Assessment of internalized stigma among patients with mental illness in Trivandrum district, Kerala
Methods: A cross sectional survey was conducted among 290 patients with mental illness attending the follow-up outpatient clinics of the government Mental Health Centre and 13 randomly selected mental health integrated primary care clinics in Trivandrum district, Kerala. A pretested interview schedule and an adapted Malayalam version of Internalized Stigma of Mental illness Inventory (ISMI) were used for data collection. A multivariate model was developed to identify the factors associated with internalized stigma.
Results: The prevalence of high internalized stigma in the total sample was 36.2 percent, which was significantly higher among patients from community-based care (42.1 percent) as compared to those from psychiatric hospital-based care (29.7 percent), p=0.028. Treatment in community-based care (95 percent CI: 1.07-3.45), unemployment (CI: 1.21-3.92), absence of long-term friendship (CI: 1.42-4.42), no hope of cure with medication (CI: 1.66-7.91), no change in job after having mental illness (CI: 1.04-3.26), family history of mental illness (CI: 1.05-3.23), presence of other illness (CI: 1.11-4.17) and number of hospitalizations due to mental illness ≥ 4 (CI: 1.05-3.55) were significantly associated with high internalized stigma. The Malayalam version of ISMI had a Cronbach’s alpha of 0.90, split half reliability of 0.86, and a construct validity of -0.16, p=0.006.
Conclusion: The prevalence of internalized stigma was high in this sample. The findings call for urgent attention by the District Mental Health Programme to widen its coverage of rehabilitation centres and to make its awareness campaigns and counselling sessions to focus more on addressing internalized stigma.