Internalized Stigma and its correlates amongst patients with Common Mental Disorders

Internalized Stigma and its correlates amongst patients with Common Mental Disorders | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Internalized Stigma and its correlates amongst patients with Common Mental Disorders Priyanka Manghani, Suma Udupa, Priyesh Chandrashekar, Sanjay Pattanshetty This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5968430/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Introduction: Mental Health is a crucial component of the Sustainable Development Goals. Common Mental Disorders are an umbrella term inclusive of mood disorders, neurotic, stress-related, and somatoform disorders, according to the International Classification of Diseases and Related Health Problems-10 (ICD-10). Internalized stigma in psychiatric patients not only impacts their self-esteem and quality of life but also influences the individual’s treatment and health-seeking behavior. Thus, stigma is a significant barrier influenced by various socio-demographic and clinical variables. This study explored the level of internalized stigma perceived by patients and the association between self-stigma and the socio-demographic as well as clinical profile of the patient. Materials and Methods: A structured socio-demographic proforma and morbidity proforma, and the Internalized Stigma of Mental Illness (ISMI) Scale were administered to 119 patients above 18 years with different Common Mental Disorders per ICD-10 criteria. This cross-sectional study included patients from the OPD service of a tertiary care hospital. Patients with epilepsy, intellectual disability, organic mental disorders, and those requiring hospital admissions were excluded. Results: A mild to moderate level of stigma was reported in patients with common mental disorders. The mean scores across the domains of alienation, discrimination, social withdrawal, and stigma resistance were highest in patients with obsessive-compulsive disorders. Age, age of onset of disease, history of suicidal ideation, and attempt were significant predictors of self-stigma. Strong correlations were found between various domains of stigma. Conclusion: Stigma can act as a barrier to addressing the burden of global mental health, influencing treatment and health-seeking behavior. Knowledge of self-stigma and its contributing factors will help us understand the extent of internalized stigma present in patients, aiding in interventions to reduce internalized stigma. Sustainable Development Goals Common mental disorders health-seeking behavior Figures Figure 1 Introduction A mental disorder is a syndrome characterized by a clinically significant difference in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning. 1 There has been a rise in the global prevalence of mental health conditions, with cases such as depression, anxiety, somatoform disorder, etc., being on the rise and contributing significantly to the global burden of non-communicable diseases. According to the National Mental Health Survey 2015-16, the weighted lifetime prevalence of ‘any mental morbidity’ was estimated at 13.67%, and the current prevalence was 10.56%. Mental and behavioral problems due to psychoactive substance use, mood disorders, and neurotic and stress-related disorders were the most commonly prevalent mental morbidities in India. The overall prevalence was estimated to be higher among males, middle-aged individuals in urban metros, less educated people, and households with lower incomes. 2 In the year 2017, 197·3 million people had mental disorders in India, including 45·7 million with depressive disorders and 44·9 million with anxiety disorders. 3 Mental health is a crucial component of well-being and a person’s overall health, and it is also an agenda of the Sustainable Development Goals (SDGs). SDG 3.4 addresses mental health and well-being with targets to address mental health, universal coverage of services, and reduce stigma and discrimination. 4 Psychiatric Disorders can be broadly classified as Common and Severe Mental Disorders. The commonly occurring mental health disorders include a variety of conditions such as depression, generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). 5 Severe mental disorders include conditions that produce psychotic symptoms, such as schizophrenia and schizoaffective disorder, and severe forms of other disorders, such as bipolar disorder. 6 It is crucial that a person with a mental health disorder receives appropriate and timely pharmacotherapy coupled with psychotherapy to aid in combating active symptomatology and promote recovery. However, this aim is met with a variety of challenges, mainly owing to the stigma and taboo surrounding the topic of mental health. Internalized stigma, in particular, is an eminent barrier to patients accessing treatment and is associated with poor mental health. 7 According to Erving Goffman, stigma is an attribute that is deeply discrediting, which reduces someone from a whole and usual person to a tainted, discounted one. 8 Evidence shows that a higher internalized stigma, especially with people diagnosed with severe mental illnesses, corresponds to lower levels of self-esteem, self-efficacy, and more severe psychiatric symptoms. 9 Stigma has long-standing impacts on health-seeking behavior, medication compliance, and quality of life of those suffering from mental health disorders. Additionally, a variety of socio-demographic and clinical variables can contribute to stigma. Stigma, thereby, is a key aspect that needs to be addressed to promote early treatment, recovery, and psycho-social rehabilitation for those diagnosed with mental health disorders. Eradicating Stigma is also one of the key strategies of India’s National Mental Health Program. 10 There have been various studies conducted to study Stigma and its correlates in the case of major psychiatric disorders such as schizophrenia and bipolar disorder 11 , 12 , but there is limited scientific evidence regarding stigma exclusively in common mental disorders and the factors predicting it. In lieu of the same, this study will be one of the foremost to consider common mental disorders completely as a study population and describe the level of internalized stigma in this group, along with its predicting factors. Materials and Methods This Cross-Sectional Study was conducted at the Department of Psychiatry, Kasturba Hospital, Manipal. Ethical Approval for the study was obtained from the Institutional Ethics Committee (IEC No: 901/2019) of Kasturba Medical College, Manipal. The study was also registered under the Clinical Trials Registry of India(CTRI), under the Indian Council of Medical Research (ICMR)- National Institute of Medical Statistics, on 3rd January 2020 ( Registration No: CTRI/2020/01/022722. The study complied with all the ethical principles for studies involving human research participants. In this cross-sectional study, 119 patients diagnosed with Common Mental Disorders as per the International Classification of Diseases, Version 10 (ICD-10, published by WHO) criteria 6 by the consulting psychiatrist, who were above 18 years of age and who provided informed consent, were included in the study. All the patients who fulfilled the inclusion criteria during the time period of the study were included in this study. Males and Females were recruited for the study from the psychiatric outpatient services of a tertiary care hospital between January and March 2020. Diagnostic criteria were checked prior to data collection, with the above inclusion criteria outlined to the consulting psychiatrist. Patients with epilepsy, intellectual disability, organic mental disorders, and those requiring hospital admissions were excluded. Any other physical and mental comorbidity in the subjects was recorded as part of the participant information. A structured socio-demographic and morbidity proforma, along with the Internalized Stigma of Mental Illness (ISMI) Scale, was administered to study the patients. Information about their remission status and medical and psychiatric comorbidities was collected from the case files and confirmed with the consulting psychiatrist. Statistical computations were performed using the EZR software ( https://cran.r-project.org/web/packages/RcmdrPlugin.EZR/index.html ). Statistical significance was considered at p-value < 0.05. Chi-square tests were performed to associate categorical variables such as socio-demographic details, while ANOVA was computed to calculate the significant mean difference between the stigma scores. Linear regression was computed to gather the model variables and predict the outcome variable, stigma scores. Results The m e an age of the subjects (47 males and 72 females) was 45.6 ± 14.2 years, with the majority of the participants being female (60.5%). The socio-demographic characteristics of the subjects are described in Table 1 , and the presenting clinical features are described in Table 2 . Table 1 Socio-Demographic Characteristics of Participants Category Sub-Category Frequency (n) Age 18–35 32 (26.9%) 35–45 32 (26.9%) 45–55 26 (21.8%) 55–80 29 (24.4%) Gender Male 47 (39.5%) Female 72 (60.5%) Marital Status Married 96 (80.7%) Unmarried 17 (14.3%) Divorced 1 (0.8%) Widowed 5 (4.2%) Type of Family Joint 34 (28.6%) Nuclear 85 (71.4%) No. of Family Members 2–4 78 (65.5%) 5–7 29 (24.4%) 8–10 10 (7.6%) 13–20 2 (1.6%) Residence Rural 88 (73.9%) Urban 31 (26.1%) Education Professional Degree Nil Graduate/ Postgraduate 24 (20.2%) Intermediate/Post High School Diploma 28 (23.5%) High School Certificate 29 (24.4%) Middle School Certificate 21 (17.6%) Primary School Certificate 12 (10.1%) Illiterate 5 (4.2%) Occupation Professional (White Collar) 6 (5%) Semi-Professional 4 (3.4%) Clerical, Shop-owner/Farm 18 (15.1%) Skilled Worker 4 (3.4%) Semi-skilled worker 14 (11.8%) Unskilled worker 5 (4.2%) Unemployed 68 (57.1%) Monthly Income of Family Rs. 6500 and below 32 (26.9%) Rs. 6500-19,000 55 (46.2%) Rs. 19,000–31,500 12 (10.1%) Rs. 31,500 − 47,000 11 (9.2%) Rs. 47,000–63,000 5 (4.2%) Rs. 63,000–1,26,000 1 (0.8%) Rs. 1,26,000 and more 3 (2.5%) Table 2 Clinical Profile of the Participants Category Sub-Category Frequency (n) Diagnosis Groups Depressive spectrum disorders 50 (42%) Anxiety spectrum disorders 39 (32.8%) Obsessive-compulsive disorders 8 (6.7%) Stress-related disorders 7 (5.9%) Somatoform disorders 15 (12.6%) Medication Compliance Good 107(89.9%) Occasionally Misses 3(2.5%) Poor 9(7.6%) Symptomatology Currently Symptomatic 39 (32.8%) Partial Remission 41 (34.5%) Remission 39 (32.8%) Frequency of Past Psychiatric Admissions Nil 96 (80.7%) 1–2 20 (16.80%) 3–5 3 (2.5%) Medical Comorbidity Yes 1 (0.8%) No 118 (99.2%) Psychiatric Comorbidity Yes 12 (10.1%) No 107 (89.9%) Insight Grade 1 2(1.7%) Grade 2 5(4.2%) Grade 3 26(21.8%) Grade 4 47(39.5%) Grade 5 39(32.8%) The comparison of the stigma scores across the diagnosis groups and stigma domains is depicted in Table 3 . ANOVA results revealed no significant differences in the stigma scores across the different diagnosis groups. Table 3 Comparison of Mean Stigma Scores across Diagnostic Groups STIGMA DOMAIN Depressive Spectrum Disorders (n = 50) Anxiety Spectrum Disorders (n = 39) Obsessive Compulsive Disorders (n = 8) Stress-Related Disorders (n = 7) Somatoform Disorders (n = 15) F (p) Alienation 12.96 ± 4.1 12.26 ± 3.8 15.62 ± 4.3 13.14 ± 2.7 11.60 ± 3.4 1.62 (0.17) Stereotype Endorsement 14.16 ± 4.3 14.10 ± 4.2 13.62 ± 3.5 16.14 ± 3.3 12.87 ± 3.5 0.81 (0.52) Discrimination Experience 10.02 ± 3.2 9.26 ± 2.6 10.50 ± 3.6 10.14 ± 2.2 9.13 ± 2.4 0.71 (0.58) Social Withdrawal 13.02 ± 4.2 12.59 ± 3.7 14.12 ± 3.0 11.71 ± 2.6 11.40 ± 3.5 0.92 (0.45) Stigma Resistance 12.00 ± 2.3 12.05 ± 2.4 13.50 ± 2.0 12.00 ± 1.8 11.73 ± 3.0 0.80 (0.53) TOTAL SCORE 62.16 ± 14.6 60.26 ± 11.9 67.38 ± 11.9 63.14 ± 7.9 56.73 ± 10.7 1.08 (0.37) 41.1% of participants had minimum to no internal stigma , with the mean score being highest in the domain of stigma resistance. 38.6% of participants had a mild internal stigma , with the mean score being highest in the domain of stereotype endorsement. 17.6% of participants had a moderate internal stigma , and the mean score was highest in the domain of stereotype endorsement. Only 2.52% of participants had severe internal stigma , with the mean score being highest in the domain of social withdrawal. Figure 1 describes the Mean stigma across different ISMI Domains. Pearson’s correlation revealed significant positive correlations between the domains of alienation, stereotype endorsement, discrimination experience, and social withdrawal (r ranging from 0.71 to 0.73, p < 0.001) of the ISMI scale. The domain of stigma resistance presented significant negative correlations with the remaining four domains of the scale (r ranging from − 0.19 to -0.21, p < 0.05). There was no multicollinearity between variables. Linear regression was computed with the outcome measure to be the stigma score, with the predicting variables for stigma taken as age, age of onset, psychiatric admissions, psychiatric comorbidity, history of suicidal ideation and attempt, diagnosis, medical comorbidity, medication compliance, gender, precipitating factors, and symptomatology. While the overall model revealed trend level significance (F = 2.778, p = 0.004), the coefficient of age, age of onset, history of suicidal ideation, and attempt presented as a significant predictor of stigma with age (t= -3.013, p = 0.003), age of onset (t = 2.381, p = 0.019), history of suicidal ideation and attempt (t = 2.167, p = 0.032) being so respectively. Discussion Our study revealed that there is a mild to moderate amount of internalized stigma present in patients with common mental disorders. A study from North India found that self-stigma is highly prevalent among patients with first-episode depression (FED), with about two-fifths of patients reporting stigma as per the ISMI Scale. 13 Additionally, a multinational European study that evaluated stigma amongst patients with FED and first-episode schizophrenia (FES), reported that subjects with first episode depression faced more discrimination in a greater number of life areas such as meeting neighbor's, dating, education, marriage, etc. 14 On the contrary, a study conducted in South India to compare the internalized stigma amongst patients with schizophrenia, bipolar and anxiety disorders in remission revealed that stigma did not differ significantly among the various diagnostic groups. 15 Further research is needed to understand the broad range of internal stigma present across a variety of common mental disorders. Additionally, factors such as mental health literacy, awareness, and myths also need to be taken into consideration, as these may impact the level of stigma. The mean score of alienation was highest in the obsessive-compulsive disorders group. Evidence states that owing to fear of stigma, people suffering from OCD avoid seeking psychiatric aid, which leads to further worsening of the symptoms. 16 Additionally, it has been seen that relatives of patients who are diagnosed with OCD anticipate or experience stigma and thereby use concealing the diagnosis of OCD of the family member as a coping strategy to avoid Stigma. 17 , 18 The mean score of stereotype endorsement was highest in the stress-related disorders group. Stress-related disorders correlate to responses, particularly towards a stressful or traumatic event. 19 Given the stigma and taboos surrounding mental health, an individual may resonate with the stereotypes society commonly puts forth regarding such a sensitive topic. Particularly, if one is facing difficulty coping with an emotional situation, society further stigmatizes the individuals as an offset of poor coping strategies and emotional resilience, thereby laying the ground for the individual to resonate the same given the beliefs followed by his peers and by society members. The mean score of discrimination experience was highest in those diagnosed as having OCD, followed by those having stress-related disorders and depressive spectrum disorders. A study describing the experiences of people diagnosed with OCD showed that the majority of participants expected a negative reaction from their surroundings to the extent of job rejections and not finding a life partner due to their condition. 18 . Likewise, the mean scores of social withdrawal and stigma resistance were also highest in this group. Our study showed that the age of the participant, age of onset of the disease, history of suicidal ideation, and attempt were significant predictors of the mean self-stigma scores. Likewise, a study conducted in North India that evaluated stigma amongst patients with schizophrenia, bipolar disorder, and recurrent depressive disorder (RDD) revealed that across the various psychiatric disorders, a younger age of onset was associated with a higher level of stigma. Similar studies have mentioned that a reciprocal relationship exists between suicide and stigma. 20 , 21 A strong correlation was found between various domains of stigma. A study conducted in North India also found a significant correlation between the domains of alienation, stereotype endorsement, discrimination experience, and social withdrawal using the original ISMI scale, except for stigma resistance, which did not correlate with any domains of stigma. 13 These findings highlight that stigma is prevalent in patients diagnosed with common mental disorders as well. Evidence states that stigma impacts all aspects of mental disorders and presents as the most crucial risk factor for the promotion of mental health. 22 Thereby, the long-term goal of mental health programs should be to focus on reducing stigma in coherence with improving patients' quality of life. Stigma, if unaddressed, leads to another cycle of stigma. 23 While one of the key strategies of the National Mental Health Program is Stigma Eradication 10 , it is crucial that attention be paid to this aspect further to achieve targets of addressing the burden of mental health. Various approaches, such as community awareness programs and comprehensive community-based programs, especially focusing on the psychological understanding of the disease, can help improve mental health literacy and reduce stigma in the community over time. 24 Reduction of self-stigma is a crucial step towards addressing mental health, and processes such as psychotherapy and counseling sessions need to be employed to improve a patient’s attitude and self-esteem. The awareness about mental health stigma should be focused from the household to the community levels, increasing the literacy levels among the public regarding mental health. 24 Given the purposive sampling, the results cannot be generalized, especially since this was a treatment-seeking population, leading to a bias. It could be possible that a non-treatment-seeking population has a higher level of internalized stigma. 21 However, the power estimation of our study showed significance at p = 0.005, with power = 80.4%. All possible known confounding variables were either collected from the patients or excluded from this study to maintain the homogeneity of the study group. However, some confounding variables could have influenced the results of this study. The Internalized Stigma of Mental Illness (ISMI) Scale has been validated for use in India and has been found to be culturally appropriate. However, the title of the scale mentions ‘Mental Illness,’ which itself could be stigmatizing. The scale also consists of various sensitive questions that participants may be uncomfortable answering and find stigmatizing. This was observed in our study, where patients showed reluctance on viewing a particular set of questions, which led to them not consenting to participate and, in some cases, withdrew consent midway through the study. Thus, even though the scale has been validated and tested for Indian Settings, there is a certain level of hesitancy owing to the title and questions, which could further add stigma. Additionally, our study did not have an additional tool to classify the severity of illness, which could have impacted the level of internalized stigma. The Scale offers a Likert grading component to assess the level of stigma, and patients may not have wanted to respond accurately due to the sensitivity of certain questions, which could have resulted in under-reporting of the stigma levels and a possible bias. A qualitative component would have been better for a more realistic and in-depth understanding of internalized stigma. Conclusion A quantitative measure for the health-seeking behavior regarding mental illness was applied in a tertiary care hospital. The related medical, family, and treatment details were acquired from patients with common mental illnesses, according to the WHO classification. Outcomes of the data suggest the influence of internalized stigma, preventing them from reaching the hospital or clinic-based settings to procure sufficient and necessary health care treatment. Declarations Acknowledgments: The authors would like to thank Dr. Prakash Narayanan Vasudevan Potty and Dr. Sheikh Shah Hossain (WHO, CDC India) from the Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, for their valuable guidance and support for this study. The authors would also like to thank the Department of Psychiatry, Kasturba Medical College, for their valuable support throughout the study period, especially Dr. Samir Kumar Praharaj, Dr. Rajeshkrishna Bhandary, and Dr. Abhiram PN. Ethics Approval and Consent: This was a Cross-Sectional Study conducted at the Department of Psychiatry, Kasturba Hospital, Manipal. Ethical Approval for the study was obtained from the Kasturba Medical College, Manipal Institutional Ethics Committee (IEC No: 901/2019) . The study was also registered under the Clinical Trials Registry of India(CTRI), under the Indian Council of Medical Research (ICMR)- National Institute of Medical Statistics, on 3 rd January 2020 ( Registration No: CTRI /2020/01/022722. The study was conducted in compliance with all the ethical principles for studies involving human research participants. Informed consent was obtained from all study participants who met the inclusion criteria. All authors have read and approved the manuscript for publication, and the requirements for authorship, as stated, have been met. Each author believes that the manuscript represents honest work. All authors have consented to publishing the research findings and manuscript. Funding : This research did not receive any funding. There is no financial or any other relationship that may lead to any dispute associated with this work. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Consent to Publish : Not Applicable. Competing interests: None.This research did not receive any specific grant from any funding agencies in the public, commercial, or not-for-profit sectors. No financial or any other relationship may lead to any dispute associated with this work. References Diagnostic and statistical manual of mental disorders (DSM-5). Arlington: American Psychiatric Publishing; 2013. National Mental Health Survey of India, 2015-2016 Prevalence, Patterns and Outcomes, Supported by Ministry of Health and Family Welfare, Government of India, and Implemented by National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru: In Collaboration with Partner Institutions; 2015-2016. Sagar R, Dandona R, Gururaj G, Dhaliwal RS, Singh A, Ferrari A et al. The burden of mental disorders across the states of India: The Global Burden of Disease Study 1990–2017. The Lancet Psychiatry. 2020 Feb 1;7(2):148-61. Fact sheets on sustainable development goals: health target. Copenhagen: WHO Regional Office for Europe; 2018. Available from: https://www.euro.who.int/__data/assets/pdf_file/0017/348011/Fact-sheet-SDG-Mental-health-UPDATE-02-05-2018.pdf National Collaborating Centre for Mental Health (UK). Common Mental Health Disorders: Identification and Pathways to Care. Leicester (UK): British Psychological Society (UK); 2011. (NICE Clinical Guidelines, No. 123.) 2, COMMON MENTAL HEALTH DISORDERS. Severe Mental Illness | Behavioral Health Evolution, 2022 Available from: https://www.bhevolution.org/public/severe_mental_illness.page Pearl RL, Forgeard MJ, Rifkin L, Beard C, Björgvinsson T. Internalized stigma of mental illness: Changes and associations with treatment outcomes. Stigma and Health. 2017 Feb;2(1):2. Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs NJ: Prentice Hall; 1963. Drapalski AL, Lucksted A, Perrin PB, Aakre JM, Brown CH, DeForge BR, et al . A model of internalized stigma and its effects on people with mental illness. Psychiatr Serv 2013; 64:264-9. National Health Portal, Government of India, 2021. Available from: https://www.nhp.gov.in/national-mental-health-programme_pg Singh A, Mattoo SK, Grover S. Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit. Indian journal of psychiatry. 2016 Jul;58(3):291. Grover S, Hazari N, Aneja J, Chakrabarti S, Avasthi A. Stigma and its correlates among patients with bipolar disorder: A study from a tertiary care hospital of North India. Psychiatry research. 2016 Oct 30; 244:109-16. Sahoo S, Grover S, Malhotra R, Avasthi A. Internalized stigma experienced by patients with first-episode depression: A study from a tertiary care center. Indian J Soc Psychiatry 2018; 34:219. Corker EA, Beldie A, Brain C, Jakovljevic M, Jarema M, Karamustafalioglu O, et al. Experience of stigma and discrimination reported by people experiencing the first episode of schizophrenia and those with a first episode of depression: The FEDORA project. Int J Soc Psychiatry 2015; 61:438‑45. Pingali S, Rao SS, Umashankar M. A Comparative study of internalized stigma and its correlates among different psychiatric disorders in remission. Telegana J Psychiatry. 2018 Jun 3;4(1):29-33. Ansari E, Mishra S, Tripathi A, Kar SK, Dalal PK. Cross-sectional study of internalised stigma and medication adherence in patients with obsessive compulsive disorder. General psychiatry. 2020;33(2). Ociskova M, Prasko J, Cerna M, Jelenova D, Kamaradova D, Latalova K et al. obsessive-compulsive disorder and stigmatization. Act Nerv Super Rediviva. 2013 Jan 1;55(1-2):19-26. Stengler-Wenzke K, Beck M, Holzinger A, Angermeyer MC. Stigma experiences of patients with obsessive compulsive disorders. Fortschritte der Neurologie-psychiatrie. 2004 Jan 1;72(1):7-13. Patra BN, Sarkar S. Adjustment disorder: current diagnostic status. Indian journal of psychological medicine. 2013 Jan;35(1):4-9. Grover S, Avasthi A, Singh A, Dan A, Neogi R, Kaur D, et al. Stigma experienced by participants with severe mental disorders: A nationwide multicentric study from India. Psychiatry Res 2017; 257:550‑8. Carpiniello B, Pinna F. The reciprocal relationship between suicidality and stigma. Frontiers in psychiatry. 2017 Mar 8; 8:3. Taghva A, Farsi Z, Javanmard Y, Atashi A, Hajebi A, Noorbala AA. Strategies to reduce the stigma toward people with mental disorders in Iran: stakeholders’ perspectives. BMC psychiatry. 2017 Dec;17(1):1-2. Dinos S. Stigma creating stigma: a vicious circle. The Psychiatric Bulletin. 2014 Aug;38(4):145-7. Kishore J, Gupta A, Jiloha RC, Bantman P. Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India. Indian Journal of Psychiatry. 2011 Oct;53(4):324. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 17 Jun, 2025 Reviews received at journal 12 Jun, 2025 Reviews received at journal 29 May, 2025 Reviewers agreed at journal 27 May, 2025 Reviewers agreed at journal 20 May, 2025 Reviewers agreed at journal 20 May, 2025 Reviews received at journal 16 May, 2025 Reviewers agreed at journal 02 May, 2025 Reviewers invited by journal 30 Apr, 2025 Editor invited by journal 25 Apr, 2025 Editor assigned by journal 25 Apr, 2025 Submission checks completed at journal 25 Apr, 2025 First submitted to journal 05 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5968430","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452314736,"identity":"8e516c34-56c7-4280-96db-7a7060e57e2c","order_by":0,"name":"Priyanka Manghani","email":"data:image/png;base64,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","orcid":"","institution":"University of California, San Francisco","correspondingAuthor":true,"prefix":"","firstName":"Priyanka","middleName":"","lastName":"Manghani","suffix":""},{"id":452314737,"identity":"d2a43b6c-901d-48f3-9127-99eab57aaa38","order_by":1,"name":"Suma Udupa","email":"","orcid":"","institution":"Manipal Academy of Higher Education","correspondingAuthor":false,"prefix":"","firstName":"Suma","middleName":"","lastName":"Udupa","suffix":""},{"id":452314738,"identity":"1f75fad6-a5fa-47bb-ba17-fdde802b6595","order_by":2,"name":"Priyesh Chandrashekar","email":"","orcid":"","institution":"Manipal Academy of Higher Education","correspondingAuthor":false,"prefix":"","firstName":"Priyesh","middleName":"","lastName":"Chandrashekar","suffix":""},{"id":452314739,"identity":"fde54c2f-6dd8-461f-97ae-ac5aab2f7cb9","order_by":3,"name":"Sanjay Pattanshetty","email":"","orcid":"","institution":"NIMS University","correspondingAuthor":false,"prefix":"","firstName":"Sanjay","middleName":"","lastName":"Pattanshetty","suffix":""}],"badges":[],"createdAt":"2025-02-05 20:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5968430/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5968430/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82177659,"identity":"59bfbbed-decd-45f5-ab65-9422a0e9b953","added_by":"auto","created_at":"2025-05-07 11:21:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64066,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMean Stigma Score across ISMI Domains\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5968430/v1/fe8e894b4d3bf08c79490e13.jpg"},{"id":82178875,"identity":"14892f65-f3af-4c61-9bfb-a22ed412d83f","added_by":"auto","created_at":"2025-05-07 11:29:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1090119,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5968430/v1/2656210d-a1ce-46dc-a13b-d6273b27f73e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eInternalized Stigma and its correlates amongst patients with Common Mental Disorders\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA mental disorder is a syndrome characterized by a clinically significant difference in an individual\u0026rsquo;s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e There has been a rise in the global prevalence of mental health conditions, with cases such as depression, anxiety, somatoform disorder, etc., being on the rise and contributing significantly to the global burden of non-communicable diseases. According to the National Mental Health Survey 2015-16, the weighted lifetime prevalence of \u0026lsquo;any mental morbidity\u0026rsquo; was estimated at 13.67%, and the current prevalence was 10.56%. Mental and behavioral problems due to psychoactive substance use, mood disorders, and neurotic and stress-related disorders were the most commonly prevalent mental morbidities in India. The overall prevalence was estimated to be higher among males, middle-aged individuals in urban metros, less educated people, and households with lower incomes.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e In the year 2017, 197\u0026middot;3\u0026nbsp;million people had mental disorders in India, including 45\u0026middot;7\u0026nbsp;million with depressive disorders and 44\u0026middot;9\u0026nbsp;million with anxiety disorders.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMental health is a crucial component of well-being and a person\u0026rsquo;s overall health, and it is also an agenda of the Sustainable Development Goals (SDGs). SDG 3.4 addresses mental health and well-being with targets to address mental health, universal coverage of services, and reduce stigma and discrimination.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePsychiatric Disorders can be broadly classified as Common and Severe Mental Disorders. The commonly occurring mental health disorders include a variety of conditions such as depression, generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Severe mental disorders include conditions that produce psychotic symptoms, such as schizophrenia and schizoaffective disorder, and severe forms of other disorders, such as bipolar disorder.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIt is crucial that a person with a mental health disorder receives appropriate and timely pharmacotherapy coupled with psychotherapy to aid in combating active symptomatology and promote recovery. However, this aim is met with a variety of challenges, mainly owing to the stigma and taboo surrounding the topic of mental health. Internalized stigma, in particular, is an eminent barrier to patients accessing treatment and is associated with poor mental health.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e According to Erving Goffman, stigma is an attribute that is deeply discrediting, which reduces someone from a whole and usual person to a tainted, discounted one.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Evidence shows that a higher internalized stigma, especially with people diagnosed with severe mental illnesses, corresponds to lower levels of self-esteem, self-efficacy, and more severe psychiatric symptoms.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Stigma has long-standing impacts on health-seeking behavior, medication compliance, and quality of life of those suffering from mental health disorders. Additionally, a variety of socio-demographic and clinical variables can contribute to stigma. Stigma, thereby, is a key aspect that needs to be addressed to promote early treatment, recovery, and psycho-social rehabilitation for those diagnosed with mental health disorders. Eradicating Stigma is also one of the key strategies of India\u0026rsquo;s National Mental Health Program.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThere have been various studies conducted to study Stigma and its correlates in the case of major psychiatric disorders such as schizophrenia and bipolar disorder \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003c/sup\u003e but there is limited scientific evidence regarding stigma exclusively in common mental disorders and the factors predicting it. In lieu of the same, this study will be one of the foremost to consider common mental disorders completely as a study population and describe the level of internalized stigma in this group, along with its predicting factors.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis Cross-Sectional Study was conducted at the Department of Psychiatry, Kasturba Hospital, Manipal. Ethical Approval for the study was obtained from the Institutional Ethics Committee \u003cb\u003e(IEC No: 901/2019)\u003c/b\u003e of Kasturba Medical College, Manipal. The study was also registered under the Clinical Trials Registry of India(CTRI), under the Indian Council of Medical Research (ICMR)- National Institute of Medical Statistics, on 3rd January 2020 (\u003cb\u003eRegistration No: CTRI/2020/01/022722.\u003c/b\u003e The study complied with all the ethical principles for studies involving human research participants.\u003c/p\u003e \u003cp\u003eIn this cross-sectional study, 119 patients diagnosed with Common Mental Disorders as per the International Classification of Diseases, Version 10 (ICD-10, published by WHO) criteria\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e by the consulting psychiatrist, who were above 18 years of age and who provided informed consent, were included in the study. All the patients who fulfilled the inclusion criteria during the time period of the study were included in this study. Males and Females were recruited for the study from the psychiatric outpatient services of a tertiary care hospital between January and March 2020. Diagnostic criteria were checked prior to data collection, with the above inclusion criteria outlined to the consulting psychiatrist.\u003c/p\u003e \u003cp\u003ePatients with epilepsy, intellectual disability, organic mental disorders, and those requiring hospital admissions were excluded. Any other physical and mental comorbidity in the subjects was recorded as part of the participant information. A structured socio-demographic and morbidity proforma, along with the Internalized Stigma of Mental Illness (ISMI) Scale, was administered to study the patients. Information about their remission status and medical and psychiatric comorbidities was collected from the case files and confirmed with the consulting psychiatrist.\u003c/p\u003e \u003cp\u003eStatistical computations were performed using the EZR software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cran.r-project.org/web/packages/RcmdrPlugin.EZR/index.html\u003c/span\u003e\u003cspan address=\"https://cran.r-project.org/web/packages/RcmdrPlugin.EZR/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Statistical significance was considered at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Chi-square tests were performed to associate categorical variables such as socio-demographic details, while ANOVA was computed to calculate the significant mean difference between the stigma scores. Linear regression was computed to gather the model variables and predict the outcome variable, stigma scores.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe m\u003cb\u003ee\u003c/b\u003ean age of the subjects (47 males and 72 females) was \u003cb\u003e45.6\u003c/b\u003e\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;\u003cb\u003e14.2\u003c/b\u003e years, with the majority of the participants being female (60.5%). The socio-demographic characteristics of the subjects are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cb\u003eand the presenting clinical features are described in\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (21.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (39.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (60.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (80.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eType of Family\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNuclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNo. of Family Members\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (7.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (73.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNil\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate/ Postgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate/Post High School Diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School Certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle School Certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary School Certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional (White Collar)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemi-Professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClerical, Shop-owner/Farm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSkilled Worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemi-skilled worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnskilled worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eMonthly Income of Family\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRs. 6500 and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRs. 6500-19,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRs. 19,000\u0026ndash;31,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRs. 31,500\u0026thinsp;\u0026minus;\u0026thinsp;47,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (9.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRs. 47,000\u0026ndash;63,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRs. 63,000\u0026ndash;1,26,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRs. 1,26,000 and more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Profile of the Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis Groups\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepressive spectrum disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (42%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety spectrum disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObsessive-compulsive disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStress-related disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomatoform disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMedication Compliance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107(89.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccasionally Misses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(7.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSymptomatology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrently Symptomatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartial Remission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRemission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eFrequency of Past Psychiatric Admissions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (80.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (16.80%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMedical Comorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118 (99.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePsychiatric Comorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (89.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eInsight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(21.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(39.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(32.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparison of the stigma scores across the diagnosis groups and stigma domains is depicted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. ANOVA results revealed no significant differences in the stigma scores across the different diagnosis groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Mean Stigma Scores across Diagnostic Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTIGMA DOMAIN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepressive Spectrum Disorders\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnxiety Spectrum Disorders\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObsessive Compulsive Disorders\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStress-Related Disorders\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSomatoform Disorders\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF (p)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlienation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.96\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.26\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.62\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e13.14\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e11.60\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.62 (0.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStereotype Endorsement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.16\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.10\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.62\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e16.14\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e12.87\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.81 (0.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscrimination Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.02\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.26\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.50\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e10.14\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e9.13\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.71 (0.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Withdrawal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.02\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.59\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.12\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e11.71\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e11.40\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.92 (0.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStigma Resistance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.00\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.05\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.50\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e12.00\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e11.73\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.80 (0.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTOTAL SCORE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e62.16\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.26\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e67.38\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e63.14\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e56.73\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.08 (0.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e41.1% of participants had minimum to no internal stigma\u003c/b\u003e, with the mean score being highest in the domain of stigma resistance. \u003cb\u003e38.6% of participants had a mild internal stigma\u003c/b\u003e, with the mean score being highest in the domain of stereotype endorsement. \u003cb\u003e17.6% of participants had a moderate internal stigma\u003c/b\u003e, and the mean score was highest in the domain of stereotype endorsement. \u003cb\u003eOnly 2.52% of participants had severe internal stigma\u003c/b\u003e, with the mean score being highest in the domain of social withdrawal. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e describes the Mean stigma across different ISMI Domains.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePearson\u0026rsquo;s correlation revealed significant positive correlations between the domains of alienation, stereotype endorsement, discrimination experience, and social withdrawal (r ranging from 0.71 to 0.73, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) of the ISMI scale. The domain of stigma resistance presented significant negative correlations with the remaining four domains of the scale (r ranging from \u0026minus;\u0026thinsp;0.19 to -0.21, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no multicollinearity between variables.\u003c/p\u003e \u003cp\u003eLinear regression was computed with the outcome measure to be the stigma score, with the predicting variables for stigma taken as age, age of onset, psychiatric admissions, psychiatric comorbidity, history of suicidal ideation and attempt, diagnosis, medical comorbidity, medication compliance, gender, precipitating factors, and symptomatology.\u003c/p\u003e \u003cp\u003eWhile the overall model revealed trend level significance (F\u0026thinsp;=\u0026thinsp;2.778, p\u0026thinsp;=\u0026thinsp;0.004), the coefficient of age, age of onset, history of suicidal ideation, and attempt presented as a significant predictor of stigma with age (t= -3.013, p\u0026thinsp;=\u0026thinsp;0.003), age of onset (t\u0026thinsp;=\u0026thinsp;2.381, p\u0026thinsp;=\u0026thinsp;0.019), history of suicidal ideation and attempt (t\u0026thinsp;=\u0026thinsp;2.167, p\u0026thinsp;=\u0026thinsp;0.032) being so respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study revealed that there is a mild to moderate amount of internalized stigma present in patients with common mental disorders. A study from North India found that self-stigma is highly prevalent among patients with first-episode depression (FED), with about two-fifths of patients reporting stigma as per the ISMI Scale.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003eAdditionally, a multinational European study that evaluated stigma amongst patients with FED and first-episode schizophrenia (FES), reported that subjects with first episode depression faced more discrimination in a greater number of life areas such as meeting neighbor's, dating, education, marriage, etc.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003eOn the contrary, a study conducted in South India to compare the internalized stigma amongst patients with schizophrenia, bipolar and anxiety disorders in remission revealed that stigma did not differ significantly among the various diagnostic groups.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Further research is needed to understand the broad range of internal stigma present across a variety of common mental disorders. Additionally, factors such as mental health literacy, awareness, and myths also need to be taken into consideration, as these may impact the level of stigma.\u003c/p\u003e \u003cp\u003eThe mean score of alienation was highest in the obsessive-compulsive disorders group. Evidence states that owing to fear of stigma, people suffering from OCD avoid seeking psychiatric aid, which leads to further worsening of the symptoms.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Additionally, it has been seen that relatives of patients who are diagnosed with OCD anticipate or experience stigma and thereby use concealing the diagnosis of OCD of the family member as a coping strategy to avoid Stigma.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe mean score of stereotype endorsement was highest in the stress-related disorders group. Stress-related disorders correlate to responses, particularly towards a stressful or traumatic event.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Given the stigma and taboos surrounding mental health, an individual may resonate with the stereotypes society commonly puts forth regarding such a sensitive topic. Particularly, if one is facing difficulty coping with an emotional situation, society further stigmatizes the individuals as an offset of poor coping strategies and emotional resilience, thereby laying the ground for the individual to resonate the same given the beliefs followed by his peers and by society members.\u003c/p\u003e \u003cp\u003eThe mean score of discrimination experience was highest in those diagnosed as having OCD, followed by those having stress-related disorders and depressive spectrum disorders. A study describing the experiences of people diagnosed with OCD showed that the majority of participants expected a negative reaction from their surroundings to the extent of job rejections and not finding a life partner due to their condition.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Likewise, the mean scores of social withdrawal and stigma resistance were also highest in this group.\u003c/p\u003e \u003cp\u003eOur study showed that the age of the participant, age of onset of the disease, history of suicidal ideation, and attempt were significant predictors of the mean self-stigma scores. Likewise, a study conducted in North India that evaluated stigma amongst patients with schizophrenia, bipolar disorder, and recurrent depressive disorder (RDD) revealed that across the various psychiatric disorders, a younger age of onset was associated with a higher level of stigma. Similar studies have mentioned that a reciprocal relationship exists between suicide and stigma.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA strong correlation was found between various domains of stigma. A study conducted in North India also found a significant correlation between the domains of alienation, stereotype endorsement, discrimination experience, and social withdrawal using the original ISMI scale, except for stigma resistance, which did not correlate with any domains of stigma.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese findings highlight that stigma is prevalent in patients diagnosed with common mental disorders as well. Evidence states that stigma impacts all aspects of mental disorders and presents as the most crucial risk factor for the promotion of mental health.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Thereby, the long-term goal of mental health programs should be to focus on reducing stigma in coherence with improving patients' quality of life. Stigma, if unaddressed, leads to another cycle of stigma.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003eWhile one of the key strategies of the National Mental Health Program is Stigma Eradication\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, it is crucial that attention be paid to this aspect further to achieve targets of addressing the burden of mental health. Various approaches, such as community awareness programs and comprehensive community-based programs, especially focusing on the psychological understanding of the disease, can help improve mental health literacy and reduce stigma in the community over time. \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eReduction of self-stigma is a crucial step towards addressing mental health, and processes such as psychotherapy and counseling sessions need to be employed to improve a patient\u0026rsquo;s attitude and self-esteem. The awareness about mental health stigma should be focused from the household to the community levels, increasing the literacy levels among the public regarding mental health.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eGiven the purposive sampling, the results cannot be generalized, especially since this was a treatment-seeking population, leading to a bias. It could be possible that a non-treatment-seeking population has a higher level of internalized stigma.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e However, the power estimation of our study showed significance at p\u0026thinsp;=\u0026thinsp;0.005, with power\u0026thinsp;=\u0026thinsp;80.4%. All possible known confounding variables were either collected from the patients or excluded from this study to maintain the homogeneity of the study group. However, some confounding variables could have influenced the results of this study.\u003c/p\u003e \u003cp\u003eThe Internalized Stigma of Mental Illness (ISMI) Scale has been validated for use in India and has been found to be culturally appropriate. However, the title of the scale mentions \u0026lsquo;Mental Illness,\u0026rsquo; which itself could be stigmatizing. The scale also consists of various sensitive questions that participants may be uncomfortable answering and find stigmatizing. This was observed in our study, where patients showed reluctance on viewing a particular set of questions, which led to them not consenting to participate and, in some cases, withdrew consent midway through the study. Thus, even though the scale has been validated and tested for Indian Settings, there is a certain level of hesitancy owing to the title and questions, which could further add stigma. Additionally, our study did not have an additional tool to classify the severity of illness, which could have impacted the level of internalized stigma.\u003c/p\u003e \u003cp\u003eThe Scale offers a Likert grading component to assess the level of stigma, and patients may not have wanted to respond accurately due to the sensitivity of certain questions, which could have resulted in under-reporting of the stigma levels and a possible bias. A qualitative component would have been better for a more realistic and in-depth understanding of internalized stigma.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA quantitative measure for the health-seeking behavior regarding mental illness was applied in a tertiary care hospital. The related medical, family, and treatment details were acquired from patients with common mental illnesses, according to the WHO classification. Outcomes of the data suggest the influence of internalized stigma, preventing them from reaching the hospital or clinic-based settings to procure sufficient and necessary health care treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments: The authors would like to thank Dr. Prakash Narayanan Vasudevan Potty and Dr. Sheikh Shah Hossain (WHO, CDC India) from the\u0026nbsp;\u003c/strong\u003eDepartment of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, for their valuable guidance and support for this study. The authors would also like to thank the Department of Psychiatry, Kasturba Medical College, for their valuable support throughout the study period, especially Dr. Samir Kumar Praharaj, Dr. Rajeshkrishna Bhandary, and Dr. Abhiram PN.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent:\u0026nbsp;\u003c/strong\u003eThis was a Cross-Sectional Study conducted at the Department of Psychiatry, Kasturba Hospital, Manipal. Ethical Approval for the study was obtained from the Kasturba Medical College, Manipal Institutional Ethics Committee \u003cstrong\u003e(IEC No:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e901/2019)\u003c/strong\u003e. The study was also registered under the Clinical Trials Registry of India(CTRI), under the Indian Council of Medical Research (ICMR)- National Institute of Medical Statistics, on 3\u003csup\u003erd\u003c/sup\u003e January 2020 (\u003cstrong\u003eRegistration No: CTRI\u003c/strong\u003e\u003cstrong\u003e/2020/01/022722.\u003c/strong\u003e The study was conducted in compliance with all the ethical principles for studies involving human research participants. Informed consent was obtained from all study participants who met the inclusion criteria. All authors have read and approved the manuscript for publication, and the requirements for authorship, as stated, have been met. Each author believes that the manuscript represents honest work. All authors have consented to publishing the research findings and manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research did not receive any funding. There is no financial or any other relationship that may lead to any dispute associated with this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e: Not Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eNone.This research did not receive any specific grant from any funding agencies in the public, commercial, or not-for-profit sectors. No financial or any other relationship may lead to any dispute associated with this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDiagnostic and statistical manual of mental disorders (DSM-5). Arlington: American Psychiatric Publishing; 2013.\u003c/li\u003e\n\u003cli\u003eNational Mental Health Survey of India, 2015-2016 Prevalence, Patterns and Outcomes, Supported by Ministry of Health and Family Welfare, Government of India, and Implemented by National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru: In Collaboration with Partner Institutions; 2015-2016.\u003c/li\u003e\n\u003cli\u003eSagar R, Dandona R, Gururaj G, Dhaliwal RS, Singh A, Ferrari A et al. The burden of mental disorders across the states of India: The Global Burden of Disease Study 1990\u0026ndash;2017. The Lancet Psychiatry. 2020 Feb 1;7(2):148-61.\u003c/li\u003e\n\u003cli\u003eFact sheets on sustainable development goals: health target. Copenhagen: WHO Regional Office for Europe; 2018. Available from: https://www.euro.who.int/__data/assets/pdf_file/0017/348011/Fact-sheet-SDG-Mental-health-UPDATE-02-05-2018.pdf\u003c/li\u003e\n\u003cli\u003eNational Collaborating Centre for Mental Health (UK). Common Mental Health Disorders: Identification and Pathways to Care. Leicester (UK): British Psychological Society (UK); 2011. (NICE Clinical Guidelines, No. 123.) 2, COMMON MENTAL HEALTH DISORDERS. \u003c/li\u003e\n\u003cli\u003eSevere Mental Illness | Behavioral Health Evolution, 2022 Available from: https://www.bhevolution.org/public/severe_mental_illness.page\u003c/li\u003e\n\u003cli\u003ePearl RL, Forgeard MJ, Rifkin L, Beard C, Bj\u0026ouml;rgvinsson T. Internalized stigma of mental illness: Changes and associations with treatment outcomes. Stigma and Health. 2017 Feb;2(1):2.\u003c/li\u003e\n\u003cli\u003eGoffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs NJ: Prentice Hall; 1963.\u003c/li\u003e\n\u003cli\u003eDrapalski AL, Lucksted A, Perrin PB, Aakre JM, Brown CH, DeForge BR, \u003cem\u003eet al\u003c/em\u003e. A model of internalized stigma and its effects on people with mental illness. Psychiatr Serv 2013; 64:264-9.\u003c/li\u003e\n\u003cli\u003eNational Health Portal, Government of India, 2021. Available from: https://www.nhp.gov.in/national-mental-health-programme_pg\u003c/li\u003e\n\u003cli\u003eSingh A, Mattoo SK, Grover S. Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit. Indian journal of psychiatry. 2016 Jul;58(3):291.\u003c/li\u003e\n\u003cli\u003eGrover S, Hazari N, Aneja J, Chakrabarti S, Avasthi A. Stigma and its correlates among patients with bipolar disorder: A study from a tertiary care hospital of North India. Psychiatry research. 2016 Oct 30; 244:109-16.\u003c/li\u003e\n\u003cli\u003eSahoo S, Grover S, Malhotra R, Avasthi A. Internalized stigma experienced by patients with first-episode depression: A study from a tertiary care center. Indian J Soc Psychiatry 2018; 34:219.\u003c/li\u003e\n\u003cli\u003eCorker EA, Beldie A, Brain C, Jakovljevic M, Jarema M, Karamustafalioglu O, et al. Experience of stigma and discrimination reported by people experiencing the first episode of schizophrenia and those with a first episode of depression: The FEDORA project. Int J Soc Psychiatry 2015; 61:438‑45.\u003c/li\u003e\n\u003cli\u003ePingali S, Rao SS, Umashankar M. A Comparative study of internalized stigma and its correlates among different psychiatric disorders in remission. Telegana J Psychiatry. 2018 Jun 3;4(1):29-33.\u003c/li\u003e\n\u003cli\u003eAnsari E, Mishra S, Tripathi A, Kar SK, Dalal PK. Cross-sectional study of internalised stigma and medication adherence in patients with obsessive compulsive disorder. General psychiatry. 2020;33(2).\u003c/li\u003e\n\u003cli\u003eOciskova M, Prasko J, Cerna M, Jelenova D, Kamaradova D, Latalova K et al. obsessive-compulsive disorder and stigmatization. Act Nerv Super Rediviva. 2013 Jan 1;55(1-2):19-26.\u003c/li\u003e\n\u003cli\u003eStengler-Wenzke K, Beck M, Holzinger A, Angermeyer MC. Stigma experiences of patients with obsessive compulsive disorders. Fortschritte der Neurologie-psychiatrie. 2004 Jan 1;72(1):7-13.\u003c/li\u003e\n\u003cli\u003ePatra BN, Sarkar S. Adjustment disorder: current diagnostic status. Indian journal of psychological medicine. 2013 Jan;35(1):4-9.\u003c/li\u003e\n\u003cli\u003eGrover S, Avasthi A, Singh A, Dan A, Neogi R, Kaur D, et al. Stigma experienced by participants with severe mental disorders: A nationwide multicentric study from India. Psychiatry Res 2017; 257:550‑8.\u003c/li\u003e\n\u003cli\u003eCarpiniello B, Pinna F. The reciprocal relationship between suicidality and stigma. Frontiers in psychiatry. 2017 Mar 8; 8:3.\u003c/li\u003e\n\u003cli\u003eTaghva A, Farsi Z, Javanmard Y, Atashi A, Hajebi A, Noorbala AA. Strategies to reduce the stigma toward people with mental disorders in Iran: stakeholders\u0026rsquo; perspectives. BMC psychiatry. 2017 Dec;17(1):1-2.\u003c/li\u003e\n\u003cli\u003eDinos S. Stigma creating stigma: a vicious circle. The Psychiatric Bulletin. 2014 Aug;38(4):145-7.\u003c/li\u003e\n\u003cli\u003eKishore J, Gupta A, Jiloha RC, Bantman P. Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India. Indian Journal of Psychiatry. 2011 Oct;53(4):324.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sustainable Development Goals, Common mental disorders, health-seeking behavior","lastPublishedDoi":"10.21203/rs.3.rs-5968430/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5968430/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eMental Health is a crucial component of the Sustainable Development Goals. Common Mental Disorders are an umbrella term inclusive of mood disorders, neurotic, stress-related, and somatoform disorders, according to the International Classification of Diseases and Related Health Problems-10 (ICD-10). Internalized stigma in psychiatric patients not only impacts their self-esteem and quality of life but also influences the individual’s treatment and health-seeking behavior. Thus, stigma is a significant barrier influenced by various socio-demographic and clinical variables. This study explored the level of internalized stigma perceived by patients and the association between self-stigma and the socio-demographic as well as clinical profile of the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods: \u003c/strong\u003eA structured socio-demographic proforma and morbidity proforma, and the Internalized Stigma of Mental Illness (ISMI) Scale were administered to 119 patients above 18 years with different Common Mental Disorders per ICD-10 criteria. This cross-sectional study included patients from the OPD service of a tertiary care hospital. Patients with epilepsy, intellectual disability, organic mental disorders, and those requiring hospital admissions were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA mild to moderate level of stigma was reported in patients with common mental disorders. The mean scores across the domains of alienation, discrimination, social withdrawal, and stigma resistance were highest in patients with obsessive-compulsive disorders. Age, age of onset of disease, history of suicidal ideation, and attempt were significant predictors of self-stigma. Strong correlations were found between various domains of stigma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eStigma can act as a barrier to addressing the burden of global mental health, influencing treatment and health-seeking behavior. Knowledge of self-stigma and its contributing factors will help us understand the extent of internalized stigma present in patients, aiding in interventions to reduce internalized stigma.\u003c/p\u003e","manuscriptTitle":"Internalized Stigma and its correlates amongst patients with Common Mental Disorders","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 11:13:20","doi":"10.21203/rs.3.rs-5968430/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-17T18:46:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T18:25:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-29T22:39:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54523355444321980006372316981304687291","date":"2025-05-27T07:51:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170764035392824798307234945063357747832","date":"2025-05-20T19:37:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277218684985904094492761700127340514968","date":"2025-05-20T08:49:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T09:39:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158024426062711965104924416424389787391","date":"2025-05-03T01:15:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-30T20:33:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-25T16:20:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-25T09:15:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-25T09:14:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2025-02-05T20:19:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"333e70f9-630a-4551-9f7e-11d72007a41d","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-30T17:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-07 11:13:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5968430","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5968430","identity":"rs-5968430","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}