In Würde zu sich stehen – Konzept und Wirksamkeit eines peer-geleiteten Programms zu Offenlegung und Stigmabewältigung

Zusammenfassung

Hintergrund Menschen mit psychischen Erkrankungen stehen aufgrund verbreiteter Stigmatisierung oft vor der schwierigen Entscheidung, ob sie ihre Erkrankung anderen gegenüber offenlegen sollen.

Methode Konzept und Inhalte von ‚In Würde zu sich stehen‘ (IWS), einem kompakten peer-geleiteten Gruppenprogramm, werden beschrieben.

Ergebnisse IWS unterstützt Teilnehmer mit psychischen Erkrankungen bei Offenlegungsentscheidungen und Stigmabewältigung. Drei RCTs zeigen positive Effekte von IWS.

Schlussfolgerungen Fragen der Wirksamkeit, Implementierung und Weiterentwicklung von IWS werden diskutiert.

Abstract

Background Due to the stigma associated with mental disorders, many people with mental illness face the difficult choice whether to disclose their illness to others. (Non-)Disclosure is a key reaction in coping with stigma. Disclosure as well as non-disclosure have risks and benefits, depending on the environment and the individual.

Methods “Honest, Open, Proud” (HOP; German: „In Würde zu sich stehen“/IWS) is a peer-led group program to support people with mental illness in their disclosure decisions. It is not HOP’s aim to make participants disclose, but to support a well-informed and empowered decision.

Results Currently three RCTs, with several others underway, show HOP’s positive effects in terms of reductions in stigma stress, disclosure distress, self-stigma, or depressive symptoms. Adolescent participants reported better quality of life, recovery, and attitudes to help-seeking. Adaptations for different diagnoses and age groups have been developed.

Conclusions HOP appears to be a feasible and effective program to support people with mental illness in their disclosure decisions and in their coping with stigma. Future developments and public health implications are discussed.

Schlüsselwörter

Stigma - Offenlegung - Geheimhaltung - peer-geleitete Intervention - Gruppenprogramm - Evaluation

Keywords

stigma - disclosure - secrecy - peer-led intervention - group program - evaluation

• Literatur

• 1 Schomerus G, Schwahn C, Holzinger A. et al. Evolution of public attitudes about mental illness: A systematic review and meta-analysis. Acta Psychiatr Scand 2012; 125: 440-452
• 2 Angermeyer MC, Matschinger H, Schomerus G. 50 Jahre psychiatrische Einstellungsforschung in Deutschland. Psychiat Prax 2017; 44: 377-392
• 3 Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol 2001; 27: 363-385
• 4 Oexle N, Rüsch N. Stigma – Risikofaktor und Konsequenz suizidalen Verhaltens. Nervenarzt 2018; 89: 779-783
• 5 Xu Z, Lay B, Oexle N. et al. Involuntary psychiatric hospitalisation, stigma stress, and recovery: a 2-year-study. Epidemiol Psychiatr Sci (publ. online) DOI: 10.1017/S2045796018000021.
• 6 Rüsch N, Corrigan PW, Waldmann T. et al. Attitudes toward disclosing a mental health problem and reemployment: A longitudinal study. J Nerv Ment Dis 2018; 206: 383-385
• 7 Rüsch N, Angermeyer MC, Corrigan PW. Das Stigma psychischer Erkrankung: Konzepte, Formen und Folgen. Psychiat Prax 2005; 32: 221-232
• 8 Corrigan PW, Larson JE, Rüsch N. Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry 2009; 8: 75-81
• 9 Rüsch N, Müller M, Heekeren K. et al. Longitudinal course of self-labeling, stigma stress and well-being among young people at risk of psychosis. Schizophr Res 2014; 158: 82-84
• 10 Rüsch N, Heekeren K, Theodoridou A. et al. Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis. Schizophr Res 2015; 166: 43-48
• 11 Mittal D, Sullivan G, Chekuri L. et al. Empirical studies of self-stigma reduction strategies: A critical review of the literature. Psychiatr Serv 2012; 63: 974-981
• 12 Tsang HW, Ching SC, Tang KH. et al. Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophr Res 2016; 173: 45-53
• 13 Yanos PT, Lucksted A, Drapalski AL. et al. Interventions targeting mental health self-stigma: A review and comparison. Psychiatr Rehabil J 2015; 38: 171-178
• 14 Schenner M, Kohlbauer D, Meise U. et al. „StigMa“ – Evaluation eines psychologischen Therapieprogramms zu Stigma-Management. Psychiat Prax 2018; 45: 16-22
• 15 Rose D, Thornicroft G. Service user perspectives on the impact of a mental illness diagnosis. Epidemiol Psichiatr Soc 2010; 19: 140-147
• 16 Perkins A, Ridler J, Browes D. et al. Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings. Lancet Psychiatry 2018; 5: 747-764
• 17 Peter O, Lang J, Stein K. et al. „Ich bin nicht die Diagnose – aber sie ist auch ein Teil von mir“: Eine qualitative Interviewstudie zu Sichtweisen psychisch erkrankter Menschen. Psychiat Prax 2018; DOI: 10.1055/s-0043-100026.
• 18 Thoits PA. “I’m not mentally ill”: Identity deflection as a form of stigma resistance. J Health Soc Behav 2016; 57: 135-151
• 19 Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull 2007; 33: 192-199
• 20 Rüsch N, Corrigan PW, Wassel A. et al. Ingroup perception and responses to stigma among persons with mental illness. Acta Psychiatr Scand 2009; 120: 320-328
• 21 Jetten J, Haslam SA, Cruwys T. et al. Social identity, stigma, and health. In: Major B, Dovidio JF, Link BG. eds. The Oxford Handbook of Stigma, Discrimination, and Health. Oxford: Oxford University Press; 2018: 301-316
• 22 Slade M. Personal recovery and mental illness: A guide for mental health professionals. Cambridge: Cambridge University Press; 2009
• 23 Yanos PT, Roe D, Lysaker PH. The impact of illness identity on recovery from severe mental illness. Am J Psychiatr Rehabil 2010; 13: 73-93
• 24 Quinn DM. When stigma is concealable: The costs and benefits for health. In: Major B, Dovidio JF, Link BG. eds. The Oxford Handbook of Stigma, Discrimination, and Health. Oxford: Oxford University Press; 2018: 287-299
• 25 Rüsch N, Malzer A, Oexle N. et al. Disclosure and quality of life among unemployed individuals with mental health problems: a longitudinal study. J Nerv Ment Dis 2019; DOI: 10.1097/NMD.0000000000000914.
• 26 Corrigan PW, Kosyluk KA, Rüsch N. Reducing self-stigma by coming out proud. Am J Public Health 2013; 103: 794-800
• 27 Morrow DF. Coming out issues for adult lesbians: a group intervention. Social Work 1996; 41: 647-656
• 28 Corrigan PW, Lundin R. Don’t call me nuts! Coping with the stigma of mental illness. Chicago: Recovery Press; 2001
• 29 Mulfinger N, Müller S, Böge I. et al. Honest, Open, Proud for adolescents with mental illness: Pilot randomized controlled trial. J Child Psychol Psychiatry 2018; 59: 684-691
• 30 Corrigan PW, Rüsch N, Scior K. Adapting disclosure programs to reduce the stigma of mental illness. Psychiatr Serv 2018; 69: 826-828
• 31 Rüsch N, Abbruzzese E, Hagedorn E. et al. Efficacy of Coming Out Proud to reduce stigma’s impact among people with mental illness: pilot randomised controlled trial. Br J Psychiatry 2014; 204: 391-397
• 32 Corrigan PW, Larson JE, Michaels PJ. et al. Diminishing the self-stigma of mental illness by Coming Out Proud. Psychiatry Res 2015; 229: 148-154
• 33 Lucksted A, Drapalski AL, Brown CH. et al. Outcomes of a psychoeducational intervention to reduce internalized stigma among psychosocial rehabilitation clients. Psychiatr Serv 2016; 68: 360-367
• 34 Vayshenker B, Mulay AL, Gonzales L. et al. Participation in peer support services and outcomes related to recovery. Psychiatr Rehabil J 2016; 39: 274-281
• 35 Corrigan PW, Morris SB, Michaels PJ. et al. Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatr Serv 2012; 63: 963-973