J Dubreucq1,2,3,4, J Plasse5,6, F Gabayet2,3, M Faraldo2,3, O Blanc7, I Chereau3,7, S Cervello1,5,6, G Couhet8, C Demily1,9, N Guillard-Bouhet10, B Gouache2, N Jaafari10, G Legrand11, E Legros-Lafarge12, R Pommier13, C Quilès14, D Straub15, H Verdoux14, F Vignaga16, C Massoubre13, N Franck1,5,6. 1. Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France. 2. Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France. 3. Fondation FondaMental, Créteil, France. 4. Réseau Handicap Psychique, Grenoble, France. 5. Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France. 6. Centre référent lyonnais de réhabilitation psychosociale CL3R, centre hospitalier Le Vinatier, Lyon, France. 7. CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France. 8. Centre référent de réhabilitation psychosociale C2RP Nouvelle-Aquitaine Sud, Pôle de réhabilitation psychosociale, Centre de la Tour de Gassies, Bruges, France. 9. Centre de référence maladies rares Génopsy, pôle ADIS, centre hospitalier Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France. 10. CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France. 11. Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, 63037 Clermont-Ferrand Cedex 1, France. 12. Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France. 13. REHALise, CHU de Saint-Etienne, France. 14. Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux& Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France. 15. Centre de Réhabilitation Psychosociale, Centre Hospitalier de Roanne, France. 16. Dispositif de Soins de Réhabilitation Psychosociale, Centre Psychothérapeutique de l'Ain, France.
Abstract
BACKGROUND: Stigma resistance (SR) is defined as one's ability to deflect or challenge stigmatizing beliefs. SR is positively associated with patient's outcomes in serious mental illness (SMI). SR appears as a promising target for psychiatric rehabilitation as it might facilitate personal recovery. OBJECTIVES: The objectives of the present study are: (i) to assess the frequency of SR in a multicentric non-selected psychiatric rehabilitation SMI sample; (ii) to investigate the correlates of high SR. METHODS: A total of 693 outpatients with SMI were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluation included standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, and personal recovery and a large cognitive battery. SR was measured using internalized stigma of mental illness - SR subscale. RESULTS: Elevated SR was associated with a preserved executive functioning, a lower insight into illness and all recovery-related outcomes in the univariate analyses. In the multivariate analysis adjusted by age, gender and self-stigma, elevated SR was best predicted by the later stages of personal recovery [rebuilding; p = 0.004, OR = 2.89 (1.36-4.88); growth; p = 0.005, OR = 2.79 (1.30-4.43)). No moderating effects of age and education were found. CONCLUSION: The present study has indicated the importance of addressing SR in patients enrolled in psychiatric rehabilitation. Recovery-oriented psychoeducation, metacognitive therapies and family interventions might improve SR and protect against insight-related depression. The effectiveness of psychiatric rehabilitation on SR and the potential mediating effects of changes in SR on treatment outcomes should be further investigated in longitudinal studies.
BACKGROUND: Stigma resistance (SR) is defined as one's ability to deflect or challenge stigmatizing beliefs. SR is positively associated with patient's outcomes in serious mental illness (SMI). SR appears as a promising target for psychiatric rehabilitation as it might facilitate personal recovery. OBJECTIVES: The objectives of the present study are: (i) to assess the frequency of SR in a multicentric non-selected psychiatric rehabilitation SMI sample; (ii) to investigate the correlates of high SR. METHODS: A total of 693 outpatients with SMI were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluation included standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, and personal recovery and a large cognitive battery. SR was measured using internalized stigma of mental illness - SR subscale. RESULTS: Elevated SR was associated with a preserved executive functioning, a lower insight into illness and all recovery-related outcomes in the univariate analyses. In the multivariate analysis adjusted by age, gender and self-stigma, elevated SR was best predicted by the later stages of personal recovery [rebuilding; p = 0.004, OR = 2.89 (1.36-4.88); growth; p = 0.005, OR = 2.79 (1.30-4.43)). No moderating effects of age and education were found. CONCLUSION: The present study has indicated the importance of addressing SR in patients enrolled in psychiatric rehabilitation. Recovery-oriented psychoeducation, metacognitive therapies and family interventions might improve SR and protect against insight-related depression. The effectiveness of psychiatric rehabilitation on SR and the potential mediating effects of changes in SR on treatment outcomes should be further investigated in longitudinal studies.