A Facility-based Assessment of Internalized Stigma among Patients with Severe Mental Illnesses in Maiduguri, North-Eastern Nigeria

Introduction: Public stigmatization of mental illnesses might lead to the internalization of the stigma by persons with mental illness (PWMIs) which might also lead to erosion of self-esteem and negative consequences on treatment outcome. This study assessed the prevalence of internalized stigma and analyzed its socio-demographic and clinical predictors among PWMIs in a sub-Saharan African mental health facility.

Methods: Patients with schizophrenia, bipolar disorder and severe depression (n = 370) were randomly interviewed at the out-patient department of the Federal Neuropsychiatric Hospital, Maiduguri. They completed the sociodemographic and clinical proformata, Oslo social support scale, and an adapted version of the internalized stigma of mental illness scale (ISMI).

Results: A total of 83 subjects (22.5%) met the study's criterion score for high internalized stigma. The independent predictors of high internalized stigma were; poor social support (Odds ratio, OR = 4.501, 95% CI = 2.423 - 8.363, p ≤ 0.001), supernatural aetiological beliefs (OR = 3.916, 95% CI = 2.322 - 6.606, p ≤ 0.001), seeking for unorthodox treatment (OR = 3.637, 95% CI = 2.073 - 6.308, p ≤ 0.001), full insight (OR = 3.595, 95% CI = 2.141 - 6.036, p ≤ 0.001), and presence of extrapyramidal side effects (OR = 12.201, 95% CI = 6.827 - 21.805, p ≤ 0.001).

Conclusion: Extrapyramidal side effects, poor social support and misconceptions about the aetiology of mental illnesses were the strongest predictors of internalized stigma among the subjects. The use of second generation antipsychotic medications, the engagement of members of the patients' social support base and the incorporation of psycho-educational programmes to dispel 'myths' about the aetiology of mental illnesses in sub-Saharan Africa are hereby recommended.