1. Self perception of stigma in mentally ill patients in Tehran, Iran Helia Ghanean MD. PhD student Umea university, department of psychiatry, Sweden Iran university of medical sciences

2. Iran, population 70 million. Persian Azari Kurdish, Lur, Baloch, Turkmen. 90% Shia Muslim, Sunni Muslim, Zoroastrian, Jewish, Christian. Tehran, the capital, 11 million inhabitants.

3. Stigma Mental illness is probably one of the most stigmatizing disorder in all cultures. Stigmatization: – External factors. – Internal factors.

4. Holly Quran According to holy Quran people suffering from a disease for example mental disorder should be treated with respect. Is there Less stigmatizing behaviour in Islamic societies ?

5. Self perception of stigma = Internalized Stigma Self stigmatization: Perception of the difference/ deviance. Importance of self-stigmatization = General stigmatization (stigmatization from people around him/her).

6. Concept of Internalized Stigma The concept of Internalized stigma was developed by J.Ritsher et al (2003). Internalized stigma is the devaluation, shame, secrecy and withdrawal trigged by applying negative stereotypes to oneself.

7. Aim To determine the experience of Internalized stigma in Mentally ill patients in Tehran, Iran. To include stigma reduction as a verifiable treatment goal in addition to symptom reduction.

8. Questionnaire Alienation Stereotype endorsement Perceived discrimination Social withdrawal Stigma resistance All items are measured by a 4-point Likert type scale from “strongly agree” to “strongly disagree” (1 = strongly disagree, to 4 = strongly agree) ISMIS, 29 items 6 items 7 items 5 items 6 items 5 items

9. Design Study design: Cross-sectional study Sampling method: Non-probability Analysis of variance: Chi-square, ANOVA. Followed by an open ended question asked by first author.

10. Subjects Participants : 130 diagnosed patients with depressive disorders, Schizophrenia spectrum, Bipolar mood spectrum disorders. From admitted and out patient clinic of : – Rasoul hospital – Navab hospital – Razi Mental Hospital The participation were on voluntary basis.

11. Pilot study ISMIS translated to Farsi and back translated to English. Pilot study : 30 individuals, the internal consistency was 0.87. Questions were comprehensive, only question 24 was not easy understood in Farsi.

12. Reliability and validity Farsi versionTurkish version Original version subscales 0.810.790.84Alienation 0.740.720.71Stereotype endorsement 0.710.750.87Perceived discrimination 0.820.800.85Social withdrawal 0.350.580.63Stigma resistance Cronbach’s alpha of different versions of ISMIS Cronbach’s alpha Total 29 items Farsi version= 0.90

13. Results Mean age : 29 range of( 18-60). 40% Female. 57%single, 7% divorced or widowed. Majority with high school diploma degree. 80% Unemployed.

14. Examples of responses ‘‘ Blind man crossing street recieves help, even cars have options for disables but nothing is provided for us’’. ‘‘I wish my family could understand that psychiatric patients are like other patients, like those with cancer or cardiac disease’’.

15. Stigma and education We found association between discrimination experience, social withdrawal and education. Higher education = lesser experience of stigma. No significant association between subscales and gender, marital status and occupation.

16. of stigma Prevalence What is Normative, High level or Low level of stigma? Mid-point Scale: High internalized stigma >2.5 Findings: 40% above 2.5

17. Lysaker, Roe et al model a.<2 minimal stigma b.2-2.5 mild stigma c.2.5 -3 moderate stigma d. >3 severe stigma 40 % 21% 12% 27%

18. Comparing these findings, we can conclude that the level of stigma in patients suffering from mental illness is estimated HIGH (40%). Same study performed on patients with Epilepsy findings show less stigma experience(23%) comparing to mentally ill. Conclusion

19. Recommendations Willingness of patients to talk about their situation gives us strong indication for further more qualitative studies. It seems necessary to inform the public about the cause of psychiatric problems and possible effective treatments.

20. Thank you for your attention