Interventions for Reduction of Stigma in People with Schizophrenia: A Systematic Review and Meta-analysis

S. Chuang, Jo Yung-Wei Wu, C. Wang
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Abstract

People with schizophrenia experienced a higher level of internalized stigma compared to people with other mental disorders. Internalized stigma could lead to pervasive negative effects in their life. Although internalized stigma interventions have shown some benefits, there is a dearth of interventions and meanwhile a lack of evidence as to their effectiveness in people with schizophrenia. This study aims at examining the effectiveness of internalized stigma reduction in people with schizophrenia through a systematic review and meta-analysis. Two electronic databases were searched. Studies were included if they (1) involved community or hospital-based interventions on internalized stigma, (2) included participants who were given a diagnosis of schizophrenia, and (3) were empirical and quantitative in nature. Thirteen articles were selected for extensive review and seven for meta-analysis. A variety of psychosocial interventions were utilized with the majority employing psychoeducation, cognitive behavioral therapy (CBT), social skills training, hope instillation program, and against stigma program. The internalized stigma was used to examine the efficacy of the intervention. Seven studies involving a total of 799 patients were included in the meta-analysis. Assuming a random effects model, the meta-analysis revealed an improvement in internalized stigma favoring the internalized stigma intervention (95% confidence interval [0.492; 1754], P = 0.001), but the heterogeneity among individual effect sizes was substantial (I 2 = 93.20%). Most internalized stigma reduction programs appear to be effective. This systematic review was unable to show light in indicating the most effective intervention, however, demonstrates evidence that psychoeducation is promising. Large-scale randomized control trials and multicomponents of intervention are required to further develop the evidence based of more targeted interventions.
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减少精神分裂症患者耻辱感的干预措施:系统回顾和元分析
与其他精神疾病患者相比,精神分裂症患者的内化成见程度更高。内化成见会给他们的生活带来普遍的负面影响。尽管内化成见干预措施已显示出一些益处,但干预措施仍然匮乏,同时也缺乏证据表明这些措施对精神分裂症患者有效。本研究旨在通过系统综述和荟萃分析,研究减少精神分裂症患者内化成见的有效性。研究人员检索了两个电子数据库。纳入的研究必须:(1)涉及社区或医院的内化成见干预措施;(2)纳入被诊断为精神分裂症的参与者;(3)具有实证和定量性质。其中有 13 篇文章被选中进行广泛的综述,7 篇文章被选中进行荟萃分析。这些文章采用了多种社会心理干预措施,其中大多数采用了心理教育、认知行为疗法(CBT)、社交技能培训、希望灌输计划和反对成见计划。内化成见被用来检验干预措施的效果。共有 799 名患者参与了七项研究的荟萃分析。假设采用随机效应模型,荟萃分析结果显示,内化成见干预对内化成见的改善更有利(95% 置信区间 [0.492; 1754],P = 0.001),但单个效应大小之间的异质性很大(I 2 = 93.20%)。大多数减少内化成见的计划似乎都很有效。本系统综述无法显示出最有效的干预措施,但有证据表明心理教育很有前景。需要进行大规模的随机对照试验和多成分干预,以进一步发展更有针对性的干预措施的证据基础。
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