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Articles   |    
The Role of Experienced and Anticipated Discrimination in the Lives of People With First-Episode Psychosis
Antonio Lasalvia, M.D., Ph.D.; Silvia Zoppei, D.Clin.Psy.; Chiara Bonetto, Ph.D.; Sarah Tosato, M.D., Ph.D.; Gioia Zanatta, D.Clin.Psy.; Doriana Cristofalo, Edu.Sci.; Katia De Santi, M.D.; Mariaelena Bertani, Ph.D.; Sarah Bissoli, Ph.D.; Lorenza Lazzarotto, D.Clin.Psy.; Enrico Ceccato, D.Clin.Psy.; Rossana Riolo, M.D.; Vanna Marangon, M.D.; Carla Cremonese, M.D.; Ileana Boggian, D.Clin.Psy.; Michele Tansella, M.D.; Mirella Ruggeri, M.D., Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300291
View Author and Article Information

Dr. Lasalvia, Dr. Zoppei, Dr. Bonetto, Dr. Tosato, Dr. Zanatta, Dr. Cristofalo, Dr. De Santi, Dr. Bertani, Dr. Bissoli, Dr. Lazzarotto, Prof. Tansella, and Prof. Ruggeri are with the Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy (e-mail: antonio.lasalvia@univr.it). Dr. Ceccato is with the Department of Mental Health, Local Health Authority, Montecchio, Italy. Dr. Riolo is with the Department of Mental Health, Local Health Authority, Camposampiero, Italy. Dr. Marangon is with the Department of Mental Health, Local Health Authority, Mirano, Italy. Dr. Cremonese is with the Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy. Dr. Boggian is with the Department of Mental Health, Local Health Authority, Legnago, Italy.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study aimed to describe patterns of experienced and anticipated discrimination in a sample of persons experiencing a first episode of psychosis and to explore associations with clinical and psychosocial variables.

Methods  This cross-sectional survey was conducted within the context of the Psychosis Incident Cohort Outcome Study, a multisite naturalistic study examining first-episode patients treated in public psychiatric services in the Veneto Region of Italy. The Discrimination and Stigma Scale was used to assess experienced and anticipated discrimination.

Results  Ninety-seven patients were interviewed. Experiences of discrimination were common in relationships with family members (43%), making friends (32%), relationships with neighbors (25%), keeping a job (25%), finding a job (24%), and intimate relationships (23%). In regard to anticipated discrimination, 37% had stopped seeking a close relationship and 34% had stopped looking for work, 58% felt the need to conceal their diagnosis, and 37% reported that other people avoided them. In regression analysis, a higher number of functioning needs together with higher anticipated discrimination were associated with a higher level of experienced discrimination. A higher level of experienced discrimination and greater illness awareness were associated with more anticipated discrimination.

Conclusions  First-episode patients reported experiencing discrimination in several key life areas. Anticipated discrimination further limited their access to life opportunities. Patients’ awareness of the negative consequences of symptoms and disabilities led them to more easily perceive discrimination.

Abstract Teaser
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Figure 1 Patients reporting experiences of discrimination in the PICOS sample with first-episode psychosis and in two INDIGO samples with chronic schizophreniaa

a PICOS, Psychosis Incident Cohort Outcome Study; INDIGO, INternational study of DIscrimination and stiGma Outcomes (Italian sites [7] and all INDIGO sites [19])

Figure 2 Patients reporting anticipated discrimination in the PICOS sample with first-episode psychosis and in two INDIGO samples with chronic schizophreniaa

a PICOS, Psychosis Incident Cohort Outcome Study; INDIGO, INternational study of DIscrimination and stiGma Outcomes (Italian sites [7] and all INDIGO sites [19])

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Table 1Characteristics of 97 patients with first-episode psychosis
Table Footer Note

a Data missing for 4 participants

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b Data missing for 11 participants

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c Data missing for 2 participants

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d Data missing for 5 participants

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e Data missing for 2 participants

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Table 2Responses to DISC-10 items by 97 patients experiencing a first episode of psychosisa
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a DISC-10, Discrimination and Stigma Scale

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b For experienced discrimination, values represent patients scoring 1–3 (slight, moderate, or strong disadvantage). For anticipated discrimination, values represent patients scoring 1–3 (a little, moderately, or a lot).

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c Data missing for 1 participant

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d Data missing for 2 participants

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Table 3Negative binomial regression models for experienced and anticipated discrimination among 97 patients experiencing a first episode of psychosisa
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a Only independent variables significant at p<.05 are shown (p is adjusted for clustering).

Table Footer Note

b PANSS, Positive and Negative Syndrome Scale; CAN, Camberwell Assessment of Need; VSSS, Verona Service Satisfaction Scale; MANSA, Manchester Short Assessment scale; SAI-E, Schedule for Assessment of Insight

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References

de Haan  L;  Peters  B;  Dingemans  P  et al:  Attitudes of patients toward the first psychotic episode and the start of treatment.  Schizophrenia Bulletin 28:431–442, 2002
[CrossRef] | [PubMed]
 
Miller  R;  Mason  SE:  Shame and guilt in first episode schizophrenia and schizoaffective disorders.  Journal of Contemporary Psychotherapy 35:211–221, 2005
[CrossRef]
 
Schulze  B;  Angermeyer  MC:  Subjective experiences of stigma: a focus group study of schizophrenic patients, their relatives and mental health professionals.  Social Science and Medicine 56:299–312, 2003
[CrossRef] | [PubMed]
 
Thornicroft  G;  Rose  D;  Kassam  A  et al:  Stigma: ignorance, prejudice or discrimination? British Journal of Psychiatry 190:192–193, 2007
[CrossRef] | [PubMed]
 
Oliver  MI;  Pearson  N;  Coe  N  et al:  Help-seeking behaviour in men and women with common mental health problems: cross-sectional study.  British Journal of Psychiatry 186:297–301, 2005
[CrossRef] | [PubMed]
 
Link  BG;  Struening  EL;  Rahav  M  et al:  On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse.  Journal of Health and Social Behavior 38:177–190, 1997
[CrossRef] | [PubMed]
 
Thornicroft  G;  Brohan  E;  Rose  D  et al:  Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey.  Lancet 373:408–415, 2009
[CrossRef] | [PubMed]
 
Jorm  AF;  Korten  AE;  Jacomb  PA  et al:  Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals.  Australian and New Zealand Journal of Psychiatry 33:77–83, 1999
[CrossRef] | [PubMed]
 
Crisp  AH;  Gelder  MG;  Rix  S  et al:  Stigmatisation of people with mental illnesses.  British Journal of Psychiatry 177:4–7, 2000
[CrossRef] | [PubMed]
 
Stuart  H;  Arboleda-Flórez  J:  Community attitudes toward people with schizophrenia.  Canadian Journal of Psychiatry 46:245–252, 2001
 
Gaebel  W;  Baumann  A;  Witte  AM  et al:  Public attitudes towards people with mental illness in six German cities: results of a public survey under special consideration of schizophrenia.  European Archives of Psychiatry and Clinical Neuroscience 252:278–287, 2002
[CrossRef] | [PubMed]
 
Lauber  C;  Nordt  C;  Falcato  L  et al:  Factors influencing social distance toward people with mental illness.  Community Mental Health Journal 40:265–274, 2004
[CrossRef] | [PubMed]
 
Angermeyer  MC;  Holzinger  A;  Matschinger  H:  Emotional reactions to people with mental illness.  Epidemiologia e Psichiatria Sociale 19:26–32, 2010
[PubMed]
 
Holzinger  A;  Floris  F;  Schomerus  G  et al:  Gender differences in public beliefs and attitudes about mental disorder in western countries: a systematic review of population studies.  Epidemiology and Psychiatric Science 21:73–85, 2012
[CrossRef]
 
Dickerson  FB;  Sommerville  J;  Origoni  AE  et al:  Experiences of stigma among outpatients with schizophrenia.  Schizophrenia Bulletin 28:143–155, 2002
[CrossRef] | [PubMed]
 
Ertugrul  A;  Uluğ  B:  Perception of stigma among patients with schizophrenia.  Social Psychiatry and Psychiatric Epidemiology 39:73–77, 2004
[CrossRef] | [PubMed]
 
Mueller  B;  Nordt  C;  Lauber  C  et al:  Social support modifies perceived stigmatization in the first years of mental illness: a longitudinal approach.  Social Science and Medicine 62:39–49, 2006
[CrossRef] | [PubMed]
 
Yanos  PT;  Roe  D;  Markus  K  et al:  Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders.  Psychiatric Services 59:1437–1442, 2008
[CrossRef] | [PubMed]
 
Maggiolo  D;  Buizza  C;  Vittorielli  M  et al:  Patterns of experienced and anticipated discrimination in patients with schizophremia: Italian results from the INDIGO international multisite project [in Italian].  Epidemiologia e Psichiatria Sociale 19:314–325, 2010
[PubMed]
 
Lam  MM;  Pearson  V;  Ng  RM  et al:  What does recovery from psychosis mean? Perceptions of young first-episode patients.  International Journal of Social Psychiatry 57:580–587, 2011
[CrossRef] | [PubMed]
 
Malla  AM;  Norman  RM:  Treating psychosis: is there more to early intervention than intervening early? Canadian Journal of Psychiatry 46:645–648, 2001
 
Bertani  M;  Lasalvia  A;  Bonetto  C  et al:  The influence of gender on clinical and social characteristics of patients at psychosis onset: a report from the Psychosis Incident Cohort Outcome Study (PICOS).  Psychological Medicine 42:769–780, 2012
[CrossRef] | [PubMed]
 
Malla  A;  Payne  J:  First-episode psychosis: psychopathology, quality of life, and functional outcome.  Schizophrenia Bulletin 31:650–671, 2005
[CrossRef] | [PubMed]
 
Lysaker  PH;  Davis  LW;  Warman  DM  et al:  Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months.  Psychiatry Research 149:89–95, 2007
[CrossRef] | [PubMed]
 
Vázquez  GH;  Kapczinski  F;  Magalhaes  PV  et al:  Stigma and functioning in patients with bipolar disorder.  Journal of Affective Disorders 130:323–327, 2011
[CrossRef] | [PubMed]
 
Lasalvia  A;  Tosato  S;  Brambilla  P  et al:  Psychosis Incident Cohort Outcome Study (PICOS): a multisite study of clinical, social and biological characteristics, patterns of care and predictors of outcome in first-episode psychosis—background, methodology and overview of the patient sample.  Epidemiology and Psychiatric Sciences 21:281–303, 2012
[CrossRef] | [PubMed]
 
Brohan  E;  Clement  S;  Rose  D  et al:  Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC).  Psychiatry Research 208:33–40, 2013
[CrossRef] | [PubMed]
 
Kay  SR;  Fiszbein  A;  Opler  LA:  The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.  Schizophrenia Bulletin 13:261–276, 1987
[CrossRef] | [PubMed]
 
Kemp  R;  David  A:  Insight and compliance; in  Treatment Compliance and the Therapeutic Alliance . Edited by Blackwell  B.  Amsterdam,  Harwood Academic Publishers, 1996
 
 WHO Psychiatric Disability Assessment Schedule .  Geneva,  World Health Organization, 1988
 
McCrone  P;  Leese  M;  Thornicroft  G  et al:  Reliability of the Camberwell Assessment of Need–European Version: EPSILON Study 6. European psychiatric services: inputs linked to outcome domains and needs.  British Journal of Psychiatry 177(suppl 39):s34–s40, 2000
[CrossRef]
 
Priebe  S;  Huxley  P;  Knight  S  et al:  Application and results of the Manchester Short Assessment of Quality of Life (MANSA).  International Journal of Social Psychiatry 45:7–12, 1999
[CrossRef] | [PubMed]
 
Ruggeri  M;  Lasalvia  A;  Dall’Agnola  R  et al:  Development, internal consistency and reliability of the Verona Service Satisfaction Scale–European Version. EPSILON Study 7. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs.  British Journal of Psychiatry 177(suppl39):s41–s48, 2000
[CrossRef]
 
Corrigan  PW;  Larson  JE;  Rüsch  N:  Self-stigma and the “why try” effect: impact on life goals and evidence-based practices.  World Psychiatry 8:75–81, 2009
[PubMed]
 
Pachankis  JE:  The psychological implications of concealing a stigma: a cognitive-affective-behavioral model.  Psychological Bulletin 133:328–345, 2007
[CrossRef] | [PubMed]
 
Corrigan  PW;  Kosyluk  KA;  Rüsch  N:  Reducing self-stigma by coming out proud.  American Journal of Public Health 103:794–800, 2013
[CrossRef] | [PubMed]
 
Lysaker  PH;  Campbell  K;  Johannesen  JK:  Hope, awareness of illness, and coping in schizophrenia spectrum disorders: evidence of an interaction.  Journal of Nervous and Mental Disease 193:287–292, 2005
[CrossRef] | [PubMed]
 
Staring  AB;  Van der Gaag  M;  Van den Berge  M  et al:  Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders.  Schizophrenia Research 115:363–369, 2009
[CrossRef] | [PubMed]
 
Morgan  KD;  David  AS:  Awareness is not the same as acceptance: exploring the thinking behind insight and acceptance; in  Metacognition and Severe Adult Mental Disorders: From Research to Treatment . Edited by Dimaggio  G;  Lysaker  PH.  New York,  Routledge, 2010
 
Drake  RE;  Cotton  PG:  Depression, hopelessness and suicide in chronic schizophrenia.  British Journal of Psychiatry 148:554–559, 1986
[CrossRef] | [PubMed]
 
Kim  CH;  Jayathilake  K;  Meltzer  HY:  Hopelessness, neurocognitive function, and insight in schizophrenia: relationship to suicidal behavior.  Schizophrenia Research 60:71–80, 2003
[CrossRef] | [PubMed]
 
Mintz  AR;  Dobson  KS;  Romney  DM:  Insight in schizophrenia: a meta-analysis.  Schizophrenia Research 61:75–88, 2003
[CrossRef] | [PubMed]
 
Yanos  PT;  Roe  D;  Lysaker  PH:  Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness.  International Journal of Group Psychotherapy 61:577–595, 2011
[CrossRef] | [PubMed]
 
Roe  D;  Hasson-Ohayon  I;  Mashiach-Eizenberg  M  et al:  Narrative Enhancement and Cognitive Therapy (NECT) effectiveness: a quasi-experimental study.  Journal of Clinical Psychology  (Epub ahead of print, Oct 2, 2013)
 
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