Stigma and mental illness

The stimulus material below is based on a research article that describes a focus group study to investigate the effect of labeling of individuals with schizophrenia.

Schizophrenia has been found to be one of the most stigmatizing conditions. Most research on stigma has looked more at public opinions about the disorder, rather than on on the views of those living with schizophrenia. Aiming to explore stigma from the perspective of people with schizophrenia, a focus group study was carried out at the four centers in Germany. For each of the centers, three separate focus groups were established. One with people suffering from schizophrenia, one with their relatives and one with mental health professionals. 83 individuals participated in the study. Participants were recruited through letters of invitation which were distributed through the centers’ out-patient department.

Focus groups are group discussions with 8–12 participants. The moderator asked the group the following opening question: What has changed for you after you first developed schizophrenia? Tell me concrete incidences and stories that you experienced. The focus of the discussion was: concrete stigmatization experiences, ideas about the causes of stigmatization and suggestions for anti-stigma interventions.

The focus group sessions were tape- and video-recorded and transcripts were coded using an inductive method. Once the focus groups of those living with schizophrenia had been analyzed, a deductive content analysis was carried out on the transcripts of relatives and mental health professionals.

Results revealed several dimensions of stigma, including changes in interpersonal interaction, discrimination in the workplace and inequity in access to health care. For most of the patients, the diagnosis of schizophrenia had resulted in a reduction of social contacts. Relatives, too, observed how friends of the patient usually stayed away, did not come to see them at hospital or shied away from speaking with them. While the patients’ experience of stigma is dominated by the hurt they experience through the loss of social contacts and the fact that the illness shapes people’s perception of them, relatives feel that patients are particularly discriminated against through deficits in the quality of the treatment they receive, especially compared with health services available for patients with physical illness.

Source: Schulze, B, M. Angermeyer. Subjective experiences of stigma: A focus group study of schizophrenic patients, their relatives and mental health professionals. Social Science & Medicine 56 (2003) 299 - 312.

Answer all of the following three questions.

1. Evaluate the sampling method used in this study.

The study used a self-selected sample. There were, however, some traits that were required in order to be in the study. This included that the volunteers had to have a diagnosis of schizophrenia that was being treated on an out-patient basis. This is important because the goal of the study was to see how they were stigmatized in their interactions within their daily lives. Their parents/relatives also had to be willing to participate in the study. One of the strengths of using a volunteer sample is that the people are eager to participate. They are more likely to disclose more easily within the group setting. It is also a quick and efficient way to get a sample together. On the other hand, there are also limitations to such a sample. In a study like this, if the aim of the study is clear to the volunteers, it may lead to a non-representative sample. These may be people who feel particularly stigmatized and thus have something to say. In addition, the group may also be more verbally articulate, have more confidence or be more educated and thus volunteer for such a study.

2. Explain considerations involved before and during conducting the focus group interviews in this study.

Before starting the focus group, the team that will be carrying out the interviews needs to be adequately trained. The goal of the study is not to influence the responses of the participants, but to let them openly share their experiences. It is also important that the interviewer demonstrate empathy and is non-judgmental, leading to more disclosure within the group. The interviewer also needs to be trained to help the group stay on the question being asked and to deal with any problems within the group, such as a single member of the group dominating or intimidating other members of the group. The way in which data will be recorded and transcribed should be decided before the focus group and during the first meeting, this needs to be clearly explained to the participants and their consent obtained. It is also important that their right to confidentiality be maintained. During the interview process, the interviewer should make sure that everyone feels comfortable with the discussion and that a good rapport is established. This should help to minimize attrition within the study. It is also important that the interview uses active listening techniques - that is, affirming the comments made by the participants, asking clarifying questions and trying to make sure that the discussion in inclusive of all its participants.

3. Explain the effect of triangulation on the credibility of this study.

Because both the concept of stigmatization and the process of an inductive content analysis can be see as highly subjective, it is important that the researchers take steps to establish credibility. One way to do this is to take the findings back to the participants and see whether their conclusions represent the ideas of the participants. If they confirm that this was the meaning of what they had said, then this establishes credibility. But another way is to use triangulation. First, there were focus groups set up in four different cities in Germany. If there is a trend between the four locations, this shows that there may be more validity to the findings. In addition, the parents and health care workers were interviewed. Their comments confirmed the perceptions of the patients, even though they may have emphasized different concerns. For example, the relatives were most concerned about the disparity in health services; the health care workers were more concerned about the public image of those with schizophrenia; however, all four areas of concern were apparent in all three groups.
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Comments 2

Chandana Bhandari 9 March 2018 - 13:27

Hi John, For this stimulus piece if the students chooses purposive sample over self-selecting and justifies his choice of the same. Can we award him marks and if so, what would be the appropriate band for such an answer.

John Crane 10 March 2018 - 07:24

Dear Chandana

Yes, that would be fine.