Stigma, discrimination and medication adherence in schizophrenia: Results from the Swedish COAST study
Cecilia Brain, Birgitta Sameby, Katarina Allerby, Patrick Quinlan, Erik Joas, Eva Lindström, Tom Burns, Margda Waern
October 22, 2014
•No association was observed between experienced discrimination and adherence.
•Non-adherence was observed in 27%.
•Two thirds of the participants reported discrimination in social relationships.
•Half of the participants had experienced discrimination by mental health staff.
•Anticipated discrimination was reported by 70% of the participants.
•Most participants (88%) wanted to conceal their mental health problems from others.
The aims were to quantify the level of stigma experienced by persons with schizophrenia and to test for an association between stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS®) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS® adherence≤0.80) was observed in 30 (27.3%). When DISC subscale scores were entered in separate regression models, neither experienced nor anticipated stigma were associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by healthcare system or cultural and sociodemographic contexts.