Self-stigma, stages of change and psychosocial treatment adherence among Chinese people with schizophrenia: a path analysis.
OBJECTIVE
Mental illness stigma is one of the key causes for poor psychosocial treatment adherence. The objective of this study was to explore the link between self-stigmatization and adherence via path analysis with insight and readiness for change conceptualized as the possible mediators. The direct effects of psychopathology causing non-adherence were also tested.


METHODS
One hundred and five participants with schizophrenia were recruited from five psychiatric settings in Hong Kong. Data concerning their level of stigma, insight, stages of change, psychopathology, and psychosocial treatment adherence were collected. Path analysis was used to test two hypothetical models.


RESULTS
The findings supported the direct effects of self-stigma on reducing psychosocial treatment adherence, and its indirect influences mediated by insight and stages of change on treatment adherence. Psychopathology was also found to have a direct effect on undermining adherence. This model showed better model fit than the one which did not consider the direct effects of self-stigmatization and psychopathology.


CONCLUSIONS
To conclude, this study deepened our understanding on the mechanism explaining how self-stigmatization undermines psychosocial treatment adherence. The findings provide direct implications on ways of formulating a self-stigma reduction program to combat self-stigma and its negative consequences.
Fung
Kelvin M T
KM
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hunghom, Hong Kong.
Tsang
Hector W H
HW
Chan
Fong
F
D000328:Adult; D044466:Asian People / Q000523:psychology* / Q000706:statistics & numerical data; D001294:Attitude to Health; D001364:Awareness; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D015928:Cognitive Behavioral Therapy; D005260:Female; D006304:Health Status; D006723:Hong Kong / Q000208:ethnology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008960:Models, Psychological; D010349:Patient Compliance / Q000523:psychology*; D011594:Psychometrics; D011613:Psychotherapy / Q000379:methods; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012565:Schizophrenic Psychology; D012649:Self Concept; D013240:Stereotyping; D011795:Surveys and Questionnaires