Background: Stigma is one of the main factors causing pasung (physical restraint or confinement in Indonesian terms) in schizophrenia patients. It is the main obstacle to reducing the number of pasung throughout the world. Thus, there is a need for appropriate interventions to reduce stigma in schizophrenia patients who go through pasung. This study aims to identify multilevel stigma interventions in people with schizophrenia who go through pasung (physical restraint and confinement). It can be applied and adapted to various cultural contexts.
Design and Methods: Quasi-experimental research with pretest and post-test analysis consists of 82 people with schizophrenia who go through pasung. Respondents were divided into the intervention group and the control group. A multilevel stigma intervention was given to the intervention group for three months.
Results: There was a significant difference in the average stigma score in the control group (moderate category stigma) and the intervention group (mild category stigma) after multilevel stigma intervention (p-value = 0.04). The average stigma score of schizophrenia patients in the intervention group decreased by 8.2%, while the average stigma score in the control group increase of 20.4%.
Conclusions: Multilevel stigma interventions are effective in reducing stigma in people with schizophrenia who go through pasung. We underline that multilevel stigma interventions through collaboration from various parties can provide great opportunities in stigma reduction programs in people with schizophrenia who go through pasung.
2. Laila NH, Mahkota R, Shivalli S, Bantas K, Krianto T. Factors associated with pasung (physical restraint and confinement) of schizophrenia patients in Bogor regency, West Java Province, Indonesia 2017. BMC Psychiatry. 2019;19(1):1–8.
3. Eka AR, Daulima NHC. Factors related to pasung on people with mental illness. Int J Nurs Heal Serv. 2019;2(2):36–41.
4. WHO. Schizophrenia [Internet]. 2019 [cited 2020 Jun 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/schizophrenia
5. Badan Penelitian dan Pengembangan Kesehatan. Hasil Utama RISKEDAS 2018 [Internet]. 2018 [cited 2020 Jun 13]. Available from: https://www.kemkes.go.id/resources/download/info-terkini/hasil-riskesdas-2018.pdf
6. Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. Global epidemiology and burden of schizophrenia: Findings from the global burden of disease study 2016. Schizophr Bull. 2018;44(6):1195–203.
7. Hill K, Startup M. The Relationship Between Internalized Stigma, Negative Symptoms and Social Functioning in Schizophrenia: The Mediating Role of Self-Efficacy. Psychiatry Res. 2013;206(2–3):151–7.
8. Livingston JD, Boyd JE. Correlates and Consequences of Internalized Stigma for People Living With Mental Illness: A Systematic Review and Meta-Analysis. Soc Sci Med. 2010;71(12):2150–61.
9. Villares CC, Sartorius N. Challenging the stigma of schizophrenia. Rev Bras Psiquiatr. 2003;25(1):1–2.
10. Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005;20(8):529–39.
11. Corrigan PW, Kerr A, Knudsen L. The stigma of mental illness: Explanatory models and methods for change. Appl Prev Psychol. 2005;11(3):179–90.
12. Ferliana H, Damayanti NA, Aisyah DN, Huda N, Ernawati D. Determinants of family independence in caring for hebephrenic on m er ci al us e on m al. J Public health Res. 2020;9(1828):149–51.
13. Rao D, Elshafei A, Nguyen M, Hatzenbuehler ML, Frey S, Go VF. A systematic review of multi-level stigma interventions: State of the science and future directions. BMC Med. 2019;17(1):1–11.
14. Richman LS, Hatzenbuehler ML. A Multilevel Analysis of Stigma and Health: Implications for Research and Policy. Policy Insights from Behav Brain Sci. 2014;1(1):213–21.
15. Cook JE, Purdie-Vaughns V, Meyer IH, Busch JTA. Intervening within and across levels: A multilevel approach to stigma and public health. Soc Sci Med [Internet]. 2014;103:101–9. Available from: http://dx.doi.org/10.1016/j.socscimed.2013.09.023
16. Çapar M, Kavak F. Effect of internalized stigma on functional recovery in patients with schizophrenia. Perspect Psychiatr Care. 2018;55(1):103–11.
17. Angermeyer MC, Matschinger H, Link BG, Schomerus G. Public attitudes regarding individual and structural discrimination: Two sides of the same coin? Soc Sci Med [Internet]. 2014;103:60–6. Available from: http://dx.doi.org/10.1016/j.socscimed.2013.11.014
18. Cook JE, Purdie-Vaughns V, Garcia J, Cohen GL. Chronic threat and contingent belonging: Protective benefits of values affirmation on identity development. J Pers Soc Psychol. 2012;102(3):479–96.
19. Windarwati HD. Perilaku spiritual keluarga Perilaku spiritual keluarga dalam merawat anggota keluarga dengan halusinasi, a grounded theory study. In: Prosiding Konferensi Nasional V keperawatan kesehatan jiwa dengan tema mental health character building: intensive psychiatric nursing development and partnership with communities. Semarang: Media Ners; 2009. p. 105–20.
20. Hartini N, Fardana NA, Ariana AD, Wardana ND. Stigma toward people with mental health problems in Indonesia. Psychol Res Behav Manag. 2018;11:535–41.
21. Dahlberg KM, Waern M, Runeson B. Mental health literacy and attitudes in a Swedish community sample – Investigating the role of personal experience of mental health care. BMC Public Health. 2008;8:1–10.
22. Van Zelst C. Stigmatization as an environmental risk in schizophrenia: A user perspective. Schizophr Bull. 2009;35(2):293–6.
23. De Silva MJ, McKenzie K, Harpham T, Huttly SRA. Social capital and mental illness: A systematic review. J Epidemiol Community Health. 2005;59(8):619–27.
24. Walsh F. Family resilience: Strengths forged through adversity. In: Walsh F, editor. ormal family processes: Growing diversity and complexity. The Guilford Press; 2012. p. 399–427.
25. Wardhani Y. Model eliminasi pasung. Surabaya; 2011.
26. Silva RDDC, Albuquerque SGC, Muniz AD V., Filho PPR, Ribeiro S, Pinheiro PR, et al. Reducing the Schizophrenia Stigma: A New Approach Based on Augmented Reality. Comput Intell Neurosci. 2017;2017:10.
27. Lestari W, Wardhani YF. Stigma dan penanganan penderita gangguan jiwa berat yang dipasung. Bul Penelit Sist Kesehat. 2014;17(2):157–66.