Ellouze S, Jenhani R, Bougacha D, Turki M, Aloulou J, Ghachem R
Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie.
Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie.
Encephale. 2023 Feb;49(1):34-40. doi: 10.1016/j.encep.2022.06.011. Epub 2022 Oct 15.
Self-stigma of people with bipolar disorder is an underestimated problem, with serious consequences in terms of clinical severity and social and professional functioning.
This study aimed to evaluate self-stigma in patients with bipolar disorder, to identify socio-demographic and clinical factors associated with it and to analyze the links between self-stigma and functioning in this population.
We conducted a cross-sectional, descriptive and analytic study including 61 patients with bipolar disorder meeting criteria of remission. We used the internalized stigma of mental illness (ISMI) to investigate self-stigma, and the functioning assessment short test (FAST) to assess functioning.
The mean age of patients was 43.4 years. The sex ratio was 2.4. Half of the patients were single or divorced (50 %). They had secondary or university education in 69 % of cases and were professionally inactive in 59 % of cases. The socioeconomic level was low or medium in 92 % of cases. A personal judicial record was found in 16 % of patients, a suicide attempt in 41 % of cases. Most patients in our series had bipolar I disorder (92 %). The mean age at onset of the disease was 23.5 years, with a mean duration of disease progression of 20 years. Patients were hospitalized an average of 5.9 times. Most patients (90 %) exhibited psychotic features during their mood relapses. The mean duration of the last remission was 27.9 months. Patients had regular follow-ups at our consultations in 87 % of cases. Among the patients included in the study, 8 % were on long-acting neuroleptics. The mean score on the internalized stigma of mental illness was 2.36±0.56. More than half of our patients (59 %) were self-stigmatized. Discrimination and alienation were found in 51 % of cases, followed by resistance to stigmatization (43 %) and assimilation of stereotypes (41 %). Regarding functioning, a global impairment was noted in more than two thirds of patients (71 %). An alteration in professional functioning was found in 82 % of cases and in cognitive functioning in 69 % of cases. Disruption of the financial sphere concerned 43 % of the patients, and the relational sphere 41 % of them. Autonomy was altered in 41 % of patients. Analysis of the relationships between self-stigma and characteristics of the study population revealed statistically significant associations between higher self-stigma scores and single or divorced status, low socio-economic level and judicial record. In terms of clinical parameters, the mean self-stigma score was significantly associated with a higher total number of thymic episodes and hospitalizations, a longer cumulative duration of hospitalizations and a shorter duration of the last remission. In addition, the mean self-stigma score was associated with significantly more impaired functioning.
Our study underlines the need to work towards the implementation of management modalities aimed at combating the self-stigmatization of patients with bipolar disorder and mitigating its negative consequences during the course of the disease.
双相情感障碍患者的自我污名化是一个被低估的问题，在临床严重程度以及社会和职业功能方面会产生严重后果。
本研究旨在评估双相情感障碍患者的自我污名化情况，确定与之相关的社会人口学和临床因素，并分析该人群中自我污名化与功能之间的联系。
我们进行了一项横断面、描述性和分析性研究，纳入了61例符合缓解标准的双相情感障碍患者。我们使用精神疾病内化污名量表（ISMI）来调查自我污名化情况，并使用功能评估简短测试（FAST）来评估功能。
患者的平均年龄为43.4岁。男女比例为2.4。一半的患者单身或离异（50%）。69%的患者接受过中等或高等教育，59%的患者无业。92%的患者社会经济水平为低或中等。16%的患者有个人司法记录，41%的患者有过自杀未遂。我们研究系列中的大多数患者为双相I型障碍（92%）。疾病的平均发病年龄为23.5岁，疾病进展的平均持续时间为20年。患者平均住院5.9次。大多数患者（90%）在情绪复发期间出现精神病性特征。上次缓解的平均持续时间为27.9个月。87%的患者在我们的门诊进行定期随访。纳入研究的患者中，8%使用长效抗精神病药物。精神疾病内化污名量表的平均得分为2.36±0.56。超过一半的患者（59%）存在自我污名化。51%的患者存在歧视和疏离感，其次是对污名化的抵抗（43%）和刻板印象的同化（41%）。关于功能，超过三分之二的患者（71%）存在整体功能损害。82%的患者存在职业功能改变，69%的患者存在认知功能改变。43%的患者存在财务领域的紊乱，41%的患者存在人际关系领域的紊乱。41%的患者自主性受到影响。对自我污名化与研究人群特征之间关系的分析显示，较高的自我污名化得分与单身或离异状态、低社会经济水平和司法记录之间存在统计学上的显著关联。在临床参数方面，自我污名化的平均得分与胸腺发作和住院的总数较多、住院的累计持续时间较长以及上次缓解的持续时间较短显著相关。此外，自我污名化的平均得分与功能损害明显更多相关。
我们的研究强调需要努力实施管理模式，以对抗双相情感障碍患者的自我污名化，并减轻其在疾病过程中的负面后果。
