Stigma impacts functioning in bipolar disorder

By Mark Cowen, Senior medwireNews Reporter

Higher levels of perceived stigma are associated with poorer functioning in patients with bipolar disorder (BD), research shows.

The team also found that increased depressive symptoms, older age at diagnosis, and older age at onset of treatment were significantly associated with poorer functioning in patients with the mood disorder.

"Despite the claim that stigma is innocuous, it strongly influences the life experiences and the self-esteem of bipolar patients," comment K Ceresér (Federal University of Rio Grande do Sul, Porto Alegre, Brazil) and colleagues. "Moreover, stigma can affect important functioning areas of these individuals."

The researchers studied 60 outpatients (73% women) with BD who were aged an average of 48 years.

Perceived stigma was assessed using the Stigma Experiences Scale (SES) and the Stigma Impact Scale (SIS). The SES score ranges from 0 to 10 and the SIS from 0 to 49, with higher scores on both tests equating to greater levels of perceived stigma.

Functionality was assessed using the 24-item Functioning Assessment Short Test (FAST), which evaluates six specific functioning areas; autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. Each of the 24 items are assessed on a difficulty scale of 0 (no difficulty) to 3 (severe difficulty).

The participants were also assessed for psychiatric symptoms using the Young Mania Rating Scale (YMRS) and the 17-item Hamilton Rating Scale for Depression (HAM-D), with higher scores indicating greater symptom severity.

Overall, median total SES, SIS, FAST, YMRS, and HAM-D scores were 5.04, 32.46, 26.5, 2.0, and 8.5, respectively.

The researchers found that SIS and SES scores were significantly and positively associated with FAST and HAM-D total scores, but not with YMRS scores.

Furthermore, older age at diagnosis and treatment initiation was positively associated with SIS and SES scores.

Ceresér and team conclude in the Journal of Psychiatric and Mental Health Nursing: "This study demonstrated that poor functioning is significantly correlated with perceived stigma in patients with BD."

They add: "The impact of stigma in the lives of people who have BD… indicates why it is critical for mental health research and policy to address stigma with intensity."

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