Psychometric evaluation of the Czech Beck Depression Inventory-II in a sample of depressed patients and healthy controls.

OBJECTIVE: The goal of this study was to explore reliability and validity of the Czech revised Beck Depression Inventory (BDI-II) and to identify the best cut-off for a correct identification of a potentially depressed individual. METHOD: Two groups of adult participants entered the study. The first group consisted of 177 patients with depression (F32x or F33x according to the ICD-10). Furthermore, there were 767 healthy controls. Each participant filled in BDI-II. A part of the patients also completed the Beck Anxiety Inventory (BAI), the Dissociative Experiences Scale (DES), and the subjective Clinical Global Impression scale (CGI). A part of the controls filled in the Adult Dispositional Hope Scale (ADHS) and the Satisfaction with Life Scale (SWLS). RESULT: The average patients' BDI-II score was 30.8±10.3, the mean controls' score was 7.2±6.8. The internal consistency of the inventory was excellent (the ordinal alpha coefficient was 0.90 for the patients and 0.93 for the controls). The stability in time, measured two weeks apart, was also good (intra-class correlation coefficient r=0.83 for the patients and 0.77 for the controls). The exploratory factor analysis of the patients showed a three-factor solution, while the analysis of the controls' data identified two factors. As expected, BDI-II significantly positively correlated with BAI, DES, and CGI and was negatively connected to ADHS and SWLS. The cut-off score with the best sensitivity and specificity was 17. CONCLUSION: The Czech BDI-II shows adequate psychometric characteristics.

Adherence, self-stigma and discontinuation of pharmacotherapy in patients with anxiety disorders - cross-sectional study.

INTRODUCTION: Treatment adherence is one of the main factors affecting the success of treatment and, secondarily, the quality of life and social adaptation of the patients. The aim of this study was to investigate the association between self-stigmatization, treatment adherence and history of discontinuation of drug treatment. METHODS: The cross-sectional study was conducted on 120 (98 completed all the questionnaires) neurotic outpatients treated in the University Hospital Olomouc. The following variables were evaluated: the objective and subjective Clinical Global Impression (CGI) scale, Drug Attitude Inventory (DAI-10) questionnaire measuring adherence, Internalized Stigma of Mental Illness (ISMI) scale measuring self-stigma, and a demographic data questionnaire. RESULTS: Data analysis showed no correlation between self-stigmatization and age, age of onset or length of the post-hospitalization phase. However, there were significant correlations between self-stigmatization and the severity of the disorder (assessed by both objective and subjective CGI), number of previous hospitalizations, total number of psychiatrists visited by the patient, the arbitrary discontinuation of medication in the past, and the dose of an antidepressant. Furthermore, self-stigma was significantly negatively correlated with the current treatment adherence. The rate of adherence was negatively correlated with both objective and subjective CGI only. CONCLUSIONS: Self-stigma significantly affects the current adherence to the treatment of neurotic spectrum disorders.

Connection between self-stigma, adherence to treatment, and discontinuation of medication.

INTRODUCTION: Self-stigma plays a role in many areas of the patient's life. Furthermore, it also discourages therapy. The aim of our study was to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups. METHODS: This cross-sectional study involved outpatients attending the Department of Psychiatry, University Hospital Olomouc, Czech Republic. The level of self-stigma was measured with the Internalized Stigma of Mental Illness and adherence with the Drug Attitude Inventory. The patients also anonymously filled out a demographic questionnaire which included a question asking whether they had discontinued their medication in the past. RESULTS: We examined data from 332 patients from six basic diagnostic categories (substance abuse disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, and personality disorders). The study showed a statistically significant negative correlation between self-stigma and adherence to treatment in all diagnostic groups. Self-stigma correlated positively and adherence negatively with the severity of disorders. Another important factor affecting both variables was partnership. Self-stigma positively correlated with doses of antidepressants and adherence with doses of anxiolytics. Self-stigma also negatively correlated with education, and positively with a number of hospitalizations and number of psychiatrists visited. Adherence was further positively correlated with age and age of onset of disorders. Regression analysis showed that self-stigma was an important factor negatively influencing adherence to treatment and significantly contributing to voluntary discontinuation of drugs. The level of self-stigma did not differ between diagnostic categories. Patients suffering from schizophrenia had the lowest adherence to treatment. CONCLUSION: The study showed a significant correlation between self-stigma and adherence to treatment. High levels of self-stigma are associated with discontinuation of medications without a psychiatrist's recommendation. This connection was present in all diagnostic groups.

Treatment adherence and self-stigma in patients with depressive disorder in remission - A cross-sectional study.

OBJECTIVE: A wide range of variables may influence the rate of adherence to treatment. These variables can be associated with the disease itself, method of treatment, patient's personality, environmental factors and therapeutic relationship. Self-stigma is one of the possible factors related to poor adherence. The aim of the study was to find out the relationship between current adherence, discontinuation of medication in the past and self-stigma in stable psychiatric outpatients diagnosed with depressive disorder. METHODS: The study included 72 stable outpatients diagnosed with depressive disorder with a mean age of 49.00 ± 12.56. Disorder severity was assessed using the Clinical Global Impression scale. Adherence was measured by the Drug Attitude Inventory - 10 items (DAI-10) scale and self-stigma by the Internalized Stigma of Mental Illness (ISMI) scale. The data were evaluated in 66 patients. Six patients were excluded because of incompletely filled in questionnaires. RESULTS: The rate of adherence was not associated with gender, education, employment, family burden (family history) or partner status. Current adherence did not differ between patients who arbitrarily discontinued their medication in the past and those who did not. Adherence was significantly positively correlated with patient's age, age at disease onset and the level of self-stigma. CONCLUSIONS: The study results suggest that the level of self-stigma and age of the patient can be very important factors associated with adherence in patients with depressive disorder.

Self-stigma and suicidality in patients with neurotic spectrum disorder - a cross sectional study.

BACKGROUND: Self-stigmatization is a step-by-step process during which the person uncritically accepts the societal negative evaluation and applies it to himself. Relation between self-stigma and suicidality in neurotic disorders is not known. The aim of our study was to find connection between self-stigma and the level of suicidality in neurotic spectrum disorders. METHOD: It was a cross-sectional study of 198 inpatients with pharmacoresistant neurotic spectrum disorders hospitalized at the psychotherapeutic ward of the Department of Psychiatry, University Hospital Olomouc. Patients were diagnosed using the ICD-10 research diagnostic criteria. The assessments included Internalized Stigma Of Mental Illness (ISMI), Beck Depression Inventory-second edition (BDI-II), objective and subjective Clinical Global Impression (CGI), Morin sleep scale, Dissociative Experience Scale (DES) and Montgomery and Asberg Depression Rating Scale, item 10 Suicidal Thoughts (MADRS item 10 suicidality) for the assessment. RESULTS: The subjective rate of suicidality and also the objective rate of suicidality were strongly positively correlated with the total score of ISMI. There were also significant correlations with all subscores except for the correlation between the BDI 9 and the sub score Resistance against stigma, which barely missed the level of statistical significance. CONCLUSIONS: More attention should be paid to self-stigma in neurotic patients, especially in those with suicidal thoughts and tendencies.

Self-stigma in psychiatric patients--standardization of the ISMI scale.

OBJECTIVE: Self-stigma in psychiatric patients is an issue deserving both research and therapeutic attention. The objective of the present study was to evaluate the psychometric properties of a Czech version of the Internalized Stigma of Mental Illness (ISMI) scale assessing the levels of self-stigma in individuals with mental disorders. METHODS: It consists of 29 items classified into 5 subscales, namely alienation, stereotype endorsement, perceived discrimination, social withdrawal and stigma resistance. The study group comprised 369 patients with a mean age of 41.5±13.3 years, of whom 210 (56.6%) were females. RESULTS: The most frequent diagnosis was neurotic disorders (46.1%), followed by affective disorders (18.4%), substance use disorders (13.3%), psychotic disorders (10.8%), personality disorders (9.5%) and organic disorders (1.6%). Reliability of the scale was evaluated by internal consistency analysis (α=0.91), the split-half method (Spearman-Brown coefficient: 0.93) and test-retest at 3 weeks from the first measurement (N=17; r=0.90, p<0.05). CONCLUSION: Exploratory factor analysis of the scale was performed, its validity was verified and norms were established that were based on T-scores and sten scores for the entire scale and individual subscales. The Czech translation of the ISMI has adequate psychometric properties.

Self-stigma and adherence to medication in patients with psychotic disorders--cross-sectional study.

OBJECTIVE: Adherence to treatment of mental disorders is one of the key factors influencing its success and, secondarily, the patients' quality of life and social adaptation. The cross-sectional study of 90 outpatients diagnosed with psychotic disorders aimed at determining if there was a relationship between discontinuation of psychoactive drugs in the past, current adherence to treatment and self-stigma. METHODS: The assessment was made with the objective and subjective Clinical Global Impression - Severity scale, Drug Attitude Inventory, Internalized Stigma of Mental Illness (ISMI) scale and demographic data. The questionnaires were filled out by 79 patients, of whom 5 handed in incomplete questionnaires. Complete sets of data were obtained from 74 patients. RESULTS: The data analysis showed that the levels of self-stigma as assessed by the total ISMI scores was not statistically significantly correlated with most of the demographic factors (age, age of illness onset, gender, education, marital status, employment, duration of the illness, number of hospitalizations and antipsychotic dosage). However, there was a significant negative correlation with current adherence to treatment.