title: Stigma as a barrier to recovery: Adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effect of concerns about stigma on social adaptation among persons with a diagnosis of bipolar affective disorder.
  
  
  METHODS
  The sample comprised 264 persons who were consecutively admitted to a psychiatric inpatient or outpatient service at a university-affiliated hospital and who met research diagnostic criteria for bipolar I disorder, bipolar II disorder, or schizoaffective disorder, manic type. Patients were evaluated with use of the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-L), the Brief Psychiatric Rating Scale (BPRS), and a measure of perceived stigma. Social adjustment was measured at baseline and seven months later with the Social Adjustment Scale (SAS).
  
  
  RESULTS
  As predicted, patients who had concerns about stigma showed significantly more impairment at seven months on the social leisure subscale but not on the SAS extended family subscale, after baseline SAS score and symptom level had been controlled for. More refined models using SAS-derived factors as dependent variables indicated that concerns about stigma predicted higher avoidance of social interactions with persons outside the family and psychological isolation at seven-month follow-up, after baseline SAS and BPRS scores had been controlled for.
  
  
  CONCLUSIONS
  Concerns about the stigma associated with mental illness reported by patients during an acute phase of bipolar illness predicted poorer social adjustment seven months later with individuals outside the patient's family. Greater attention to patients' concerns about stigma is needed from both researchers and clinicians.
authors.affiliation: Northeast Program Evaluation Center, VA Connecticut Healthcare Systems, West Haven, CT 06516, USA. deborah.perlick@yale.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Perlick
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: J F
authors.initials: JF
authors.lastname: Clarkin
authors.forename: J A
authors.initials: JA
authors.lastname: Sirey
authors.forename: J
authors.initials: J
authors.lastname: Salahi
authors.forename: E L
authors.initials: EL
authors.lastname: Struening
authors.forename: B G
authors.initials: BG
authors.lastname: Link
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D010054:Brief Psychiatric Rating Scale; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D020127:Recovery of Function; D012917:Social Adjustment; D013240:Stereotyping