Self-stigma among caregivers of people with mental illness: toward caregivers' empowerment.
BACKGROUND
In addition to economic and material burdens, caregivers of people with mental illness are exposed to psychosocial challenges. Self-stigma is among the psychological challenges that can be exacerbated by intrinsic and/or extrinsic factors. Caregivers' self-stigma can negatively influence the patients' treatment and rehabilitation process. The objective of this study was to measure the level and correlates of self-stigma among caregivers of people with mental illness.


METHODS
An interviewer-administered cross-sectional study was conducted in the Jimma University Specialized Hospital Psychiatry Clinic in Ethiopia on a sample of 422 caregivers. Data were collected by trained nurses working in the clinic using a pretested questionnaire. Multivariate linear regression was performed to identify the correlates of self-stigma among caregivers of people with mental illness.


RESULTS
The majority (70.38%) of the caregivers were male. On a scale of 0 to 15, with 0 being low and 15 being high, the average self-stigmatizing attitude score was 4.68 (±4.11). A statistically significant difference in mean self-stigma score was found between urban and rural respondents (t=3.95, P<0.05). Self-stigma of caregivers showed significant positive correlation with perceived signs of mental illness (r=0.18, P<0.001), perceived supernatural explanations of mental illness (r=0.26, P<0.001), and perceived psychosocial and biological explanations of mental illness (r=0.12, P<0.01). The only independent predictor of caregivers' self-stigma was perceived supernatural explanation of mental illness (standardized β=0.22, P<0.001).


CONCLUSIONS
The tendency of caregivers to avoid being identified with the patients was observed. Low exposure to mental health information was also reported. Caregivers' self-stigma in this study was significantly correlated with perceived supernatural explanation of mental illness. Since caregivers' self-stigma may negatively influence patients' treatment-seeking, adherence, and rehabilitation processes, programs that enhance coping strategies by strengthening self-esteem and empowerment by health care providers and establish family support groups may be helpful to tackle self-stigma among caregivers of people with mental illness.
Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia ; CIH Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany.
Eshetu
E
Girma
CIH Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany ; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
Anne Maria
AM
Möller-Leimkühler
CIH Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany ; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
Sandra
S
Dehning
CIH Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany ; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
Norbert
N
Mueller
Department of Psychiatry, Jimma University, Jimma, Ethiopia.
Markos
M
Tesfaye
CIH Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany ; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität, Munich, Germany.
Guenter
G
Froeschl
caregivers; internalized stigma; mental illness; self-stigma