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Home arrow Language & Literature arrow The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health
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Adherence to Treatment

In a patient survey by nurses conducted during the Schizophrenia Guidelines Project in the USA, stigma was identified as one of the two biggest reasons for medication non-adherence—the other reason being the side effects of medication (Hudson et al. 2004). With pharmacotherapy being the mainstay of treatment for schizophrenia, non-adherence can have a pronounced impact on people’s capacity to achieve treatment goals. Stigma can also impact negatively on individuals’ capacity to adhere to psychosocial interventions. In a study in Hong Kong, Fung et al. (2008) conducted a study exploring how adherence to psychosocial treatment was related to self-stigma in 86 participants. In this study, higher levels of self-stigma predicted poor psychosocial treatment attendance. Indeed, self-stigma and self-esteem were the factors most strongly related to adherence to psychosocial treatment.

The Impact of Stigma on Families of Individuals with Mental Health Difficulties

The experience of stigma is not confined to the individual with mental health difficulties alone but casts its shadow over their families across generations. This has been referred to as ‘courtesy stigma’ (Goffman 1963) or ‘associated stigma’ (Quinn and Knifton 2014). Research conducted by Shibre et al. (2001) in Ethiopia investigated the stigma experienced by family members of individuals experiencing mental health difficulties. A total of 75% of family members (of individuals with either psychotic or mood disorders) indicated that they had experienced stigma, and 37% stated that they wanted to withhold their relative’s mental illness from others (Shibre et al. 2001). Research conducted in Uganda by Kigozi et al. (2008) found that many families make concerted efforts to hide the mental health difficulties that their relative is experiencing. Research from China determined that more than half of the relatives of people with schizophrenia who were surveyed indicated that they concealed the occurrence of schizophrenia within their family (Phillips et al. 2002). Similarly, Thara et al. (2003) highlighted that the families of individuals with schizophrenia in India hid the condition because they were fearful about the implications that this would have for the likelihood of the individual getting married and/or accepted by their local community.

 
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