Paweł Grygiel

Loneliness mediates the relationship between internalised stigma and depression among patients with psychotic disorders

Background: Stigmatisation is a source of chronic stress and a major barrier to recovery for people with mental illnesses. The internalisation of stigma can have a negative impact on an individual’s social relations and lead to feelings of loneliness and depression. Aim: This research is aimed at testing the hypothesis that the internalised stigma of mental illness contributes to the intensification of depressive symptoms indirectly, through its impact on feelings of loneliness. Methods: A total of 110 individuals with diagnoses of psychotic disorders (International Classification of Diseases–10th Revision (ICD-10): F20–F29) were assessed with measures of internalised stigma, loneliness, depression, positive and negative symptoms and global functioning. The ordinary least squares regression was used for data analysis. Results: After adding loneliness to the regression model, the initially significant impact of internalised stigma on depressive symptoms disappeared. As expected, loneliness proved to be a full mediator in the relationship between stigma and depression. Conclusion: The study findings provide useful insights into the mechanisms of the harmful effects of stigma on people with mental illness. Internalised stigma and loneliness should be considered important targets for interventions aiming to promote recovery.

Experiences of stigma and discrimination among users of mental health services in Poland.

Stigmatization is commonly recognized as one of the main barriers to recovery and to social inclusion of people with mental illnesses. This exploratory study investigated the frequency, type, and sources of actual stigma and discrimination experiences among Polish psychiatric patients. A total of 442 people, treated in various psychiatric health care facilities in Warsaw, were interviewed with the use of the Consumer Experiences of Stigma Questionnaire (CESQ). Qualitative data regarding sources of experienced stigma were also obtained. The respondents reported relatively frequent experiences of stigmatization in everyday situations and interpersonal relations, but they seldom complained of any specific instances of discrimination. The most frequently reported source of stigma was employers and supervisors at work, followed by family, and general community members. Implications of the findings for clinical practice and policy are discussed.

Peer Rejection and Perceived Quality of Relations With Schoolmates Among Children With ADHD.

Objective: The main aim of the current study was to investigate the links between ADHD diagnosis and the objective and subjective dimensions of social relationships among children from primary schools. Method: We used the data from 36 regular classrooms, consisting of 718 students, with each containing at least one child with an established clinical diagnosis of ADHD (38 children). Results: For children with ADHD, the level of the perceived quality of social relations was lower than that of children without such a diagnosis. After controlling for sociometric status, the impact of ADHD on perceived status proved to be statistically nonsignificant but the indirect impact of ADHD on this status through sociometric status was statistically significant. Conclusion: Children diagnosed with ADHD are more often rejected by their peers and have a more pessimistic view of their social world. Moreover, ADHD diagnosis does not have a direct influence on the perceived quality of social relations otherwise than through sociometric status.

Exploring Factors Associated with the Psychosocial Impact of Stigma Among People with Schizophrenia or Affective Disorders

Stigmatization can exert a variety of pernicious effects on the lives of persons with mental illnesses. The purpose of this study was to explore factors related to the psychosocial impact of stigma among 229 people receiving psychiatric treatment: 123 with schizophrenia [International Classification of Diseases, 10th Revision (ICD-10): F20] and 106 with affective disorders (ICD-10: F31–F33). In the whole sample, the factors most prominently associated with a greater impact of stigma on personal and family life were schizophrenia diagnosis, current inpatient treatment, actually experienced stigma and self-stigma. However, the patterns of predictors varied between the two diagnostic categories. For the schizophrenia group, only self-stigma significantly contributed to a stronger stigma impact. In the affective group, a more severe impact of stigma was significantly predicted by inpatient status and experienced stigma. Anti-stigma programs should address the specific features of stigmatization associated with various psychiatric diagnoses.

Experiences of discrimination and the feelings of loneliness in people with psychotic disorders: The mediating effects of self-esteem and support seeking

OBJECTIVE People with psychotic disorders frequently become targets of discrimination, which may have devastating effects on their social relations and lead to the feelings of loneliness. This study has explored whether self-esteem and support seeking serve as mediators in the relationship between experiences of discrimination and loneliness. METHODS A total of 110 persons with psychotic disorders (International Classification of Diseases, 10th Revision (ICD-10): F20-F29) were evaluated with self-report measures of discrimination experiences, self-esteem, support seeking and loneliness. The relationships between variables were examined with path modeling. Bootstrap mediation analyses were used for testing the statistical significance of indirect effects. RESULTS Experiences of discrimination have been demonstrated to increase the level of loneliness both directly and indirectly. The indirect effect of discrimination on loneliness via self-esteem decrement has been proven to be significant. Support has been also found for a mediation model in which discrimination experiences negatively affect self-esteem, an undermined self-esteem diminishes the tendency to seek social support, and reduced support seeking worsens the sense of loneliness. However, discrimination experiences and support seeking have turned out to be unrelated and thus the hypothesized indirect effect of discrimination on loneliness through the weakening of the willingness to seek social support has not been confirmed by the data. CONCLUSIONS The findings contribute to the understanding of the mechanisms through which experiences of discrimination aggravate perceived social isolation. Self-esteem and the tendency to seek social support have emerged as possible targets for interventions aiming to counteract the negative influence of rejection experiences on social relationships of people with psychotic disorders.

The intensity and correlates of the feelings of loneliness in people with psychosis

OBJECTIVE Loneliness is an established risk factor for numerous negative health outcomes. The aims of the present study were to compare the levels of loneliness between patients with psychotic disorders and members of the general population and to identify factors independently associated with loneliness in psychosis. METHODS A total of 207 patients with psychotic disorders recruited between February 2013 and February 2015 from inpatient and day wards and an outpatient clinic of the Institute of Psychiatry and Neurology (IPN) in Warsaw (Poland) were included in this cross-sectional study. They were administered the De Jong Gierveld Loneliness Scale (DJGLS) and a set of instruments assessing three types of explanatory variables: socio-demographic, psychosocial and psychiatric (clinical). The comparison group was a random sample of 20,000 inhabitants of Poland who took part in the Generations and Gender Survey (GGS-PL) conducted in 2011. The two groups were matched for socio-demographic characteristics. RESULTS The patient sample proved to be significantly lonelier than the general population sample. The higher level of loneliness in people with psychotic disorders was most strongly related to psychosocial factors, particularly more severe internalized stigma and lesser social support, followed by worse interpersonal competence and smaller social network. After adjusting for socio-demographic and psychosocial variables, the only clinical variable significantly associated with more intense feelings of loneliness turned out to be the greater number of psychiatric inpatient admissions. The findings did not lend support to the view that socio-demographics play a major role in explaining variation in loneliness in psychosis. CONCLUSIONS People with psychotic disorders are predisposed to experiencing elevated levels of loneliness. To counteract the pernicious effects of this on their health and well-being, there is a need for comprehensive therapeutic programs targeting self-stigma, enhancing social support networks and improving social skills.

The Stigma subscale of the Consumer Experiences of Stigma Questionnaire (CESQ): A psychometric evaluation in Polish psychiatric patients

OBJECTIVE There is a scarcity of well validated measures of the subjective experience of the stigma of mental illness. The aim of this paper was to evaluate the psychometric properties of the Stigma subscale of the Consumer Experiences of Stigma Questionnaire (CESQ). METHODS A secondary analysis of the data from two cross-sectional studies using the CESQ was conducted in order to assess the factor structure, internal consistency and concurrent validity of the Stigma subscale. Sample 1 included 373 diagnostically heterogeneous patients (65% had psychotic disorders) and Sample 2 included 136 patients with schizophrenia. RESULTS Since none of the factor models of the original 9-item scale was satisfactory, it was shortened by removing two psychometrically weakest items. The abbreviated 7-item scale proved to be a one-dimensional instrument, with good estimates of internal consistency. Its concurrent validity was partly confirmed by demonstrating negative correlation with quality of life and positive correlations with self-rated psychopathological symptoms. However, contrary to theoretical expectations, the stigma score was not associated with global functioning and clinician-rated symptoms. CONCLUSIONS The psychometric properties of the Stigma subscale of the CESQ may be improved by shortening the instrument. Although the reliability and validity of the abbreviated version were partly established, further research is needed to explore in particular its test-retest reliability and concurrent validity.

The sense of coherence as a predictor of the scope and impact of stigma experiences among people with mental illness

This study explored the role of the sense of coherence (SOC) in predicting the scope and impact of stigma experiences in 229 patients with schizophrenia or affective disorders. Findings revealed that SOC significantly predicted lower levels of stigma, accounting for 13% of the variance in stigma experiences and 4% of the variance in stigma impact, over and above that explained by background characteristics, diagnosis and the psychiatric symptoms of the participants.

Fears and Difficulties Experienced by Ukrainian Nationals During Their Period of Study in Poland

The overall aim of this study is to review problems relating to the acculturation of Ukrainian students during their initial period of study abroad in Poland. More importantly, our objective was to recognize the fears and difficulties these students experience and examine the strategies of coping with major stressors. Based on group interviews we identified four themes, which mainly related to the language barrier, social isolation, discrimination, and financial issues. Our results show that the main acculturation strategy among the students in our sample was integration rather than assimilation, marginalization, or separation. Our respondents actively sought contacts with the locals, for example, by giving up their living quarters in the socially isolated and remote university campus and renting shared accommodation in the city, which made it possible for them to maintain closer links with their Ukrainian friends and to receive social support while also staying open to establishing relationships with Poles and having more opportunities to improve their Polish. At the same time, these students maintained their contacts with family and friends abroad through the Internet. This study also suggests the ways for higher education institutions to improve the services rendered to international students and to support their integration into a new community.

Using the De Jong Gierveld Loneliness Scale With Early Adolescents: Factor Structure, Reliability, Stability, and External Validity

The present investigation is the first examination of the factor structures, reliability, external validity, longitudinal invariance, and stability of the De Jong Gierveld Loneliness Scale (DJGLS), as used with early adolescents. It is based on a two-wave, large, representative sample of Polish primary school pupils. The results demonstrate that the model most reflective of the factor structure of the DJGLS is the bifactor model, which assumes the occurrence of one, highly reliable, general factor (overall sense of loneliness) and two, relatively irrelevant, subfactors. Essential unidimensionality (the general factor accounting for three fourth of the common variance) suggest that the interpretation of the subfactors over and above the general factor is inappropriate. The longitudinal confirmatory factor analysis indicated that the bifactor structure of the DJGLS is invariant over time. Correlations with self-rated loneliness, sociometric acceptance/rejection, social self-efficacy, identification with class group, family structure, and gender provide support for the validity of the DJGLS. This implies that it could be used as a measure of loneliness in adolescence, which does not involve references to the school context, making it possible to conduct studies that go beyond school period and compare the intensity of the feeling of loneliness in that group with other age groups.