Login Register Cart 0
Generic placeholder image

Current Psychiatry Research and Reviews

Editor-in-Chief

ISSN (Print): 2666-0822
ISSN (Online): 2666-0830

Back
Journal Home About Journal Editorial Board Current Issue Volumes/Issues
Subscribe
Cross-Sectional Study

The Association Between Internalized Stigma and Feelings of Loneliness and Quality of Life in Patients with Mental Disorders

Author(s): Mohammad Akhoondi, Efat Sadeghian*, Erfan Aubi and Farshid Shamsaei

Volume 21, Issue 2, 2025

Published on: 29 January, 2024

Page: [200 - 214] Pages: 15

DOI: 10.2174/0126660822283482231205111717

Price: $65

Abstract

Background: Individuals with mental disorders are subject to stigma from society. Some patients accept and internalize this stigma, while others suffer from loneliness and reduced quality of life.

Objective: This study aimed to investigate the relationship between internalized stigma, feelings of loneliness, and quality of life in patients with mental disorders.

Methods: In 2023, a descriptive study was conducted on 250 patients with psychological disorders who were referred to Sina Hospital (Farshchian) in Hamadan. The patients were selected using a convenience sampling method. Data were collected through face-to-face interviews using four questionnaires: demographic information, the internalized stigma of mental illness, Russell's loneliness scale, and the World Health Organization's 26-item quality of life questionnaire. The data were analyzed using descriptive and inferential statistical tests in SPSS-22 software.

Results: There was a significant positive correlation between internal stigma and loneliness (p < 0.001, r = 0.817) and a significant negative correlation between internal stigma and quality of life (p < 0.001, r = -0.777). Additionally, loneliness and quality of life had a significant negative correlation (p < 0.001, r = -0.838).

Conclusion: The results generally indicate that approximately half of the patients with internalized stigma experience moderate to severe distress. As internalized stigma increases, patients are more likely to experience feelings of loneliness and decrease their quality of life. Therefore, it is recommended that measures be taken to reduce internalized stigma in patients with psychiatric disorders to alleviate feelings of loneliness and improve their quality of life.

Keywords: Internalized stigma, feeling alone, quality of life, mental disorder, feelings of loneliness, severe distress.

« Previous
Graphical Abstract

[1]
Charlson, F.; van Ommeren, M.; Flaxman, A.; Cornett, J.; Whiteford, H.; Saxena, S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet, 2019, 394(10194), 240-248.
[http://dx.doi.org/10.1016/S0140-6736(19)30934-1] [PMID: 31200992]
[2]
Bodeker, G. Mental welness in asia asian development bank: Mandaluyong City; Metro Manila: Philippines, 2020.
[3]
Taheri Mirghaed, M.; Abolghasem Gorji, H.; Panahi, S. Prevalence of psychiatric disorders in Iran: a systematic review and meta-analysis. Int. J. Prev. Med., 2020, 11, 21.
[PMID: 32175061]
[4]
Høegh MC, Melle I, Aminoff SR, et al. Affective lability and social functioning in severe mental disorders. Eur Arch Psychiatry Clin Neurosci, 2022, 272(5), 873-885.
[http://dx.doi.org/10.1007/s00406-022-01380-1] [PMID: 35084540 ]
[5]
Bosc, M. Assessment of social functioning in depression. Compr. Psychiatry, 2000, 41(1), 63-69.
[http://dx.doi.org/10.1016/S0010-440X(00)90133-0] [PMID: 10646621]
[6]
Maddineshat, M.; Cheraghi, F.; Ghaleiha, A.; Khalafbeigi, M.; Sadeghian, E. Exploring the return-to-work process in working people with serious mental illness. Arch. Psychiatr. Nurs., 2022, 38, 21-28.
[http://dx.doi.org/10.1016/j.apnu.2021.12.007] [PMID: 35461643]
[7]
Maddineshat, M.; Cheraghi, F.; Ghaleiha, A.; Khalafbeigi, M.; Sadeghian, E. Identifying return to work perception in people with serious mental illness: A qualitative study. J. Psychosoc. Nurs. Ment. Health Serv., 2022, 60(4), 11-20.
[http://dx.doi.org/10.3928/02793695-20211014-02] [PMID: 34677119]
[8]
Walker, H.K.; Hall, W.D.; Hurst, J.W. Clinical methods: The history, physical, and laboratory examinations, 3rd Ed; Butterworths: Boston, 1990.
[9]
Commey, I.T.; Ninnoni, J.P.K.; Asamoah Ampofo, E.; Miezah, D. Living with Schizophrenia: the role of interpersonal relationships. Discover Psychology, 2023, 3(1), 13.
[http://dx.doi.org/10.1007/s44202-023-00071-9]
[10]
Yanos, P.T.; West, M.L.; Gonzales, L.; Smith, S.M.; Roe, D.; Lysaker, P.H. Change in internalized stigma and social functioning among persons diagnosed with severe mental illness. Psychiatry Res., 2012, 200(2-3), 1032-1034.
[http://dx.doi.org/10.1016/j.psychres.2012.06.017] [PMID: 22763091]
[11]
Johnstone, M.J. Stigma, social justice and the rights of the mentally ill: Challenging the status quo. Aust. N. Z. J. Ment. Health Nurs., 2001, 10(4), 200-209.
[http://dx.doi.org/10.1046/j.1440-0979.2001.00212.x] [PMID: 11703270]
[12]
Ran, M.S.; Zhang, T.M.; Wong, I.Y.L. Internalized stigma in people with severe mental illness in rural China. Int. J. Soc. Psychiatry, 2018, 64(1), 9-16.
[http://dx.doi.org/10.1177/0020764017743999] [PMID: 29183250]
[13]
Phelan, J.E.; Basow, S.A. College students’ attitudes toward mental illness: An examination of the stigma process 1. J. Appl. Soc. Psychol., 2007, 37(12), 2877-2902.
[http://dx.doi.org/10.1111/j.1559-1816.2007.00286.x]
[14]
Çam, O.; Çuhadar, D. Ruhsal bozukluğu olan bireylerde içselleştirilmiş damgalanma. Anadolu Psikiyatri Derg., 2009, 10, 84-85.
[15]
Snyder, M. Changing the Tide. NASN Sch Nurse, 2015, 30(2), 130-132.
[http://dx.doi.org/10.1177/1942602X14553307] [PMID: 25816446]
[16]
Corrigan, P.W.; Larson, J.; Rüsch, N. Self‐stigma and the “why try” effect: impact on life goals and evidence‐based practices. World Psychiatry, 2009, 8(2), 75-81.
[http://dx.doi.org/10.1002/j.2051-5545.2009.tb00218.x] [PMID: 19516923]
[17]
Subu, M.A.; Wati, D.F.; Netrida, N. Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis. Int. J. Ment. Health Syst., 2021, 15(1), 77.
[http://dx.doi.org/10.1186/s13033-021-00502-x] [PMID: 34663399]
[18]
Thornicroft, G.; Brohan, E.; Rose, D.; Sartorius, N.; Leese, M. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet, 2009, 373(9661), 408-415.
[http://dx.doi.org/10.1016/S0140-6736(08)61817-6] [PMID: 19162314]
[19]
Gyamfi, S.; Hegadoren, K.; Park, T. Individual factors that influence experiences and perceptions of stigma and discrimination towards people with mental illness in Ghana. Int. J. Ment. Health Nurs., 2018, 27(1), 368-377.
[http://dx.doi.org/10.1111/inm.12331] [PMID: 28345310]
[20]
Fırat, M.; Gökmen, B.D.; Cengiz, M. Investigation of the relationship between internalized stigmatization and social loneliness in psychiatric inpatients. J. Psychiatr. Nurs., 2020, 11(4), 268-274.
[21]
Prizeman, K.; Weinstein, N.; McCabe, C. Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms. BMC Psychiatry, 2023, 23(1), 527.
[http://dx.doi.org/10.1186/s12888-023-04991-7] [PMID: 37479975]
[22]
Mushtaq, R.; Shoib, S.; Shah, T.; Mushtaq, S. Relationship between loneliness, psychiatric disorders and physical health? A review on the psychological aspects of loneliness. J. Clin. Diagn. Res., 2014, 8(9), WE01-WE04.
[http://dx.doi.org/10.7860/JCDR/2014/10077.4828] [PMID: 25386507]
[23]
Lim, M.H.; Gleeson, J.F.M.; Alvarez-Jimenez, M.; Penn, D.L. Loneliness in psychosis: a systematic review. Soc. Psychiatry Psychiatr. Epidemiol., 2018, 53(3), 221-238.
[http://dx.doi.org/10.1007/s00127-018-1482-5] [PMID: 29327166]
[24]
de Jong Gierveld, J.; Van Tilburg, T.; Dykstra, P.A. Loneliness and social isolation. In: In: Cambridge handbook of personal relationships; , 2006; pp. 485-500.
[25]
Heinrich, L.M.; Gullone, E. The clinical significance of loneliness: A literature review. Clin. Psychol. Rev., 2006, 26(6), 695-718.
[http://dx.doi.org/10.1016/j.cpr.2006.04.002] [PMID: 16952717]
[26]
Prince, J.D.; Oyo, A.; Mora, O.; Wyka, K.; Schonebaum, A.D. Loneliness among persons with severe mental illness. J. Nerv. Ment. Dis., 2018, 206(2), 136-141.
[http://dx.doi.org/10.1097/NMD.0000000000000768] [PMID: 29256980]
[27]
Stefanidou, T.; Wang, J.; Morant, N.; Lloyd-Evans, B.; Johnson, S. Loneliness in early psychosis: a qualitative study exploring the views of mental health practitioners in early intervention services. BMC Psychiatry, 2021, 21(1), 134.
[http://dx.doi.org/10.1186/s12888-021-03138-w] [PMID: 33676456]
[28]
Fortuna, K.L.; Ferron, J.; Bianco, C.L. Loneliness and its association with health behaviors in people with a lived experience of a serious mental illness. Psychiatr. Q., 2021, 92(1), 101-106.
[http://dx.doi.org/10.1007/s11126-020-09777-8] [PMID: 32458342]
[29]
Park, K.H.; Yoo, E.Y.; Kim, J.; Hong, I.; Lee, J.S.; Park, J.H. Applying latent profile analysis to identify lifestyle profiles and their association with loneliness and quality of life among community-dwelling middle-and older-aged adults in South Korea. Int. J. Environ. Res. Public Health, 2021, 18(23), 12374.
[http://dx.doi.org/10.3390/ijerph182312374] [PMID: 34886100]
[30]
Group, W. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol. Med., 1998, 28(3), 551-558.
[http://dx.doi.org/10.1017/S0033291798006667] [PMID: 9626712]
[31]
Adewuya, A.O.; Makanjuola, R.O.A. Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlates. Acta Psychiatr. Scand., 2009, 120(2), 160-164.
[http://dx.doi.org/10.1111/j.1600-0447.2009.01395.x] [PMID: 19416124]
[32]
Huang, R.R.; Chen, Y.S.; Chen, C.C. Quality of life and its associated factors among patients with two common types of chronic mental illness living in Kaohsiung City. Psychiatry Clin. Neurosci., 2012, 66(6), 482-490.
[http://dx.doi.org/10.1111/j.1440-1819.2012.02380.x] [PMID: 22989344]
[33]
Shumye, S.; Amare, T.; Derajew, H.; Endris, M.; Molla, W.; Mengistu, N. Perceived quality of life and associated factors among patients with severe mental illness in Ethiopia: a cross-sectional study. BMC Psychol., 2021, 9(1), 152.
[http://dx.doi.org/10.1186/s40359-021-00664-w] [PMID: 34602067]
[34]
Post, F.; Pardeller, S.; Frajo-Apor, B. Quality of life in stabilized outpatients with bipolar I disorder: Associations with resilience, internalized stigma, and residual symptoms. J. Affect. Disord., 2018, 238, 399-404.
[http://dx.doi.org/10.1016/j.jad.2018.05.055] [PMID: 29909303]
[35]
Murphy, O.; Looney, K.; McNulty, M.; O’Reilly, G. Exploring the factors that predict quality of life, and the relationship between recovery orientation and quality of life in adults with severe mental health difficulties. Curr. Psychol., 2023, 42, 22419-22428.
[36]
Oliveira, S.E.H.; Carvalho, H.; Esteves, F. Internalized stigma and quality of life domains among people with mental illness: the mediating role of self-esteem. J. Ment. Health, 2016, 25(1), 55-61.
[http://dx.doi.org/10.3109/09638237.2015.1124387] [PMID: 26828897]
[37]
Bipeta, R.; Yerramilli, S.S.R.R.; Pillutla, S.V. Perceived stigma in remitted psychiatric patients and their caregivers and its association with self-esteem, quality of life, and caregiver depression. East Asian Arch. Psychiatry, 2020, 30(4), 101-107.
[http://dx.doi.org/10.12809/eaap1943] [PMID: 33349616]
[38]
Ritsher, J.B.; Phelan, J.C. Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res., 2004, 129(3), 257-265.
[http://dx.doi.org/10.1016/j.psychres.2004.08.003] [PMID: 15661319]
[39]
Ghanean, H.; Nojomi, M.; Jacobsson, L. Internalized stigma of mental illness in Tehran, Iran. Stigma Res. Action, 2011, 1(1), 11-17.
[http://dx.doi.org/10.5463/sra.v1i1.10]
[40]
Demir, A. UCLA yalnızlık ölçeğinin geçerlik ve güvenirliği. Psikoloji Dergisi, 1989, 7(23), 14-18.
[41]
Nemati, S; Nemati, DM; Fruzande, R The effect of group reminiscence therapy on depression of elderly. Armaghane danesh, 2008, 13(3), 57-64.
[42]
Nejat, S.; Montazeri, A.; Holakouie Naieni, K.; Mohammad, K.; Majdzadeh, S.R. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. J. Sch. Public Health Inst. Public Health Res., 2006, 4(4), 1-12.
[43]
Szcześniak, D.; Kobyłko, A.; Wojciechowska, I.; Kłapciński, M.; Rymaszewska, J. Internalized stigma and its correlates among patients with severe mental illness. Neuropsychiatr. Dis. Treat., 2018, 14, 2599-2608.
[http://dx.doi.org/10.2147/NDT.S169051] [PMID: 30349258]
[44]
Khan, N.; Kausar, R.; Khalid, A.; Farooq, A. Gender differences among discrimination & stigma experienced by depressive patients in Pakistan. Pak. J. Med. Sci., 2015, 31(6), 1432-1436.
[PMID: 26870110]
[45]
Kulesza, M.; Raguram, R.; Rao, D. Perceived mental health related stigma, gender, and depressive symptom severity in a psychiatric facility in South India. Asian J. Psychiatr., 2014, 9, 73-77.
[http://dx.doi.org/10.1016/j.ajp.2014.03.005] [PMID: 24813041]
[46]
Guo, Y.; Qu, S.; Qin, H. Study of the relationship between self-stigma and subjective quality of life for individuals with chronic schizophrenia in the community. Gen. Psychiatr., 2018, 31(3), e100037.
[http://dx.doi.org/10.1136/gpsych-2018-100037] [PMID: 30815634]
[47]
Yildirim, T.; Kavak Budak, F. The relationship between internalized stigma and loneliness in patients with schizophrenia. Perspect. Psychiatr. Care, 2020, 56(1), 168-174.
[http://dx.doi.org/10.1111/ppc.12399] [PMID: 31093994]
[48]
Livingston, J.D.; Boyd, J.E. Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Soc. Sci. Med., 2010, 71(12), 2150-2161.
[http://dx.doi.org/10.1016/j.socscimed.2010.09.030] [PMID: 21051128]
[49]
Oexle, N.; Waldmann, T.; Staiger, T.; Xu, Z.; Rüsch, N. Mental illness stigma and suicidality: The role of public and individual stigma. Epidemiol. Psychiatr. Sci., 2018, 27(2), 169-175.
[http://dx.doi.org/10.1017/S2045796016000949] [PMID: 27919303]
[50]
Yanos, P.T.; Lysaker, P.H.; Roe, D. Internalized stigma as a barrier to improvement in vocational functioning among people with schizophrenia-spectrum disorders. Psychiatry Res., 2010, 178(1), 211-213.
[http://dx.doi.org/10.1016/j.psychres.2010.01.003] [PMID: 20417973]
[51]
Borys, S.; Perlman, D. Gender differences in loneliness. Pers. Soc. Psychol. Bull., 1985, 11(1), 63-74.
[http://dx.doi.org/10.1177/0146167285111006]
[52]
Ludwig, K.A.; Nye, L.N.; Simmons, G.L. Correlates of loneliness among persons with psychotic disorders. Soc. Psychiatry Psychiatr. Epidemiol., 2020, 55(5), 549-559.
[http://dx.doi.org/10.1007/s00127-019-01789-5] [PMID: 31667560]
[53]
Solmi, M.; Veronese, N.; Galvano, D. Factors associated with loneliness: An umbrella review of observational studies. J. Affect. Disord., 2020, 271, 131-138.
[http://dx.doi.org/10.1016/j.jad.2020.03.075] [PMID: 32479308]
[54]
Bornheimer, L.A.; Li, J.; Im, V.; Taylor, M.; Himle, J.A. The role of social isolation in the relationships between psychosis and suicidal ideation. Clin. Soc. Work J., 2020, 48(1), 54-62.
[http://dx.doi.org/10.1007/s10615-019-00735-x]
[55]
Koohi, F.; Nedjat, S.; Yaseri, M.; Cheraghi, Z. Quality of life among general populations of different countries in the past 10 years, with a focus on human development index: A systematic review and meta-analysis. Iran. J. Public Health, 2017, 46(1), 12-22.
[PMID: 28451525]
[56]
Özçelik, E.K.; Yıldırım, A. Schizophrenia patients’ family environment, internalized stigma and quality of life. J. Psychiatr. Nurs., 2018, 9(2), 80-87.
[57]
Bonsaksen, T. Exploring gender differences in quality of life. Ment. Health Rev., 2012, 17(1), 39-49.
[http://dx.doi.org/10.1108/13619321211231815]
[58]
Lehman, A.F.; Rachuba, L.T.; Postrado, L.T. Demographic influences on quality of life among persons with chronic mental illnesses. Eval. Program Plann., 1995, 18(2), 155-164.
[http://dx.doi.org/10.1016/0149-7189(95)00006-W]
[59]
Berghöfer A, Martin L, Hense S, Weinmann S, Roll S. Quality of life in patients with severe mental illness: A cross-sectional survey in an integrated outpatient health care model. Qual. Life Res., 2020, 29(8), 2073-2087.
[http://dx.doi.org/10.1007/s11136-020-02470-0] [PMID: 32170584]
[60]
Shafie, S.; Samari, E.; Jeyagurunathan, A. Gender difference in quality of life (QoL) among outpatients with schizophrenia in a tertiary care setting. BMC Psychiatry, 2021, 21(1), 61.
[http://dx.doi.org/10.1186/s12888-021-03051-2] [PMID: 33509142]
[61]
Świtaj, P.; Grygiel, P.; Anczewska, M.; Wciórka, J. Loneliness mediates the relationship between internalised stigma and depression among patients with psychotic disorders. Int. J. Soc. Psychiatry, 2014, 60(8), 733-740.
[http://dx.doi.org/10.1177/0020764013513442] [PMID: 24346002]
[62]
Sevinik, H.; Arslan, F.T. Determination of internalized stigma and social functioning level in schizophrenia patients. J. Psychiatr. Nurs., 2020, 11(3), 173-180.
[63]
Căpățână, O.; Micluția, I. Internalized stigma as a predictor of quality of life in Schizophrenia. J. Evid. Based Psychother., 2018, 18(2), 35-53.
[http://dx.doi.org/10.24193/jebp.2018.2.13]
[64]
Cheng, C.M.; Chang, C.C.; Wang, J.D.; Chang, K.C.; Ting, S.Y.; Lin, C.Y. Negative impacts of self-stigma on the quality of life of patients in methadone maintenance treatment: The mediated roles of psychological distress and social functioning. Int. J. Environ. Res. Public Health, 2019, 16(7), 1299.
[http://dx.doi.org/10.3390/ijerph16071299] [PMID: 30978986]
[65]
Sibitz, I.; Amering, M.; Unger, A. The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. Eur. Psychiatry, 2011, 26(1), 28-33.
[http://dx.doi.org/10.1016/j.eurpsy.2010.08.010] [PMID: 21036554]
[66]
Taheri, L.; Shamsaei, F.; Sadeghian, E.; Tapak, L. Treatment adherence in aatients with mental illnesses: The effect of stigma and spirituality. Arch. Psychiatry Psychother., 2021, 23(4), 32-45.
[http://dx.doi.org/10.12740/APP/138429]
[67]
Nevarez-Flores, A.G.; Breslin, M.; Carr, V.J. Health-related quality of life in people with psychotic disorders: The role of loneliness and its contributors. Aust. N. Z. J. Psychiatry, 2022, 56(11), 1421-1433.
[http://dx.doi.org/10.1177/00048674211072437] [PMID: 35075914]

Rights & Permissions Print Cite
Article Metrics
5
1
Wayfinder Image
© 2024 Bentham Science Publishers | Privacy Policy