Iran Journal of Nursing

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Ranjbar M, Seyed Fatemi N, Mardani Hamooleh M, Esmaeeli N, Haghani S. Correlation of Stigma with Self-compassion in Patients with Bipolar Disorder. IJN 2020; 32 (122) :1-13
URL: http://ijn.iums.ac.ir/article-1-3080-en.html

Background & Aims: The bipolar disorder is important mental disorder, which is characterized by recurrent episodes of mania and depression. This chronic and complex disease affects the mood of the patient, causing continuous and abnormal mood changes from extremely good to extremely poor and depressed. These fluctuations often last for weeks or months. Frequent episodes of depression and mania affect the functioning of the individual in personal, professional, family, social, and cultural domains. Patients with the bipolar disorder experience a phenomenon known as stigma. Stigma is defined as a set of cognitions and behaviors that are activated by labeling, leading to social exclusion and isolation. The stigma of mental illness distinguishes the patients from other populations. The stigma of mental illness renders the patients incapacitated and socially isolated. In addition, the experience of stigma decreases the quality of life and health-seeking behaviors of the patients, threatening their socio-economic health. Subsequently, the social participation of patients with mental illness is disrupted, and they refrain from seeking social assistance. In fact, stigma leads to the rejection of patients with mental illness by the society, disrupting their emotional regulation and making them unable to have proper emotional regulation strategies. Furthermore, the stigma of mental illness causes the patients not to have appropriate coping strategies for the disease, hide their medical history from the medical staff, and avoid communicating with their friends after discharge from the hospital. Given the importance of the concept of stigma, identifying the positively correlated behaviors seems essential. Self-compassion is a positive behavior that may be associated with stigma. Individuals with high self-compassion are more likely to accept negative life events and have more accurate self-assessments and better mental health. Self-compassion is an important factor in the adaptive responses to the mood problems in patients with a history of recurrent depression. High self-compassion reduces the mental vulnerability of patients with mental illness to problems, their depression and social anxiety, shame caused by the illness, and self-criticism. In contrast, the lack of self-compassion leads to self-judgment, a sense of further isolation, and a rush of negative emotions about oneself, which ultimately lead to the loss of intimacy in the relationships with others. Low self-compassion is present in a wide range of individuals with mental disorders and causes emotional distress, so that individuals with mental illness and low self-compassion are more likely to have suicidal thoughts. The present study aimed to assess the correlation between stigma and self-compassion in patients with the bipolar disorder.

Materials & Methods: This cross-sectional, descriptive-analytical study was conducted on 200 patients with the bipolar disorder admitted to Iran Psychiatric Center in Tehran, Iran, who were selected via continuous sampling. Data were collected using a demographic data form and stigma and self-compassion tools. The demographic data form included data on age, gender, marital status, number of children, education level, occupation status, family history of mental disorders, number of family members, and number of admissions. The researcher evaluated the validity and reliability of the instruments. To determine validity, the instruments were provided to seven professors of the department of psychiatric nursing at Iran and Tehran universities of medical sciences, and the content validity was confirmed. In addition, the retest method was used to determine the reliability of the tools. For this purpose, the tools were completed by 15 individuals with the same characteristics as the research community, who were not among the research samples, and re-completed by the same individuals two weeks later. Afterwards, Pearson's correlation-coefficient was calculated for two tests. In terms of ethical considerations, the required permit was obtained from the Ethics Committee of Iran University of Medical Sciences, and after receiving the letter of introduction from the university, the necessary coordination was made with the management of Iran Psychiatric Center. The research process was explained to the participants, and they were ethically informed that participation in the research was voluntary. Furthermore, the patients were reassured of the confidentiality of their personal information. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics. Pearson's correlation-coefficient was applied to determine the correlation between the two main variables, independent t-test was used to compare the mean scores of the two groups, and the analysis of variance (ANOVA) was employed to compare the mean scores of more than two groups. In all the statistical analyses, the P-value of less than 0.05 was considered significant.
Results: The mean scores of stigma and self-compassion were 77.03±7.06 and 77.57±4.47, respectively. Pearson's correlation-coefficient showed no significant correlation between stigma and self-compassion in the patients (P=0.301; r=-0.073). On the other hand, significant correlations were observed between the subscales of discrimination (P=0.030; r=-0.153), disclosure (P=0.045; r=-0.142), and positive aspects of stigma with the isolation dimension of self-compassion (P=0.034; r=-0.150), which were inverse, weak correlations as reduced isolation was associated with increased stigma in these subscales. Among the demographic variables, significant correlations were denoted between the number of family members, age, and family history of mental disorders with stigma (P<0.05). However, no significant associations were observed between the demographic characteristics and self-compassion.
Conclusion: The results indicated no significant correlation between stigma and self-compassion. However, significant associations were observed between the subscales of stigma with the isolation dimension of self-compassion, which were inversely and significantly correlated. Therefore, it could be concluded that as the patients further perceived the dimensions of discrimination, disclosure, and positive aspects of stigma, they were less inclined toward isolation. Stigma is an inherent cultural element rooted in the community, which is so strong and complex that even high self-compassion could not diminish its effects.