A comprehensive systematic review on the perception and experience of stigma among people with schizophrenia.

BACKGROUND: Research has shown that stigma associated with mental illness is pervasive in many countries. Schizophrenia is considered one of the most highly stigmatised psychiatric disorders due to an array of negative stereotypes associated with it. Stigma has deleterious consequences for people suffering a mental illness. A review on the subjective perception and experience of stigma may aid the development of effective anti-stigma programs and raise awareness of clinicians about the meaning of stigma for individuals in order to minimise harmful health outcomes.

OBJECTIVE: The overall objective of this systematic review was to determine perception and experience of stigma among people with schizophrenia.

INCLUSION CRITERIA: Types of participants Studies that included adults (18 years and over) diagnosed with any types of schizophrenia.Phenomena of interest Primary studies which explored the perception and experience of stigma among people with schizophrenia.Context Studies conducted in either inpatient, outpatient, or community settings and published in English.Types of studies Any interpretive studies and quantitative descriptive studies which explored the phenomena of interest.

SEARCH STRATEGY: The literature search sought published studies and papers. Electronic databases searched were: METHODOLOGICAL QUALITY: Qualitative and quantitative studies selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardised critical appraisal instruments from the JBI-SUMARI.

DATA EXTRACTION: Information was extracted by two independent reviewers from each paper using standardised JBI data extraction tools.

DATA SYNTHESIS: Meta-synthesis was carried out which resulted in eight synthesised findings. A narrative summary of the quantitative study findings is also presented.

RESULTS: Both qualitative and quantitative studies revealed similar findings, including negative attitudes, discrimination and lack of understanding from community, friends, colleagues, family members, as well as mental health professionals due to negative stereotypes and media portrayals. Self stigmatisation among individuals was revealed too.

CONCLUSION: Stigma affects important domains of individuals' lives, and is mainly due to a lack of knowledge and understanding of others towards people with schizophrenia. Self stigma, which contributes to negative self concept and perceptions, appears to be a prominent problem too.

IMPLICATIONS FOR PRACTICE: Education programs should be developed and targeted at various groups of people to enhance knowledge and understanding of mental illness. Additional legislation may be required to protect the rights of individuals. Media can help to disseminate accurate information to the public. Healthcare professionals have the responsibility to advocate for individuals, empower them in decision making, and understand the meaning and experience of stigma for individuals, in order to plan appropriate interventions to help them cope effectively.

IMPLICATIONS FOR RESEARCH: Further qualitative research investigating stigma could be conducted in different cultural settings. A systematic review on the association between stigma experiences and clinical or demographic characteristics may aid mental health professionals in recognising individuals at risk of the adverse effects of stigma. Periodic research in this area could evaluate the effectiveness of community-based educational programs or interventions introduced which combat stigma.