title: Mixed-methods analysis of internalized stigma correlates in poorly adherent individuals with bipolar disorder.
abstract: Internalized stigma, which occurs when stigmatized individuals accept society's assessment and incorporate this assessment into their sense of self, is prevalent in individuals with bipolar disorder (BD). This study explored the correlates of internalized stigma in a research sample of patients with BD who were poorly adherent to their medications.
  
  
  
  Both quantitative and qualitative analyses were performed. Scores of 115 individuals with BD on the Internalized Stigma of Mental Illness (ISMI) scale were correlated with scores on the General Self-Efficacy (GSE) Scale, Brief Psychiatric Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Young Mania Rating Scale (YMRS). Regression was run for GSE (dependent variable) and ISMI (independent variable). In-depth qualitative interviews were conducted on a representative subsample (N=21).
  
  
  
  Internalized stigma levels were moderately high. Internalized stigma and self-efficacy correlated, and internalized stigma related to self-efficacy after adjusting for demographic variables (age, gender, years of education), comorbidities, and symptom severity (BPRS and MADRS). Internalized stigma was also associated with the BD symptoms of depression, anxiety, guilt feelings, suspiciousness, and hallucinogenic behaviors. No association was found with mania.
  
  
  
  Because internalized stigma has strong psychosocial and psychiatric symptom associations, it is recommended that clinicians address both societal stigma and internalized stigma. Strategies such as cognitive-behavioral therapy may help modify BD patients' internalized stigma.
authors.affiliation: Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106. Electronic address: molly.howland@case.edu.
authors.forename: Molly
authors.initials: M
authors.lastname: Howland
authors.affiliation: Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106. Electronic address: jennifer.levin@uhhospitals.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Levin
authors.affiliation: Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106. Electronic address: cxb28@case.edu.
authors.forename: Carol
authors.initials: C
authors.lastname: Blixen
authors.affiliation: Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, 44106; Department of Neurology, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106. Electronic address: cmt66@case.edu.
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
authors.affiliation: Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106; Department of Neurology, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106; Department of Psychiatry, Case Western Reserve University School of Medicine, 10524 Euclid Ave, Cleveland, OH, 44106. Electronic address: martha.sajatovic@uhhospitals.org.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D010054:Brief Psychiatric Rating Scale; D003430:Cross-Sectional Studies; D003674:Defense Mechanisms; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D020377:Self Efficacy; D057545:Social Stigma; D013240:Stereotyping