
Citation & Link
o http://www.sciencedirect.com.proxy.library.vcu.edu/science/article/pii/S0010440X10000416
o Hasson-Ohayon, I., Levy, I., Kravetz, S., Vollanski-Narkis, A., & Roe, D. (2011). Insight into mental illness, self-stigma,
and the family burden of parents of persons with a severe mental illness. Comprehensive Psychiatry,52(1), 75-80.
doi:10.1016/j.comppsych.2010.04.008
 Summary
o The study wanted to find out if parents’ self-stigma moderates the relationship between burden and insight. However, selfstigma was found to mediate the relationship between burden and insight.
 Why It’s Included
o This study focuses solely on parents which I have yet to include in my research so far, and the study discusses stigma
and burden and their relationship which is a key element to my paper.
The Text
My Ideas
ABSTRACT
In the present study, the possibility that parents' self-stigma moderates
Personally, I know there is a relationship. My parents go through
the relationship between the parents' insight into a daughter's or son's
it. Also, self-stigma is a new concept to be introduced into my
illness and the parents' sense of burden was investigated. [75]
research
Self-stigma was found to mediate rather than moderate the relationship
Results of the study. Need more context t fully interpret the
between insight and burden. Accordingly, parent insight into the mental results, but currently it seems that stigma negatively affect the
illness of a daughter or son appears to increase parent burden because it situation. Also, knowledge, increases burden because it
increases parent self-stigma.[75]
increases stigma??
INTRODUCTION
With the advent of the policy of deinstitutionalization, the number of
Institutionalization is seen as negative. Therefore, the burden is
persons with SMI who live with family members has increased
moved from the institution to the family. This adds to all the
significantly. [75]
problems.
Consequently, parents of persons with an SMI often have to deal with
More info about how caring for a person with MI negatively
the positive and negative symptoms of their loved ones and feel concern impacts family members of the PWMI.
about providing daily needs such as food, self and home care, child care,
and financial support [2]. Coping with the stress generated by these
challenges have been found to often lead to anxiety, frustration, anger,
grief, and shame [3,4]. [75]
The negative consequences experienced by family caretakers have been Specific info about burden. Not present in other studies. I think I
traditionally conceptualized as family burden [5], which has been
want to focus on subjective burdens more than objective burdens.
commonly conceived as having objective and subjective components
[6,7]. Objective burden includes practical routine limitations on the
social, occupational, and familial domains of quality of life, and
subjective burden includes such psychological reactions of the relatives
as anxiety and depression [8-10]. [75]
Recently, Kallert and Nitshe [21] have showed that family members'
opinions about, and cognitive attributions related to the illness, impact
their experience of burden. [75]
Self-stigma, or internalized stigma, refers to the process by which a
person adopts stigmatizing views widely held by the general public [22].
[75]
In the psychiatric literature, the term, insight into SMI, is generally used
to refer to a multidimensional phenomenon that consists of the
awareness of being ill, the awareness of having symptoms, and the
attribution of the experience of reduced functioning and quality of life to
the illness and symptoms of persons who have received a mental illness
diagnosis [23] [75-76]
Some research has shown that insight into a psychiatric disorder is a
necessary step toward compliance with treatment and recovery for
persons with an SMI [26,27], whereas other research indicates that
acquiring insight into a disorder can lower self-esteem, emotional wellbeing and hope, and increase the despair of these persons [28-30]. [76]
One potential factor that might moderate the relationship between
insight and family burden is the family's experience of stigma in relation
to his/her relative's mental illness. [76]
One source is the perception of the family as an extension of the
deviation, and the second source is the attribution of the illness to the
family. The internalized stigma of family members has also been found
to affect self-perception and esteem [32,33]. [76]
They found that high insight is associated with lower depression, lower
quality of life, and lower self-esteem and that these associations are
stronger for persons with high self-stigma than for those with low selfstigma. [76]
…stigma moderated the associations between insight and depression,
low quality of life, and negative self-esteem. Thus, persons with high
levels of insight and low levels of stigma exhibited positive outcome
across various outcome measures. [76]
Self-stigma?? Or just stigma about mental illness
Definition of self-stigma. Self-stigma is subjective rather than
objective.
How physical illness and MI are similar.
All of my knowledge is power in treatment argument is actually
not 100% correct? That’s really a disappointment. But so many of
my studies argue that point?? Is it because some people see the
info as positive and others see it as negative/depressing?
Stigma affects family burden and insight!! It’s in writing. It says
potential, but close enough.
Possible sources of self-stigma & what it does to family members.
Seeing the family members as a part of the deviation is
ridiculous. MI isn’t contagious. The attribution of the illness to the
family I understand.
Looking it up, insight has a different meaning in this context. It
means an understanding of the forces behind one’s thoughts and
actions. In the case of the PWMI, higher insight/knowledge is
worse, but for family members, higher insight/knowledge is better.
Interesting.
High insight but low stigma was great! Stigma screws everything
up! High Insight and high stigma probably means negative
outcomes. More information for my paper woo!
The following hypothesis was derived from this assumption: For family Study’s hypothesis. Where it says positive it means that
members with high self-stigma, the relationship between insight and
relationship is present. Where it says negative, it means that the
burden was expected to be positive, whereas for family members with
relationship is not present
low self-stigma, the relationship between insight and burden was
expected to be negative. [76]
METHODS
One hundred twenty-seven parents of an adult son or daughter with a
Again, a relatively small sample size. That seems to be the issue
diagnosis of an SMI participated in this study. [76]
with a lot of the studies that I have been looking at.
Demographics of the parents in the study. Mostly mothers, race is
not specified, variety of MIs within the children.
Thus, the scale was made up of a total of 7 items. [77]
Thus, the scale was made up of 26 items. [77]
The scale used to measure the parents’ insight was made up of 7
items. Adjusted from original
Scale used to measure parents’ self-stigma was made up of 26
items. Adjusted from original.
Burden scale not adjusted, 29 items.
In the present study, the Cronbach α estimate of internal consistency for
the total burden score of the parents was .91. [77]
These centers located in central Israel… [77]
Study took place in Israel
All instruments were self-report measures and were administered by the Procedure of administering the questions. Not to put into my
same psychologist during a single meeting with each participant in the
paper, but possibly helpful for interpreting data later.
study [77]
RESULTS
In this analysis, insight and self-stigma were the independent variables
More info for helping to interpret the study
and family burden was the dependent variable. [77]
Thus, parents with higher levels of insight tend to report higher levels of
burden. [78]
Thus, parents with higher levels of self-stigma tend to report higher
levels of burden. [78]
…suggests a mediation model according to which self-stigma plays a
mediating role that links insight to family burden. [78]
…these correlations fulfill the conditions that confirm the existence of a
mediation model was uncovered. These conditions are (1) a positive
correlation between insight into the illness and family burden (r = .27; P
b .01), (2) a positive correlation between self-stigma and family burden
(r = .54; P b .01), and (3) a positive correlation between insight and selfstigma (r = .23; P b .01). [78]
Thus, these findings indicate that persons who report more general
awareness of their son's or daughter's mental illness tend to have higher
levels of family burden due in part to their increased likelihood of
experiencing self-stigma in relation to their relatives' mental illness. [78]
Although the moderating model was not supported, significant support
was found for a mediating model according to which self-stigma
mediates the relationship between insight and burden. [78]
Data interpretation after step one (insight)
Data interpretation after step 2 (self-stigma)
A bunch of science lingo proceeded this, and I didn’t understand
it. However, I did understand this part of the quote, so it is
included.
Ignore the numbers. More insight=more burden, more selfstigma=more burden, & more insight=more self-stigma. The last
data contradicts what I have been saying about knowledge being
power. Used as a counter argument later in the paper??
What the 3rd condition of the above quote says but in words and
without numbers.
Part of the hypothesis was incorrect. Mediating v. moderating.
Mediating found. Mediating means to settle something as an
intermediary between parties.
DISCUSSION
In this mediation model, insight into SMI increased the burden of
Why the findings of the study fit a mediation model
parents of persons with SMI because it increased these parents' selfstigma. [78]
According to such a model, insight increases family burden by
What the relationship between insight, family burden, and selfincreasing self-stigma [78]
stigma is like in a mediating (linear) model
…the “insight paradox.” This term refers to two sets of theoretical
Data is different in multiple studies about insight. My theory is not
arguments and empirical findings regarding the relationship between
incorrect! However, data is not conclusive because data keeps
insight into mental illness and outcomes for persons with SMI.
contradicting one another. IS this because of the subjectivity of
Although each of these sets of arguments and findings is internally
MI and how it affects everyone differently? Possibly…
consistent, they contradict each other. [78]
… the perception of the family as an extension of the person with SMI
The vicious cycle I was talking about! Outside stigma influences
and the attribution of the illness to the family produce a sense of shame self-stigma. It’s all a vicious cycle that is almost never ending.
and guilt that are likely to increase family self-stigma, reducing
Eliminate the outside stigma, and the cycle stops!
professional help-seeking behavior [46] and increasing social isolation
[47]. This process of stigma internalization, shame and guilt induction,
reduced professional help seeking, and social isolation could produce a
cycle, one of the consequences of which could be a sense of burden.
[79]
A core element of these three interventions is the use of family members
and consumers as part of the team that coordinates the interventions.
[79]
Two additional core elements that are shared by both narrative
enhancement and cognitive therapy for self-stigma and National
Alliance on Mental Illness' family education programs are personal
stories of how consumers and family members confront the hardships
associated with mental illness and presentations of the coping strategies
used by consumers and family members to deal with these hardships.
[79]
Actually, an argument could be made for the claim that this relationship
might be opposite to the direction discussed in this article. Parents with
high family burden might seek more information about the illness. This
information could increase their insight. [79]
GET THE FAMILY INVOLVED IN TREATMENT. MI is not a oneperson battle. Although, a lot of people seem to think it is.
Peer help line study tie in. With an issue that is so subjective,
getting multiple opinions is key. MI is subjective while physical
illness is objective. Therefore, different methods should be used
for treating the different types of ailments
My counterargument brought up in the limitations of the study.
Fab.