|
Comparison of the attitude
toward stigma among the staff and students and
faculty at Abadan School of Medical Sciences
Mohammad
Mahboobi (1)
Saeid Gholamzadeh (2)
Mohammad Zarenezhad (3)
Zeynab Namadmaliani Zadeh (4)
Nahid Mahmoodi (4)
(1) Abadan School of Medical Sciences, Abadan,
Iran.
(2) MD, General Practitioner, Legal Medicine
Research Center, Legal Medicine Organization,
Tehran, Iran.
(3) MD, PhD Candidate, Legal Medicine Research
Center, Legal Medicine Organization, Tehran,
Iran. Gastroenterohepatology Research Center,
Shiraz University of Medical Sciences, Shiraz,
Iran.
(4) MSc in Clinical Psychology, Abadan School
of Medical Sciences, Abadan, Iran
Correspondence:
Nahid Mahmoodi
Abadan School of Medical Sciences,
Abadan, Iran
|
Abstract
Background:
Stigma is a powerful social, inclusive
and sustainable phenomenon and affects
vulnerable
populations. Stigma increases to psychiatric
disease and is a leading burden of the
disease on public health. This study aimed
to investigate the attitude of students,
faculty and staff toward stigma toward
severe psychiatric patients in Abadan.
Methods: This
study is descriptive. The study population
included all students, staff and faculty
members of Abadan School of Medical Sciences
in 2016. The sample consisted of 282 subjects
who were selected by convenience sampling
method. To collect the data, demographic
data, social distance questionnaires and
being dangerous questionnaires were used.
Data were considered using KS-test, independent
T test, I U-Whitney, Wilcoxon test and
were analyzed in SPSS-22, significance
level was (0.05> p).
Results: The
results showed that stigma of Employees
with severe psychiatric disorders (34.21
10.64) is more than students (31.27 10.84)
and professors (26.42 8.79). There is
a direct correlation between age and stigma
of professors, 0.514. No correlation was
found between students and staff (0.05>
p). It was also found that in the three
groups health care and the fight against
diseases in clinical laboratory sciences
have more social Distance than other fields
of study (mean 10.62, 8.86, 7) and two
of the groups in clinical laboratory sciences
and nursing have more stigma than other
academic fields (34.06, 31.48), but the
feeling of being dangerous has less stigma
than other factors (23.43, 22.62).
Conclusion:
According to the findings, it can
be concluded that of the three groups
of teachers, students and staff in clinical
laboratory sciences, nursing has less
social Distance, and higher stigma and
yet feels dangerous has a higher sigma
than the other disciplines. It is essential
for the university community to understand
components of the stigma towards mental
illness.
Key words:
severe psychiatric illnesses, attitudes,
stigma, Abadan.
|
The human body and mind have deep connection
and attachment to each other. Therefore, their
disease will affect each other. Complications
and signs of physical illness are commonly visible
and can be perceived by the five senses, but
psychiatric symptoms usually influence emotions,
feelings and behavior of the person and give
a vague sense in early disease that the person
does not understand it easily (1).
Total load and the prevalence of psychiatric
disorders are a priority of the mental health
services system. Mental health problems form
8.1 percent of =all diseases (2). Based on the
results of a study that is part of a national
study on health in Iran, the prevalence of mental
disorders in the study population was 21% and
depressive symptoms was in 21%, anxiety symptoms
were in 20.8 percent, physical symptoms were
in 17.9 percent and symptoms of social dysfunction
were in 14.2 percent of people (3). In a study,
the prevalence of mental disorders in Tehran
was 14.3 and anxiety and mood disorders are
8.6 and 4.5 percent, respectively, reported
as the most prevalent psychiatric disorders
(2).
Despite the high prevalence of mental illness
and despite major upgrade in quality and effectiveness
of mental health services in the past decade,
there is a significant Distance between the
prevalence of these disorders and the use of
mental health services (2). In an epidemiological
study, it was shown that less than 30% of psychiatric
patients follow treatment processes and another
study showed that about 40 percent of patients
with schizophrenia refuse to accept treatment
(4). Most Asians and Westerners have the lowest
latency delay in referral to treatment (5).
One of the factors that can be a barrier in
improving these diseases is stigmatization of
mental illness (6). Goffman knows stigma as
a split identity, that the feature is assigned
to the individual or group, of which the credibility
of members of the group or individual have unwanted
attention imposed on them (7). Stigma indicates
conditions of debasement(1), so that the stigmatised
person, is not considered as a normal human
with sufficient adequacy for acceptance in society
(7). In Persian language, stigma is also called
social stigma. The patient feels lack of compliance
with the aspirations and social demands due
to signs and symptoms of disease and feels the
shame and despair and tries hiding their illness
to compensate for this difference (8-9, 2).
This makes them avoid treatment (4), which would
protect them from withdrawal from society (8).
Patients with mental illness often are faced
with two major problems. Firstly, they have
compromising symptoms that vary depending on
the type of disease (such as anxiety, delusions,
hallucinations, etc.). These symptoms can influence
employment, independent living and life satisfaction
of these individuals (8). Secondly, social misconceptions
can help in the creation of stigma against these
people, even people who have well controlled
disease in the workplace, or who are experiencing
this problem when looking for a job. So, mental
patients often will suffer loss of self-esteem
(10) followed by declining confidence in their
efficiency and confidence in the future. They
are believed to be less valuable than others
(4); they consider themselves responsible for
causing the disease (12-11). And so, stigma
affects their personal emotions (4).
Naturally, the conditions create restrictions
for the stigmatised person, which strongly influences
their individual psychosocial life. Limitations
in acceptance among peers, use of economic and
social benefits, jobs and education, social
relations and loss of social support networks
and even deprivation of looking healthy and
having normal experiences (9-8). In such a situation,
those with stigma see themselves as unworthy
and not fitting in with society.\ (8).
At present, perceptions of psychiatric patients
is different from patients with physical illness.
One part of this attitude relates to knowing
the psychiatric patient may be dangerous and
another part is due to their lack of understanding
of abnormal experiences. The diseases usually
cause symptoms such as delusions and hallucinations,
and these symptoms can affect their daily lives
(13).
Attitudes of stigma of people with psychiatric
illness is based on stereotypes and reaches
a peak when there is insufficient awareness,
misinterpretation and slight contact with the
patients and this prevents attitude correction
(9). Studies show that in people from the general
population with familiarity of mental illness,
the belief of these people with mental illness
being dangerous is less (14). Other studies
have also shown that medical students due to
more information of mental illness have less
stigma toward them than the freshmen (15).
The community response to mental illness can
vary by severity, type of disease, the prevailing
culture and traditions (8). The reaction can
change over time (4). Stigma of schizophrenia,
in Iran, follows in terms of both documentary
and risk assessment (2). It has been shown that
the stigma frequency varies between different
nations and has increased in recent years (16).
People have more stigma toward these patients
than patients with physical diseases (4).
Noting that stigma is not an individual problem
, it is a social problem and it is product of
a reaction between society and the individual
patient. It is a heavily discredited opinion
that can be dealt with differently according
to cultural norms. Considering the importance
of this issue and that this phenomenon is a
public health problem (13), in order to plan
to control stigma, underlying information is
required (4) and because students and teachers
directly are related to the patient both during
school and during their employment, we decided
to study attitudes of Abadan School of Medical
Sciences (students, faculty and staff) as part
of the educated sections of Abadan residents
toward stigma of severe psychiatric diseases.
This study is cross-sectional and was performed
in 2016 in order to determine the attitude of
students, faculty members and staff of Abadan
School of Medical Sciences toward stigma of
severe psychiatric disease. The population included
all students in different fields (nursing, operation
room, laboratory, medical, oral health, public
health, health to fight disease, anesthesia)
who numbered 595 people. All faculty members
were 46 people and all the employees of Department
of education, research and student were 100
people. The sample size for this study was calculated
as 282 people. The samples were selected randomly
from those who agreed to cooperate. All students,
staff and faculty without restrictions in terms
of age, gender, economic status, marital status
and physical illness and psychiatric history
were accepted. Study entry criteria was being
a student of University of Medical Sciences,
being a member of Faculty of Medical Sciences,
being an employee of training assistance and
having willingness to participate in the study.
Among participants the least education level
was diploma and Exclusion criteria included
only those who refused to participate in the
scheme. After obtaining written permission and
submitting to the President of the University,
check lists and questionnaires were explained
to students, faculty and employees. Participants
completed questionnaires which showed their
agreement to participate in this research project.
In a meeting that was held in classrooms, at
first a description of the project was offered
to students and teachers. The subjects completed
questionnaires of the plan. Information was
collected without giving their name. Firstly,
participants completed their demographic information.
Also a briefing was held for employees and after
consenting to the study, questionnaires were
available to them. Sampling lasted a month.
The questionnaire had two items of social distance
and dangerousness in addition to the check list
of information.
Social distance scale analyzes respondents tendency
to interact with a person with close or far
relation. This scale was invented and used by
Bogard to measure social distance scale on the
basis of race and ethnicity in 1925, but in
1957, Cumming first used this scale for attitude
towards the mentally ill patients. Philip (1963)
was the first person using this scale by description.
The questionnaire has 7 questions and a history
and grading scale varies from study to study
(no / yes, disagree / or I do not want / agree
or would like). Spiro was the first person using
definitely would like to / would not desire.
Today, biographies are set based on the DSM
(17 and 13). Cronbach alpha and reliability
coefficient of the questionnaire is estimated
by North (2006) (82%), Link (2003) 75% and Ranjbar
(1389) 92 %( 19-18-13).
Dangerousness scale measures respondents’
attitudes about the dangers of psychiatric morbidity.
beleiving mental patients as dangerous, leads
to patients’ incidence of discrimination
and segregation. This scale has 8 Likert questions
and answers are rated in three forms (disagree
/no idea / agree) (17 and 13). Cronbach alpha
and reliability coefficient of the questionnaire
is estimated by Pan (2001) 78%, Erik 72% and
Ranjbar 96% (21-20V 13).
Stigma score was obtained by adding both of
the questionnaires. Checklist contains demographic
variables (age, gender, job and marital status,
educational level, place of residence).
Analysis of data was done using descriptive
statistics (mean, frequency, percentage, standard
deviation) and analytical methods suh as KS
test, independent T-test, Mann-Whitney, Wilcoxon
test. Data were analyzed using SPSS version
22. The level of significance was considered
as (0.05> p).
It is worth noting in this study that the Cronbach
alpha for dangerousness was 0.70 and for social
distance was 0.86 that represents the reliability
of the results.
A
total
of
282
patients
were
enrolled
based
on
the
results
of
this
study
as
191
students
(100%),
21
faculty
members
(100%)
and
70
employees
(100%),
respectively.
The
average
age
of
students
was
20.82
2.17
and
the
average
age
of
faculty
members
was
33.75
4.77
and
the
average
age
of
employees
was
33.09
7.86.
Overall,
160
were
men
and
122
were
women.
In
students,
the
highest
rate
of
education
was
at
the
undergraduate
level,
of
136
cases
(71.2%)
and
in
terms
of
education,
in
nursing,
for
75
cases
(39.3%),
in
terms
of
marital
status,
177
were
single
(93.2%).
In
terms
of
most
frequent
education
of
the
employees,
24
were
undergraduate
level
(34.3%)
and
in
terms
of
BMI,
42
cases
were
single
(60%)
and
among
faculty
members,
the
highest
rate
of
education
was
at
the
graduate
level
for
14
cases
(66.7%)
and
in
terms
of
marital
status
18
cases
were
married
(85.7%).
In
this
study,
the
stigma
of
Employees
for
severe
psychiatric
disorders
(34.21
10.64)
was
higher
than
students
(31.27
10.84)
and
professors
(26.42
8.79)
(Table
1).
Also
during
study,
the
correlation
between
stigma
and
age
in
three
groups
of
students,
faculty
and
staff
determined
that
there
is
a
direct
correlation
between
age
and
stigma
of
professors
as
0.514,
but
no
correlation
was
found
for
students
and
staff
(Table
2
and
3).
This
study
also
reviews
the
dangers
and
stigma
were
identified
between
eight
majors.
3
groups
of
teachers,
students
and
staff
in
clinical
laboratory
sciences,
health
care
and
fighting
disease
had
more
social
stigma
than
other
academic
disciplines
(with
an
average
of
10.62,
8.86,
7)
and
3
Groups
in
the
clinical
laboratory
sciences
and
nursing,
had
more
stigma
than
other
academic
disciplines
(34.06,
31.48),
but
the
feeling
of
being
dangerous
had
less
stigma
than
other
fields
(23.43,
22.62)
and
significance
level
was
(0.05>
p).
(Table
4).
Click
here
for
Tables
1-4
Pearson
correlation
is
used
according
to
both
interval
scale
variables.
Null
hypothesis
indicates
independence
between
two
variables
and
the
alternative
hypothesis
shows
a
relationship
between
two
variables
under
consideration.
Results
are
shown
in
Table
3.
There
is
a
direct
correlation
between
age
and
stigma
among
professors,
0.514,
also
there
is
a
direct
correlation
between
age
and
dangerousness
among
professors
0.648,
but
the
relationship
was
not
found
for
students
and
staff.
The
findings
of
the
study
about
the
level
of
stigma
of
staff
toward
psychiatric
disease
is
more
severe
than
students
and
teachers
and
can
be
interpreted
as
due
to
the
reaction
of
the
population
to
mental
illness
can
vary
by
severity,
the
disease
type,
the
prevailing
culture
and
traditions,
but
the
attitudes
of
stigma
toward
people
with
mental
illness
is
based
on
stereotypes
and
reaches
a
peak
when
there
is
insufficient
awareness,
misinterpretation
and
slight
contact
with
the
patients.
This
can
prevent
attitude
correction.
Of
course,
it
goes
to
the
media
and
the
culture
of
our
society.
Given
that
the
media
has
a
very
influential
role
in
shaping
public
attitudes,
consultants
are
trying
to
exaggerate
the
newspaper
headlines
in
some
rare
events
(e.g.,
death
or
damage
by
a
person
with
psychiatric
patients).
The
language
used
is
often
insulting
and
degrading
and
with
induction
of
psychiatric
illness
lasting
relationship
with
violence,
encourage
or
spread
negative
stereotypes.
The
scheme,
including
the
mentally
ill
population
of
the
species
are
formed
in
a
way
that
the
patients
are
dangerous
and
should
be
away
from
them.
In
the
present
study,
as
the
personnel
are
training
department
employees
and
somehow
work
in
a
riddled
environment,
they
have
less
communication
with
them
and
in
terms
of
education,
they
are
mostly
at
the
expert
level,
so
they
are
not
familiar
with
these
conditions,
the
apparent
cause
of
illness
and
lot
of
these
problems.
Therefore,
according
to
the
formed
Schema
in
these
patients,
this
group
is
described
as
dangerous
and
have
more
social
distance
and
they
have
greater
stigma
to
the
disease.
This
finding
is
consistent
with
studies
of
Corrigan
(2004),
Sartorius
(2002),
Mess
(2002),
and
Lev
(1388).
Corrigan’s
study
(2004)
showed
that
in
people
of
the
general
population
with
relative
familiarity
with
severe
mental
illness
belief
of
dangerousness
is
less
and
associated
with
less
underestimated
risk
of
persons
with
mental
illness
with
less
fear
of
them
and
ultimately
with
social
avoiding.
Cooper’s
Study
(2002)
found
that
seniors
who
had
more
information
of
the
disease
and
had
prior
contact
with
persons
with
mental
illness
give
less
stigma
to
these
patients
than
freshmen.
The
finding
that
there
is
a
direct
correlation
between
age
and
stigma
of
professors,
0.514
and
the
significant
level
of
these
two
variables
was
0.017,
but
no
relationship
was
found
in
students
and
staff,
it
can
be
explained
in
this
way
that
having
knowledge
about
mental
illness
can
have
an
impact
on
more
tolerance
toward
mental
illnesses
and
contact
with
this
disease
alone
is
not
enough
to
change
attitudes
with
which
is
in
line
with
Cooper’s
Study
(2002)
and
not
in
line
with
Eastman
(2002).
Eastman’s
study
(2002)
on
the
subject
showed
that
increasing
age,
lower
socio-economic
level,
lack
of
familiarity
and
dealing
with
mentally
ill
people
can
add
to
the
stigmatization
toward
them.
The
study
is
in
line
in
terms
of
the
view
that
stigma
increases
with
ageing,
but
in
terms
that
the
teachers
have
good
socio-economic
conditions
is
not
in
line
with
Eastman,
that
says
stigma
is
associated
with
a
reduced
economic
and
social
level.
On
the
finding
that
three
groups
of
teachers,
students
and
staff
in
clinical
laboratory
sciences,
Nursing
and
health,
and
fighting
disease
have
more
social
distance
than
other
academic
disciplines
(with
an
average
of
10.62,
8.86,
7)
and
2
groups
of
clinical
laboratory
sciences
and
nursing
have
more
stigma
than
other
academic
disciplines
(34.06,
31.48)
but
have
less
feeling
of
being
dangerous
than
other
fields
(23.43,
22.62)
it
can
be
interpreted
in
this
way
that
the
Department
of
Health
Laboratory
and
fighting
disease
pass
only
two
units
of
psychology
theory
and
no
single
apprenticeship
is
able
to
have
direct
contact
with
patients
and
are
not
closely
familiar
with
them.
So,
their
social
distance
and
stigma
is
associated
with
lack
of
their
connection
with
this
class.
But
this
class
in
the
group
of
nurses
has
more
social
distance
and
stigma
with
less
dangerousness.
It
can
be
generally
interpreted
that
the
cultural
background
and
the
previous
experiences
of
nurse
and
other
people
affect
conditions
of
labeling
and
stigma.
Stigma
is
a
force
that
shaped
both
in
local
as
well
as
affecting
its
properties
.
The
interpersonal
relationship
of
patients
with
people
who
have
a
high
social
situation
(e.g.,
nurse,
teacher)
and
also
accepting
the
label
by
the
affected
person
are
the
things
that
lead
to
stigma
and
social
distance.
When
a
person
becomes
labeled
by
society,
expectations
change
according
to
it.
Stigma
may
affect
the
behavior
of
people
with
the
disease.
They
behave
as
they
are
expected
to
and
this
may
change
both
their
beliefs
and
senses,
a
kind
of
negative
reinforcement
of
stigma
and
social
distance
in
themselves
and
others.
This
finding
is
consistent
with
studies
Major
(2005)
and
Link
(2001)
and
Soudmand
(2016).
But
it
can
be
said
about
feeling
less
dangerous
of
the
mentally
ill,
due
to
the
pervasive
nature,
it
is
necessary
for
nurses
to
understand
the
components
of
stigma
towards
mental
illness.
Perceived
stigma
is
promoted
by
nursing
practice
in
two
ways:
First,
it
helps
that
nurses
do
care
for
each
person
individually
and
the
second
makes
nurses
examine
their
own
beliefs
and
values
and
how
they
interact
with
patients.
This
is
especially
important
in
evaluating
care,
support,
acceptance
and
confidence
and
should
be
the
primary
focus
of
all
nursing
activities.
In
this
issue,
open
communication
by
nurses
is
necessary
in
such
a
way
that
the
patient
can
act
to
express
their
feelings
freely
and
without
fear
of
being
judged
or
stigmatized
as
behaving
repulsively,
because
the
stigma
and
labeling
of
mental
illness
can
prevent
treatment
and
that
is
a
basic
principle
to
be
taught
to
students.
Regarding
the
relationship
of
stigma
with
nursing,
the
meaning
of
stigma
is
reflected
too
low
in
nursing
and
patient
care.
This
finding
is
consistent
with
Soudmand
(2016).
Considering
three
groups
of
teachers,
students
and
staff
in
clinical
laboratory
sciences,
nursing,
has
more
social
Distance
and
stigma
and
yet
less
feeling
of
danger
than
the
other
fields,
and
since
this
study
was
conducted
for
the
first
time
in
this
community,
it
needs
to
be
replicated
in
different
samples
with
greater
sample
size
to
interpret
findings
with
more
confidence
and
extend
them.
Stigma
can
occur
in
many
different
forms
(culture,
obesity,
gender,
race
and
mental
illness)
and
in
different
environments
(work,
learning
environments,
health
care
and
even
in
one’s
own
family)
and
prevent
mental
health
treatment.
It
is
also
recommended
to
have
more
training
and
workshops
and
making
plans
in
this
regard
at
the
university
level
and
occuring
in
public,
especially
through
the
mass
media
and
to
have
normalization
of
mental
illnesses
for
stigmatization,
because
this
training
is
to
improve
public
health
and
reduce
stigma.
Acknowledgement:
This
paper
is
from
the
approved
project
in
Abadan
School
of
Medical
Sciences
number
95st-
0070
and
code
of
ethics
is
IR.ABADANUMS.REC.1395.101.
1.
Younesi
SJ.
Stigma
and
infertility
in
Iran-coping
skills.
JRI2002;
3:
74-76.
2.
Saman
Tavakoli,
Vandad
Sharif,
Taj
Mahshid,
Mohammadi
MR.
Investigating
the
relationship
between
stigma
of
depression
and
mental
health
in
students’
attitudes
toward
seeking
professional
help.
New
Cognitive
Science
2010;
12
(3):
33-19.
3.
Noorbala
A,
Bagheri
Yazdi
S
A,
Yasamy
M.
T,
Mohammad
K.
Mental
health
survey
of
the
adult
population
in
Iran.
British
Journal
of
Psychiatry2004;
184:
70-73.
4.
M.
Sadeghi.
The
impact
of
stigma
on
mental
health.
New
Cognitive
Science
2003;
5
(2):
85-84.
5.
Gelder
MG,
Lopez-Ibor
J
J,
AndreasenN.
C.
New
Oxford
textbook
of
psychiatry.
Oxford:
Oxford
University
Press2000.
6.
Corrigan,
P.
How
stigma
interferes
with
mental
health
care.
American
Psychologist2004;
59(7):
614-625.
7.
Yonsei
SJ,
Akbari
Zardkhaneh
S.,
Behjati
Ardakani
Z.
Evaluating
stigma
among
infertile
men
and
women
of
Iran.
Journal
of
Reproduction
and
Infertility2005;
545-531.
8.
M.
Nojomi,
Malakoti
K.,
Ganean
Helia,
Joghataee
Muhammad
Taqi,
Jacobson
Larsh.
Extensive
stigmatization
of
mental
patients
in
Tehran
in
1388.
Razi
Journal
of
Medical
Sciences
2010;
17(79-78):
52-45.
9.
Lev
Julian,
Richard
Warner.
Restoring
the
mentally
ill
people
in
the
community.
Translation
of
Dr.
Babak
Jafari
and
colleagues2009,
first
edition,
Tehran:
Danzheh.
10.
Rusch
N,
Angermeyer
MC,
Corrigan
PW.
Concepts,
consequences,
and
initiatives
to
reduce
stigma.
European
Psychiatry
2005;20:
529-39.
11.
Weiner
B,
Perry
RP,
Magnusson
J.
An
attributional
analysis
of
reactions
to
stigmas.
J
Pers
Soc
Psychol1988;
55:
738-48.
12.
Corrigan
PW,
River
LP,
Lundin
RK,
Wasowski
KU,
Campion
J,
Mathisen
J,
et
al.
Stigmatizing
attributions
about
mental
illness.
J
Community
Psychol
2000;
28:
91-102.
13.Ranjbar
Kerman
F,
Mazinani
R,
Fadayee
F,
Dolatshahi
B.
Determining
the
validity
and
reliability
of
social
distance
and
being
dangerous
questionnaire
to
assess
health
care
workers’
attitudes
towards
stigma
of
mental
in
severe
psychiatric
disorders
in
Iran.
PhD
thesis2010.
14.
Corrigan
P
W,
Green
A,
Lundin
R,
Kubiak
M.
A,
Penn
DL.
Familiarity
with
and
social
distance
from
people
who
have
serious
mental
illness.
Psychiatric
Services2001;
52(7):
953-958.
15.
Mas
A,
Hatim
A.
Stigma
in
mental
illness:
Attitudes
of
medical
students
towards
mental
illness.
Medical
Journal
of
Malaysia2002;
57(4):
433-444.
16.
Phelan
JC,
Link
BG,
Stueve
A,
Pesco
solido
BA.
Public
conceptions
of
mental
illness
in
1950
and
1996:
What
is
mental
illness
and
is
it
to
be
feared?
J
Health
Soc
Behav
2000;
41:188-207.
17.
SartoriusN,
Arboleda
J.
Understanding
the
stigma
of
mental
illness:
Theory
and
interventions.
John
Wiley
&
Sons
Ltd2008.
18.
Nordt
C,
Rossler
W.
Attitude
of
mental
health
professionals
toward
people
with
schizophrenia
and
major
depression.
Schizophrenia
Bulltin2006;
(32):709-714.
19.
Link
B.G,
Phelan
J.C.
Public
conceptions
of
mental
illness,
labels,
causes,
dangerousness
and
social
distance.
American
Journal
of
Public
Health1999;
(89):
1328-1333.
20.
Arikan
K,
Vysal
O.
Public
awareness
of
the
effectiveness
of
psychiatric
treatment
may
reduce
stigma.
Isrj
psychiatry
relat
sci1999;
(36):
95-99.
21.
Penn.
Dispelling
the
stigma
of
schizophrenia.
The
impact
of
information
on
dangerousness.
Schizophrenia
bulletin2001;
25(3).
22.
Sartorius,
N.
Iatrogenic
Stigma.
BMJ.
June2002:324.
23.
Ostman
M,
Keyllin
L.
Stigma
by
Association:
Psychological
Factors
in
Relatives
of
People
with
Mental
Illness.
British
Journal
of
Psychiatry2002;181:
494-498.
24.
Major
B,
O’Brien
LT.
The
Social
Psychology
of
Stigma.
Annu
Rev
Psychol2005;
56(1):393-421.
25.
Link
BG,
Phelan
JC.
Conceptualizing
stigma.
Annual
Review
ofsociology2001;
27:
363-85.
26.
Soudmand
P,
Haideri
A,
Meshkin
Yazd
A.
The
concept
of
stigma
of
mental
illness.
New
care,
Journal
of
Nursing
and
Midwifery
at
University
of
Medical
Sciences2014;
11(
3):
218-228.
|
