https://doi.org/10.1177/0020764019850204
International Journal of
Social Psychiatry
1–7
© The Author(s) 2019
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0020764019850204
journals.sagepub.com/home/isp
E CAMDEN SCHIZOPH
Introduction
Stigma has a substantial impact on various facets of life for
people with mental illness. A large body of literature focuses
on public stigma and its reduction, but much has discounted
internalized stigma and the role it plays in the lives of indi-
viduals with psychosis. Internalized stigma (also referred to
as personal stigma or self-stigma) is defined as the endorse-
ment and internalization of negative stereotypes and preju-
dices associated with mental illness in persons with mental
health conditions (Corrigan & Watson, 2002).
Prevalence rates for internalized stigma for people
with mental illness vary and are difficult to compare due
to inconsistencies in metrics used and populations
assessed (Link, Yang, Phelan, & Collins, 2004).
International prevalence rates of internalized stigma for
individuals with psychosis range from 18.8% to 44.2%
(Drapalski et al., 2013; Lv, Wolf, & Wang, 2013; Mosanya,
Adelufosi, Adebowale, Ogunwale, & Adebayo, 2014;
Werner, Aviv, & Barak, 2008), and within Europe, 33% to
41.7% of patients with psychosis have moderate-to-high
levels of internalized stigma (Brohan, Elgie, Sartorius, &
Thornicroft, 2010; Krajewski, Burazeri, & Brand, 2013).
Research indicates that prevalence rates of internalized
stigma can be greater in patients living with psychosis
than in patients with non-psychotic mental illness (Lien
et al., 2015). While a recent study found no significant
variance between internalized stigma levels and various
demographic variables in patients with psychosis (Vrbová
et al., 2015), one systematic review detected marginal
associations among patient sociodemographic variables
and levels of internalized stigma, reporting a significant
Correlates of internalized stigma
levels in people with psychosis in
the Czech Republic
Aneta Alexová
1,2
, Anna Kågström
1
, Petr Winkler
1,3
,
Lucie Kondrátová
1
and Miroslava Janoušková
1
Abstract
Background: Internalized stigma negatively affects lives and prognosis of individuals with psychosis.
Aim: This study aimed to identify correlates of internalized stigma among individuals with psychosis in a sample of
community care users in the Czech Republic.
Methods: A cross-sectional study was conducted among 133 community service users with psychosis. A shortened
version of the Internalized Stigma of Mental Illness (ISMI-10) scale was used alongside the 5-level EQ-5D version (EQ-
5D-5L), assessing health-related quality of life. Descriptive and linear regression analyses were performed in order to
determine levels of internalized stigma and its correlates.
Results: High levels of internalized stigma were reported in 25% of participants. Lower internalized stigma levels were
associated with better self-reported health status and being married, and higher internalized stigma with a longer period
of time since initial contact with psychiatric care.
Conclusion: Lower internalized stigma levels are associated with better self-reported health-related quality of life. In
addition, clients having used psychiatric care for longer periods of time reported significantly higher internalized stigma
levels. Therefore, authors suggest self-stigma reduction interventions based in a community setting with an emphasis on
targeting clients with chronic psychosis.
Keywords
Internalized stigma, correlates, psychosis, community care setting, CZEPOS
1
National Institute of Mental Health, Klecany, Czech Republic
2
Faculty of Social Sciences, Charles University, Prague, Czech
Republic
3
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
Corresponding author:
Lucie Kondrátová, Department of Social Psychiatry, National Institute
of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic.
Email: lucie.kondratova@nudz.cz
850204ISP 0 0 10.1177/0020764019850204International Journal of Social PsychiatryAlexová et al.
research-article 2019
Original Article