Psychiatric nursing

What is known on this subject? • Stigmatization of and discrimination against schizophrenia affect not only patients, but also their loved ones, including parents, siblings, spouses and friends. What is the contribution of this paper? • This study indicates that parents experience both social stigmatization and internalized stigmatization, and that this experience results in emotional burden and social losses. It also indicates that parents use avoidance and active methods to cope with stigmatization. What is its contribution to the practice? • The results of this study show that parents, who act as caregivers, are also affected by stigmatization and discrimination, and that this should be considered in structuring the mental health policies. New models should also be developed to support them. 60 Psikiyatri Hemşireliği Dergisi Journal of Psychiatric Nursing A qualitative study conducted in the Czech Republic determined that the family members of individuals with schizophrenia experience stigmatization and discrimination within their families, in society and in public support systems.[4] In another study conducted in China, 71% of the caregivers reported that they received less support from their friends and frequently experienced discrimination during their applications for shelter, school and job after diagnosis.[11] A mixed methods study conducted in India, in which most of the participants were family members, highlighted the negative effects of the caregivers’ experience of stigmatization on their relationships and emotional well-being. They experienced negative reactions and exclusion, and avoided social interaction.[12] Family members report that others are reluctant to communicate with them, and that they feel rejected. Both family members and patients also reported denigration and attacks on their rights by others.[13] Other qualitative studies, in which most of the participants were parents, determined that families are affected by the stigmatization of patients, experience social exclusion, are exposed to curiosity, derision and criticism and are judged as guilty.[9,14] The siblings of the individuals with schizophrenia also encounter difficulties with finding jobs, marriage and career management, as well as family structure. [10] It is also indicated that family members tend to internalize the stigmatic beliefs of others.[15] Family members experience a sense of worthlessness, disappointment, shame, fear, concerns, loneliness, hopelessness, sadness, despair and guilt as a result of stigmatization.[10,13,16] Socially, families experience isolation and ignorance, and therefore, they hide the disease and avoid relationships.[16] Accusations, criticism and avoidance by others result in psychological distress, hopelessness and social withdrawal.[12] Shame also negatively affects families’ acceptance of the disease and undertaking of caregiver roles.[17] Reducing the effects of stigmatization is important for strengthening families during the caregiving process.[10] The literature includes qualitative studies that describe the stigmatization experiences of the families of individuals with schizophrenia. However, none of them focus directly on parents’ stigmatization experiences. Some studies have been conducted with all family members,[9] while others have also included distant relatives such as cousins in their samples. [3,4,10] The data of the other qualitative studies reflect the experiences of both the patients and family members.[13,16,17] However, the stereotypes on which stigmatization and discrimination are based are also shaped by the roles and positions of family members within families. Being a parent, child or spouse may affect the nature of the experience of stigmatization and its effects.[1] This study aims to describe the stigmatization experiences of the parents of individuals diagnosed with schizophrenia. Its results can help to guide the efforts to reduce parents’ burden due to stigmatization and to improve the nature of the efforts to fight stigmatization by rebuilding the societal systems. Materials and Method