Psychosocial Intervention to Reduce Self-stigma and Improve Quality of Life Among People With Mental Illness in Chile
Condition: Schizophrenia; Bipolar Disorder; Schizoaffective Disorder
MeSH terms: Schizophrenia; Bipolar Disorder; Psychotic Disorders
Study type: Interventional

Summary: 
      The principal objective of this pilot trial is to evaluate the effectiveness of a
      psychosocial intervention to reduce self-stigma and improve treatment adherence and quality
      of life among people with a severe mental illness who attend to Community Mental Health
      Centers in Chile. The intervention is based on recovery and narrative therapy and considers
      10 group sessions, mainly with patients, but also integrating relatives and professionals in
      some of the activities.
    

Detailed description: 
      It has been shown that stigma is one of the main barriers faced by individuals with mental
      illness, negatively impacting their service use and continuity of treatment. Additionally,
      given its impact on self-esteem, personal empowerment, and social inclusion, stigma greatly
      affects the quality of life of this population.

      Consequently, a pilot randomized controlled trial (RCT) with two arms (intervention group vs.
      control group) was designed and implemented. Participants were identified and recruited from
      two community mental health centers located in Central Chile. The intervention group, in
      addition to usual care, received a psychosocial intervention based on narrative therapy,
      recovery and psychoeducation which was specially tailored for this population by the authors.

      The sample corresponds to 76 individuals with a severe mental illness (ICD-10), currently
      treated in the two participating Community Mental Health Centers (COSAM). The category
      "severe mental illness" includes patients with diagnosis of schizophrenia, schizoaffective
      disorder, bipolar disorder and severe depressive disorder with psychotic symptoms. Finally,
      those two clinics were chosen by convenience in order to facilitate the implementation of
      this study.

      Before and after the intervention, the participants' self-stigma (Internalized Stigma of
      Mental Illness, ISMI), treatment adherence (weeks in treatment), and quality of life (Sevilla
      Quality of Life Scale) were measured. In addition, the following control variables were also
      evaluated, due to their influence on the principal outcomes: 1) sociodemographic information,
      2) symptom presence and severity (Positive and Negative Syndrome Scale, PANSS), and 3)
      alcohol consumption (The Alcohol Use Disorders Identification Test, AUDIT).
    

Intervention name(s): Intervention to reduce self-stigma among people with mental illness; Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This is a 10-session group intervention (held once a week), each lasting approximately 90 minutes, taking place where the participants receive mental health treatment.
The intervention is informed by the following key areas: (1) recovery perspective of mental health and severe mental disorders; (2) constructivist epistemology approach to learning, using cases and users' experiences; and (3) psychotherapeutic and collective narrative practices, to address internalized problems and challenges shared among the group members, respectively.; Generally, each community mental health center in Chile includes two full-time psychologists, a full-time social worker and half-time occupational therapist, nurse, and psychiatrist. This team mainly offers psychiatric medication, psychotherapy, and psycho-education for users and relatives. They do not offer any specific intervention to tackle stigma among providers.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Health Services Research
Keywords: stigma; psychosocial intervention; low-and-middle income countries