title: Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Internalized stigma can lead to pervasive negative effects among people with severe mental illness (SMI). Although prevalence of internalized stigma is high, there is a dearth of interventions and meanwhile a lack of evidence as to their effectiveness. This study aims at unraveling the existence of different therapeutic interventions and the effectiveness internalized stigma reduction in people with SMI via a systematic review and meta-analysis.
  
  
  METHODS
  Five electronic databases were searched. Studies were included if they (1) involved community or hospital based interventions on internalized stigma, (2) included participants who were given a diagnosis of SMI>50%, and (3) were empirical and quantitative in nature.
  
  
  RESULTS
  Fourteen articles were selected for extensive review and five for meta-analysis. Nine studies showed significant decrease in internalized stigma and two showed sustainable effects. Meta-analysis showed that there was a small to moderate significant effect in therapeutic interventions (SMD=-0.43; p=0.003). Among the intervention elements, four studies suggested a favorable effect of psychoeducation. Meta-analysis showed that there was small to moderate significant effect (SMD=-0.40; p=0.001).
  
  
  CONCLUSIONS
  Most internalized stigma reduction programs appear to be effective. This systematic review cannot make any recommendation on which intervention is more effective although psychoeducation seems most promising. More Randomized Controlled Trials (RCT) on particular intervention components using standard outcome measures are recommended in future studies.
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong. Electronic address: hector.tsang@polyu.edu.hk.
authors.forename: Hector W H
authors.initials: HW
authors.lastname: Tsang
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: S C
authors.initials: SC
authors.lastname: Ching
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: K H
authors.initials: KH
authors.lastname: Tang
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: H T
authors.initials: HT
authors.lastname: Lam
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: Peggy Y Y
authors.initials: PY
authors.lastname: Law
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: C N
authors.initials: CN
authors.lastname: Wan
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D019468:Disease Management; D006801:Humans; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D057545:Social Stigma
keywords: Internalized stigma; Psychoeducation; Psychosocial intervention; Self-stigma; Severe mental illness