SOCIO-DEMOGRAPHIC CORRELATES OF STIGMATIZATION OF PSYCHIATRIC PATIENTS AMONG HEALTH CARE WORKERS IN NEUROPSYCHIATRIC HOSPITAL, ENUGU

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Abstract

The purpose of the study was to determine the socio-demographic correlates of stigmatization of psychiatric patients among health care workers in neuropsychiatric hospital, Enugu. Eight objectives with corresponding research questions and seven hypotheses were postulated to guide the study. A descriptive correlational survey research design was employed for the study. The instrument for data collection was the researcher-designed questionnaire titled socio- demographic correlates of stigmatization of psychiatric patients’ questionnaire, (SODCOSPQ).Three of the experts were drawn from the Department of Health and Physical Education, and two from the Department of Psychology for face validation. The population of the study was 210 health care workers (HCWs). They were all involved in the study.  This was because the population was manageable.  A total of two hundred and ten copies of the questionnaire were distributed and one hundred and seventy nine copies were properly completed and used for the study. Cronbach Alpha was used for test of reliability. The research question one was answered using a criterion mean.  The relationship of HCW’s variables against the psychiatric patient was analyzed applying Pearson’s Product Moment Co-efficient. Wilson (1989) principle for interpretation of value ‘r’ was employed for the research questions of two to eight, and  linear  regression was used for testing  of the null  hypotheses at .05 level of significance. The result of the study showed that HCWs stigmatization status of psychiatric patients was negative (grand = 2.40 < 2.50, SD = .845) Table 1. The result further showed that the correlation between HCWs’ age, religious denomination, and level of education, gender, specialization, marital status, rank, and stigmatization of psychiatric patients indicated very low correlation respectively. The linear regression test for the hypotheses indicated that there were no significant relationship between HCWs’ religious denomination, level of education, gender, specialization, marital status, and stigmatization of psychiatric patients. However, this test revealed that significant relationship exists between HCW’s age, rank and stigmatization of the psychiatric patients.

 

CHAPTER ONE

Introduction

Background to the Study

Stigma is a social menace. It leads to captivity when perpetrated, and holds one in bondage for the rest of one’s life. It involves the reaction of others which spoils one’s normal identity. Sometimes, it results from the perception or attribution which may be right or wrong but once marked and labeled becomes indelible. Stigmatization deals with linking negative attributes to an individual or groups of individuals which usually culminates in separation of ‘us’ and ‘them’ (Link & Phelan, 2006). This ‘us’ and ‘them’ according to Link and Phelan (2006) implies that the labeled group is slightly less human. The attributes the society selects in labeling and stigmatizing differs according to time and place and what is considered out of place in one society may be a norm in another. The argument as to whether stigmatization is fixed or inherited is yet to be resolved but what is more important is its dangerous effect on the individual or group of individuals whom the society identified and labeled as deviant and therefore, stigmatized. Stigma lowers self-esteem, induces isolation and robs one the opportunity to be one’s best. One can be stigmatized based on one’s ethnicity, nationality, physical disabilities, diseases, and psychiatric illness among others.        

Stigmatization is the process wherein one condition or aspect of an individual is attributionally linked to some pervasive dimension of the target person’s identity (Mansouri & Dowell, 1989).Goffman (1963) defined stigmatization as demeaning and discrediting attributions arising during social interaction. Koomen and Dijke (2007) defined stigmatization as the process by which an individual’s or group’s character or identity is negatively responded to on the basis of the individual’s or group’s association with a past, imagined, or currently present deviant condition, often with harmful physical or psychological consequences for the individual or group. They observed that deviant condition may or may not actually be present; what is important is that the individual is associated with a past or present deviant condition and hence that the perceiver cannot but respond to the motivational implications of that deviant condition, imagined or not.

 Stigmatization involves dehumanization, threat, aversion, and sometimes the depersonalization of others into stereotypic caricatures (Heatherton, 2000). Stigmatization involves a separation of individuals labeled as different from “us” who are believed to possess negative traits, resulting in negative emotional reactions, discrimination, and status loss for the stigmatized persons (Link & Phelan, 2001). Lee (2002) noted that the most characteristic feature of stigmatization is to publicly associate a person with a shameful deviant condition. In the context of this work, stigmatization is a perception, attribution, character devaluation which may rightly or wrongly be ascribed to an individual or group of individuals which often results in status loss and discrimination. Stigmatization performs several functions.

             One of its functions is that it enhances the well-being of the stigmatizer. Heatherton (2000) noted that stigmatizing others can serve several functions for an individual, including self-esteem enhancement, control enhancement, and anxiety buffering. For example, in relatively large social groups or societies people need to identify and label particular individuals in terms of their (association with a) deviant condition in order to warn each other of these individuals’ bad or shameful reputation or dangerous character. Stigmatization manifests itself in different ways.

Goffman (1963) observed that stigmatization is manifested in three different ways:  abomination of the body, blemishing of individual character and tribal stigmatization. According to him, the first manifestation refers to negative attributions directed toward physical appearance; the second includes negative attributions towards one’s personal character and the latter implies negative attributions toward religious, ethnic, racial communities among others. Similarly, Sailard (2010) conceptualized stigmatization process into ‘internalized stigma’ and ‘institutional stigma’. Internalized stigmatization involves the emotions, thoughts, beliefs and fears that people experience in their private domain while institutional stigmatization takes place in the public domain. Institutional stigmatization involves indirect, non-personal, implicit attitudes and relationship. Sailard (2010) further noted that people with mental illness can be exposed to institution stigma both in the workplace and also in their preferred health institutions. For example, Lykouras and Douzenis (2008) stated that stigmatization is the underlying cause for doctors’ neglect to examine the physical complaints of people with psychiatric illness. It follows that negligence and hesitation on the physicians’ part provide striking evidence of institutional stigma. According to Ewhurdjakpor (2010) in Nigeria, like most developing economies, psychiatric services is amorphous with few heavily overburdened bucreaucratic institutions due to some cultural practices and systemic crisis in the society. Ewhrudjakpor further noted that lip service is paid to the issue of improving the mental health care structures and service. Psychiatric illness affects everyone directly or indirectly.

Psychiatric illness can affect persons of any age and they can occur in any family. Levin and Laar (2010) opined that individuals are all likely to have to deal with mental illness at some time, whether in family members, work colleagues or themselves. Morrison (1997) stated that if ineffective or maladaptive behaviours interfere with daily activities, impair judgment, or alter reality, the person is said to be mentally ill.  In this work mentally ill and psychiatric patient are used interchangeably.  In the context of this work, a psychiatric patient is an individual who is unable to maintain satisfying personal relationships, has an exaggerated normal mental state and is unable to contribute for the well-being of his or her community.

Psychiatric patients with physical illness do not have access to same quality health services in comparison to other patients. The reason is the stigmatizing attitude of health care workers (Corrigan & Penn, 1999). Health care worker refers to all people delivering health services. For the purpose of this work the researcher is interested in health care workers such as psychiatric resident doctors, psychiatric nurses, clinical psychologist, pharmacists, laboratory scientists, consultant psychiatrist, and social welfare staff. Related studies in several parts of the world suggest that health workers stigmatize psychiatric patients. Healthcare workers in Neuropsychiatric Hospital, Enugu may not be completely free from these unfavourable dispositions towards psychiatric patients. It is in line with the above views that the researcher seeks to determine whether the health care workers stigmatize and socio- demographic variables that are likely to contribute to the stigmatization of psychiatric patients by the Health Care Workers in Neuropsychiatric Hospital, Enugu. There are many socio-demographic factors that are likely to contribute to health care workers stigmatization of psychiatric patients.

The present study is concerned with demographic factors of gender, age, level of education, and religion, marital status, specialization, and rank.  Socio according to Hornby (2007) is connected with society or the study of society. Weeks (1999) noted that demography is concerned with virtually everything that influences or can be influenced by population size, distribution, processes, structure or characteristics. Correlation involves establishing if any relationship exists between two or more variables.

Hornby (2007) stated that to correlate is to show that there is a close connection between two or more facts. In the context of this work, correlate deals with establishing if any relationship exists between HCW’s age, gender, and level of education, religion, marital status, specialization, rank and stigmatization of psychiatric patients. According to Koul (2009) when we study bivariate data we may like to know the degree of relationship between variables of such data. This degree of relationship is known as correlation. Anaekwe (2007) stated that measures of correlation or association are the degree of relationship or association between two or more variables. Socio-demographic variables of interest are discussed.

        Gender is a strong factor that can influence stigmatization of psychiatric patient. Phelan, Bromet and Link (2000) stated that family members were more likely to conceal psychiatric illness if they did not live with the ill relative, if the relative was a female. There is some evidence that male gender is linked to greater stigmatizing attitudes, although results across studies are not consistent (Chandra & Moses, 2009). This concurs with a survey of some undergraduate students on the impact of diagnosis, attitudes about treatment and psychiatric terminology on stigma associated with psychiatric illness.  This study found that less stigmatization of mental illness among male than female exist.

 Age has influence on stigmatization of psychiatric patients. According to (Jorm & Wright, 2008) the relationship between age and stigma appears to be complex and may be linked to increases in some stigmatising attitudes but not others. Farina (1984) stated that young members of the public are likely to stigmatize and discriminate against the mentally ill because others members of the society do. This may be due to the fact that the younger generation learn from older and therefore may perceive stigmatization and discrimination as a norm. These seems to concur with the assertion of Walker (2008) that stigmatizing attitudes towards people with mental disorders are common in adolescents and are of major concern to those with these disorders. Such attitudes may act as barriers to help-seeking, can interfere with treatment and adversely affect quality of life as they may cause a person to feel abnormal, socially disconnected and dependent on others (Corrigan, 2004).Education is a strong factor that influences stigmatization of psychiatric patients.

Education has been widely perceived as one of the most important socioeconomic determinants of health and mortality. There is considerable evidence that low educational attainment is strongly correlated with diseases, health risks and mortality (Winkleby, 1992). It has been suggested that education affects health and mortality through a number of pathways, such as lifestyle, health behaviour, problem-solving abilities, social relations, self-esteem and stress-management, as well as through income or occupation (Preston, 1996).In other words education contributes to ones well-being. Pinfold (2003) stated that an improved understanding of factors predicting stigma may help in the development of interventions to reduce stigma from peers and improve help-seeking for those developing mental disorders. According to him, there is some evidence that receiving mental health information at school can result in reductions in stigmatizing attitudes. Moses (2009) further asserted that a mutual understanding of stigma, achieved through education, could eliminate social stigma entirely.

Religion may also influence stigmatization of a psychiatric patient. Morrison (1997) opined that many times, mental health clients may have religious components to their illness. Moreover, Schlosberg (1993) observed that western societies have always linked the idea of morality and virtue with health and reason, and early Christian societies tainted psychiatric illness with the images of the demonic, the perverse, the promiscuous and the sinful. Schlosberg further noted that knowledge of these associations is necessary to understand the origins and perpetuation of psychiatric stigma.  Furthermore, in the New Testament , one of the most famous miracles of healing (Mark 5:1-20) is the restoration of sanity to a man so stigmatized by his villagers that he was hunkered down  in the graveyard. Marital status can influence stigmatization.

Marital status is an important determinant of wellness and illness states in our health status.  Whether someone is single, married, divorced or separated from his or her spouse has long been shown to be related the risks and patterns of morbidity, mortality and utilization of health and medical services and their capacity to practice health promoting behaviours (Abanobi, 2005). The author’s personal experience suggests that stigmatization of psychiatric patients is lower among married couples that unmarried ones. According to Smith and Zick (1994) married people have significantly better health and a lower mortality than their single counterparts. They noted that as people age and die, there is an increase in the proportion of widows and widowers. This can bring economic, social, psychological and other changes.

Furthermore, studies suggest that married people have a lower prevalence of psychological and psychiatric disorders, higher self-ratings of mental health, and more optimistic attitudes in comparison to their never-married and previously married counterparts. Similarity, married people have also shown lower rate of outpatient treatment for mental illness, lower rate of admission to psychiatric facilities, and a lower suicide rate. Following from above, one may be tempted to believe that marital status is likely to influence stigmatization of psychiatric patients. In other words, married health care workers are likely to show les stigmatization for patients than their single counterparts. One’s choice of specialization is likely to determine one’s stigmatization status.

Specialization influences stigmatization of psychiatric patients. The need for quality and standardization of graduate medical education necessitated specialization. This field contains the segment of the population that a health care service provider chooses to service a specific medical service, a specialization in treating a specific disease, or any other descriptive characteristics about the provider’s practice relating to the services rendered of the practitioner at a specific organization unit. Rank deals with position one occupies. Studies have shown that qualified staff general felt better equipped to cope with psychiatric patients depending on their psychiatric experience. Filipcic (2003) observes that trainee doctors have been found to have stigmatizing attitudes to mental illness, largely based upon fear and ignorance. There are some theories pertinent in this work.

This study was anchored on four theories. These were theories of reasoned action, social learning theory, labeling theory, and unitary theory of stigmatization. Theory of reasoned action is based on the assumption that most behaviour of social relevance are under willful control. According to this theory, a person’s intention to perform a specific behaviour is a function of two factors namely attitude (positive or negative) towards the behaviour and the influence of the social environment on the behaviour. Social learning theory plays significant role in understanding of how society transmits stigmatization from one generation to another.

 The social learning theory maintains that environment which includes family members, friends, colleagues and physical environment influences the behaviour of the public. The young members of the public are likely to stigmatize and discriminate against the mentally ill because others members of the society do. They are likely to emulate the behaviour of the older members of public and interpret it as a norm. The next important theory is labeling theory which deals with deviant behaviour or social stigma.

The labeling theory is concerned with how the self-identity and behaviour of individuals may be determined or influenced by the terms used to describe or classify them. This theory viewed stigma as a powerfully negative label that changes a person’s self-concept and social identity. The unitary theory of stigmatization helps to unravel the purpose of the stigmatizers.

The unitary theory of stigmatization is of the view that labeling and discrimination of others could occur even when the labeled individuals do not portray the features, characteristics or deviant behaviour in which they are being labeled and discriminated against. The theory maintains that stigmatization can sometimes be tied so closely to self- interest which is the basis of most human behaviour.

SOCIO-DEMOGRAPHIC CORRELATES OF STIGMATIZATION OF PSYCHIATRIC PATIENTS AMONG HEALTH CARE WORKERS IN NEUROPSYCHIATRIC HOSPITAL, ENUGU