Michal Mashiach-Eizenberg

The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders

In recent years, growing emphasis has been placed on the vision of recovery, which is broadly organized into two types: clinical objective versus personal subjective. The purpose of the present study was to investigate the relation between objective clinical recovery as defined by symptom severity and level of functioning, and subjective personal recovery as defined by quality of life, domains of personal confidence and hope, willingness to ask for help, reliance on others and no domination by symptoms. One hundred and fifty-nine persons diagnosed with schizophrenia or schizoaffective disorder completed measures of recovery, quality of life, perceived social support and emotional loneliness. Clinicians used the Modified Brief Psychiatric Rating Scale and the Global Assessment Functioning Scale to assess the severity of symptoms and level of functioning. Results revealed no direct correlation between total score of observer ratings of symptoms and total score of subjective self-report of being in recovery. The relationship between total score of symptoms and total score of subjective self-report of recovery was moderated by the age of onset. Magnitude of the self-report of subjective recovery was related to higher levels of reported social support and lower levels of reported loneliness. Finally, analyses suggested that the impact of social support and loneliness upon self-reported recovery was mediated by quality of life. Taken together, results are consistent with literature suggesting that clinical objective recovery is not synonymous with personal subjective recovery yet can be conceptualized as complementary.

Internalized stigma and quality of life among persons with severe mental illness: The mediating roles of self-esteem and hope

Research has revealed the negative consequences of internalized stigma among people with serious mental illness (SMI), including reductions in self-esteem and hope. The purpose of the present study was to investigate the relation between internalized stigma and subjective quality of life (QoL) by examining the mediating role of self-esteem and hope. Measures of internalized stigma, self-esteem, QoL, and hope were administrated to 179 people who had a SMI. Linear regression analysis and structural equation modeling (SEM) were used to analyze the cross-sectional data. Self-esteem mediated the relation between internalized stigma and hope. In addition, hope partially mediated the relationship between self-esteem and QoL. The findings suggest that the effect of internalized stigma upon hope and QoL may be closely related to levels of self-esteem. This may point to the need for the development of interventions that target internalized stigma as well as self-esteem.

Narrative Enhancement and Cognitive Therapy (NECT) Effectiveness: A Quasi-Experimental Study

OBJECTIVE Accumulated evidence suggests that approximately one third of people with a serious mental illness (SMI) experience elevated self-stigma. Narrative enhancement and cognitive therapy (NECT) is a structured group-based intervention aimed to reduce self-stigma. The current study aims to examine the effectiveness of NECT. A quasi-experimental design. DESIGN Baseline and follow-up data were collected and outcomes were compared between 63 persons with SMI who participated in NECT and 56 persons who received treatment as usual. RESULTS The NECT treatment group showed significant (p < .05) reductions in self-stigma and increases in self-esteem, quality of life, and Hope-Agency scores between pre- and posttreatment assessments, compared with the control group. CONCLUSIONS The current results provide preliminary support for the use of NECT as an effective treatment to reduce self-stigma and its implications for treatment and practice are discussed.

Between self-clarity and recovery in schizophrenia: reducing the self-stigma and finding meaning

Although there are extensive theoretical reviews regarding the self-experience among persons with schizophrenia, there is limited research that addresses the implications of self-clarity on the recovery of persons with schizophrenia while exploring the role of possible mediators within this process. Accordingly, the current study explored the relationship between self-clarity and recovery while examining the possible mediating role of self-stigma and sense of meaning in life. 80 persons with schizophrenia or schizoaffective disorder were administered four scales: self-concept clarity, self-stigma, meaning in life, and recovery. Results confirmed the hypothesized model in which self-clarity affects self-stigma, self-stigma affects meaning in life, and meaning in life affects recovery. No direct relationship was uncovered between self-clarity and recovery. Implications of the current study for future research and clinical practice are discussed with the emphasis on the importance of the self-experience with regard to the process of recovery.

Measuring the internalized stigma of parents of persons with a serious mental illness: the factor structure of the parents' internalized stigma of mental illness scale.

Abstract Research has revealed that approximately one third of persons with a serious mental illness (SMI) experience elevated internalized stigma, which is associated with a large number of negative outcomes. Family members of persons with SMI are also often subject to stigma, but the degree to which these experiences are internalized and lead to self-stigma has rarely been studied. The present study investigated the factor structure of a modification of the Internalized Stigma of Mental Illness (ISMI) scale by Ritsher, Otilingam, and Grajales (Psychiatry Res 121:31–49, 2003). A central assumption of this investigation was that the factor structure of the Parents’ Internalized Stigma of Mental Illness (PISMI) scale would be similar to the factor structure of the ISMI scale. A total of 194 parents of persons with SMI completed the PISMI scale. The results revealed that the PISMI scale has high internal consistency and that it is made up of three distinctive factors: discrimination experience, social withdrawal and alienation, and stereotype endorsement. These factors are similar, but not identical, to the factors that underlie the ISMI scale. This study’s findings also indicate that parents’ prominent reaction to self-stigma is stereotype endorsement.

Housing Model for Persons with Serious Mental Illness Moderates the Relation Between Loneliness and Quality of Life

This study compared levels of loneliness, quality of life (QOL) and social support among people with serious mental illness (SMI) living in two different types of housing: group homes and supportive community housing. Forty persons with SMI living in supportive community housing and 57 living in a group home completed measures of QOL, symptoms, perceived social support and loneliness. Analysis of variance tests were conducted to examine whether there were differences in degree of loneliness, QOL and social support between the groups living in the two residential types. No significant differences between the two housing models were found. Correlational analysis, however, indicated a strong relationship between loneliness and QOL. Subsequent regression analysis revealed that residence in group homes moderates the relationship between social loneliness and QOL, such that social loneliness impacted QOL only among group home residence. Implications of the findings for understanding the impact of housing on QOL are discussed.

Confirmatory factor analysis of the brief version of the recovery assessment scale.

Abstract The Recovery Assessment Scale (RAS) is a 41-item scale that assesses perceptions of recovery (article by Corrigan, Salzer, Ralph, Sangster, and Keck [Schizophr Bull 30:1035–1041, 2004]). This article presents a confirmatory factor structure of a brief 20-item version of the RAS and investigates its relation to measures of quality of life, symptoms severity, social support, loneliness, and functioning. The validation sample included 152 persons with serious mental illness living in the community. The results of the confirmatory factor analyses of the RAS yielded four factors: personal confidence and hope, willingness to ask for help, reliance on others, and no domination by symptoms. Subsequent regression analysis showed that these factors were related to some of the measures assessed in the study, providing support for the convergent and discriminate validity of the RAS. The study findings support the convergent and discriminate validity of the brief version of the scale.

How long should women persevere with IVF

The Israeli public health insurance system covers an (almost) unlimited number of IVF cycles. In a global context, this is a policy which is looked upon as a northern star. However, many women may continue IVF treatment when the probability of a successful pregnancy is ‘zero’. This paper argues that the implication of a policy of unlimited rounds of IVF from the perspective of the ‘culture of perseverance’ that develops in IVF clinics has not yet been fully assessed. A systematic long term assessment of the health and welfare of women after IVF in Israel - especially after prolonged treatment with IVF - is necessary. In a global context, an evidence-based policy on ART may improve both the allocation of resources and the duty of care, not only in Israel, but also in other countries.

Reprogenetics, Genetic Tools and Reproductive Risk: Attitudes and Understanding Among Ethnic Groups in Israel

The present study investigated a possible relationship between the attitudes toward genetic technologies and the understanding of genetics, reproduction, and reproductive risk among Israeli Arabs and Israeli Jews. The study included 203 respondents, who answered a structured self-report questionnaire. They were recruited using a snowball method, which increased the participation of Israeli Arabs in the sample, although the sample was not representative of the Israeli population as a whole (there were more Arabs and fewer men). The respondents in this study expressed a positive attitude toward genetic technologies, but were less in favor of using genetic tools for non-medical purposes. Respondents of both groups were not knowledgeable of genetics; however, they scored higher on the items related to reproductive risk, which suggests that some awareness about genetic risk exists in both sectors of the Israeli population. Nevertheless, Israeli Arabs were less positive than Israeli Jews regarding the application of genetic tools. Moreover, although an understanding of genetics correlated positively with the attitude among Arabs, it did not affect the attitude of Jews, who remained very positive, regardless of their level of understanding. This result suggests that other social and cultural factors, besides understanding, might be at work among these two major ethnic sectors. Further studies that integrate educational, social, and cultural aspects among ethnic sectors of the population are required to improve health services and genetic counselling in Israel and in other countries.

Self-concealment among couples who cope with chronic illness: development and preliminary validation of the Couples Illness Self-Concealment (CISC) questionnaire

PurposeThe aim of this study was to develop and assess the psychometric characteristics of a new brief self-report measure, which evaluates self-concealment behavior in the context of couples coping with chronic illness.MethodsThe Couples Illness Self-Concealment (CISC) scale was developed, emphasizing the active process involved in self-concealment. It was then tested among 56 cancer patients and partners of cancer patients. Correlations and multiple regression analysis were used to assess the internal consistency reliability and validity of the scale.ResultsPsychometric evaluation of the CISC final version, which includes 13 items, provides evidence that the scale has high internal consistency reliability. The findings support the construct validity of the scale, examined by both convergent validity and between group differences (patients vs. spouses).ConclusionsThe CISC scale has acceptable psychometric qualities, internal consistency reliability and validity. The use of CISC may assist in revealing important aspects of couple’s illness communication patterns, and enable examination of possible links between self-concealment behavior in the context of illness, and psychological outcome. It may also contribute to the assessment of interventions aimed at enhancing communication between partners coping with chronic illness.