Self-stigma and treatment effectiveness in patients with anxiety disorders – a mediation analysis
Received 21 September 2017
Accepted for publication 7 November 2017
Published 26 January 2018 Volume 2018:14 Pages 383—392
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Roger Pinder
Marie Ociskova,1 Jan Prasko,1 Kristyna Vrbova,1 Petra Kasalova,1 Michaela Holubova,1 Ales Grambal,1 Klara Machu2
1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, 2Department of Psychology, Faculty of Arts, University of Ostrava, Ostrava, The Czech Republic
Goal: The goal of this study was to explore the impact of self-stigma on the treatment outcomes in patients with anxiety disorders and to find possible mediators of this relationship.
Method: Two hundred and nine patients with anxiety disorders, who were hospitalized in a psychotherapeutic department, attended the study. The average age was 39.2±12.4 years; two-thirds were women. Most of the patients used a long-term medication. The participants underwent either cognitive behavioral therapy (CBT) or short psychodynamic therapy. The selection to the psychotherapy was not randomized. All individuals completed several scales – Beck Depression Inventory, the second edition (BDI-II), Beck Anxiety Inventory (BAI), Dissociative Experience Scale (DES), Sheehan Disability Scale (SDS), subjective Clinical Global Impression (subjCGI), and The Internalized Stigma of Mental Illness Scale (ISMI). A senior psychiatrist filled out the objective CGI (objCGI).
Results: The patients significantly improved in the severity of anxiety (BAI), depression (BDI-II), and overall severity of the mental disorder (objCGI). The self-stigma predicted a lower change of the objCGI, but not a change of the anxiety and depressive symptoms severity. Anxiety, depressive symptoms, dissociation, and disability were assessed as possible mediators of the relationship between the self-stigma and the treatment change. None of them were significant.
Conclusion: Self-stigma lowers the effectiveness of the combined treatment of anxiety disorders. Future research should explore other possible mediators influencing this relationship.
Keywords: self-stigma, anxiety disorders, treatment effectiveness, medication
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