vrbová et. al, 2014; Yilmaz & Okanli, 2015). Therefore, in this study, the relationship between illness perception and stigma were examined.

Purpose: This study aimed to investigate the relationships between the illness perception of patients with schizophrenia and their stigma.

Methods: A cross-sectional research design was used to examine the relationship between schizophrenia patients’ illness perception and stigma. The Institutional Review Board (IRB) of the hospital approved the study protocol and written informed consent was obtained from each participant. Based on the inclusion criteria, 240 patients with schizophrenia were purposively recruited into this study. Patients’ illness perception and perceived stigma were assessed with self-rated Illness Perception Questionnaires-Revised (IPQ-R) and Perceived Psychiatric Stigma Scale (PPSS). The data were analyzed by Pearson correlation and multiple regression.   

Results: Most patients were male, unmarried, unemployed, graduated from junior high school with 9 educational years, and onset during adulthood. Their mean age was 47.07±11.88 and mean illness years was 19.14±12.02. There were significant positive relationship between IPQR-identity, timeline, consequence, timeline cyclical, emotional representation, and stigma; while illness coherence was negatively associated with stigma. The results indicated that patients’ IPQR could significantly predict their sigma. Regarding to illness perception, consequence and emotional representation could positively predict sigma.   

Conclusion: The results provided empirical knowledge about illness perceptions and stigma in patients with schizophrenia, which could equip professionals with the their subjective interpretations and concerns about their illness and treatments in terms of how to assist them to decide in favor of treatments preference and to develop sensitive interventions to increase that adherence. Future research is suggested to further examine the relationships among treatment adherence, illness perception, and stigma to understand the influence of patients’ subjective perception concerning about their illness on adherent behaviors.