SOCIO-DEMOGRAPHIC CORRELATES OF STIGMATIZATION OF PSYCHIATRIC PATIENTS AMONG HEALTH CARE WORKERS IN NEUROPSYCHIATRIC HOSPITAL, ENUGU

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ABSTRACT

The purpose of the study was to determine the socio-demographic correlates of stigmatization of psychiatric patients among health care workers in neuropsychiatric hospital, Enugu. Eight objectives with corresponding research questions and seven hypotheses were postulated to guide the study. A descriptive correlational survey research design was employed for the study. The instrument for data collection was the researcher-designed questionnaire titled socio-demographic correlates of stigmatization of psychiatric patients’ questionnaire, (SODCOSPQ).Three of the experts were drawn from the Department of Health and Physical Education, and two from the Department of Psychology for face validation. The population of the study was 210 health care workers (HCWs). They were all involved in the study. This was because the population was manageable. A total of two hundred and ten copies of the questionnaire were distributed and one hundred and seventy nine copies were properly completed and used for the study. Cronbach Alpha was used for test of reliability. The research question one was answered using a criterion mean. The relationship of HCW’s variables against the psychiatric patient was analyzed applying Pearson’s Product Moment Co-efficient. Wilson (1989) principle for interpretation of value ‘r’ was employed for the research questions of two to eight, and linear regression was used for testing of the null hypotheses at .05 level of significance. The result of the study showed that HCWs stigmatization status of psychiatric patients was negative (grand X = 2.40 < 2.50, SD = .845) Table 1. The result further showed that the correlation between HCWs’ age, religious denomination, and level of education, gender, specialization, marital status, rank, and stigmatization of psychiatric patients indicated very low correlation respectively. The linear regression test for the hypotheses indicated that there were no significant relationship between HCWs’ religious denomination, level of education, gender, specialization, marital status, and stigmatization of psychiatric patients. However, this test revealed that significant relationship exists between HCW’s age, rank and stigmatization of the psychiatric patients.

TABLE OF CONTENTS

Title Page
Table of Contents
List of Tables
Abstract

CHAPTER ONE: Introduction
Background to the Study
Statement of the Problem
Purpose of the Study
Research Questions
Hypotheses
Significance of the Study
Scope of the Study

CHAPTER TWO: Review of Related Literature
Conceptual Framework
Stigmatization
Socio demographic correlates of stigmatization
Neuropsychiatric hospital, and health care workers
Psychiatric patient, and psychiatric illness
Consequences of stigmatization
Frame work showing components of stigmatization
Theoretical Framework
Labeling theory
Unitary theory of stigmatization
Reasoned action
Social learning
Schematic representation of theories
Review Empirical Studies
Summary of Literature Review

CHAPTER THREE:            Methods
Research Design
Area of Study
Population for the Study
Sample and Sampling Technique
Instrument for Data Collection
Validity of the instrument
Reliability of the instrument
Method of Data Collection
Method of Data Analysis

CHAPTER  FOUR: Results and Discussion
Results
Summary of Major Finding
Discussions
Stigmatization Status of Health Care Workers
Socio-demographic Correlates of Stigmatization

CHAPTER FIVE: Summary, Conclusions and Recommendations
Summary
Conclusions
Recommendations
Limitations to the Study
Suggestions Further Studies
References
Appendices

CHAPTER ONE
Introduction
Background to the Study
Stigma is a social menace. It leads to captivity when perpetrated, and holds one in bondage for the rest of one’s life. It involves the reaction of others which spoils one’s normal identity. Sometimes, it results from the perception or attribution which may be right or wrong but once marked and labeled becomes indelible. Stigmatization deals with linking negative attributes to an individual or groups of individuals which usually culminates in separation of ‘us’ and ‘them’ (Link & Phelan, 2006). This ‘us’ and ‘them’ according to Link and Phelan (2006) implies that the labeled group is slightly less human. The attributes the society selects in labeling and stigmatizing differs according to time and place and what is considered out of place in one society may be a norm in another. The argument as to whether stigmatization is fixed or inherited is yet to be resolved but what is more important is its dangerous effect on the individual or group of individuals whom the society identified and labeled as deviant and therefore, stigmatized. Stigma lowers self-esteem, induces isolation and robs one the opportunity to be one’s best. One can be stigmatized based on one’s ethnicity, nationality, physical disabilities, diseases, and psychiatric illness among others.

Stigmatization is the process wherein one condition or aspect of an individual is attributionally linked to some pervasive dimension of the target person’s identity (Mansouri
&    Dowell, 1989).Goffman (1963) defined stigmatization as demeaning and discrediting attributions arising during social interaction. Koomen and Dijke (2007) defined stigmatization as the process by which an individual’s or group’s character or identity is negatively responded to on the basis of the individual’s or group’s association with a past, imagined, or currently present deviant condition, often with harmful physical or psychological consequences for the individual or group. They observed that deviant condition may or may not actually be present; what is important is that the individual is associated with a past or present deviant condition and hence that the perceiver cannot but respond to the motivational implications of that deviant condition, imagined or not.
Stigmatization involves dehumanization, threat, aversion, and sometimes the depersonalization of others into stereotypic caricatures (Heatherton, 2000). Stigmatization involves a separation of individuals labeled as different from “us" who are believed to possess negative traits, resulting in negative emotional reactions, discrimination, and status loss for the stigmatized persons (Link & Phelan, 2001). Lee (2002) noted that the most characteristic feature of stigmatization is to publicly associate a person with a shameful deviant condition. In the context of this work, stigmatization is a perception, attribution, character devaluation which may rightly or wrongly be ascribed to an individual or group of individuals which often results in status loss and discrimination. Stigmatization performs several functions.

One of its functions is that it enhances the well-being of the stigmatizer. Heatherton (2000) noted that stigmatizing others can serve several functions for an individual, including self-esteem enhancement, control enhancement, and anxiety buffering. For example, in relatively large social groups or societies people need to identify and label particular individuals in terms of their (association with a) deviant condition in order to warn each other of these individuals’ bad or shameful reputation or dangerous character. Stigmatization manifests itself in different ways.

Goffman (1963) observed that stigmatization is manifested in three different ways: abomination of the body, blemishing of individual character and tribal stigmatization. According to him, the first manifestation refers to negative attributions directed toward physical appearance; the second includes negative attributions towards one’s personal character and the latter implies negative attributions toward religious, ethnic, racial communities among others. Similarly, Sailard (2010) conceptualized stigmatization process into ‘internalized stigma’ and ‘institutional stigma’. Internalized stigmatization involves the emotions, thoughts, beliefs and fears that people experience in their private domain while institutional stigmatization takes place in the public domain. Institutional stigmatization involves indirect, non-personal, implicit attitudes and relationship. Sailard (2010) further noted that people with mental illness can be exposed to institution stigma both in the workplace and also in their preferred health institutions. For example, Lykouras and Douzenis (2008) stated that stigmatization is the underlying cause for doctors’ neglect to examine the physical complaints of people with psychiatric illness. It follows that negligence and hesitation on the physicians’ part provide striking evidence of institutional stigma. According to Ewhurdjakpor (2010) in Nigeria, like most developing economies, psychiatric services is amorphous with few heavily overburdened bucreaucratic institutions due to some cultural practices and systemic crisis in the society. Ewhrudjakpor further noted that lip service is paid to the issue of improving the mental health care structures and service. Psychiatric illness affects everyone directly or indirectly.

Psychiatric illness can affect persons of any age and they can occur in any family. Levin and Laar (2010) opined that individuals are all likely to have to deal with mental illness at some time, whether in family members, work colleagues or themselves. Morrison (1997) stated that if ineffective or maladaptive behaviours interfere with daily activities, impair judgment, or alter reality, the person is said to be mentally ill. In this work mentally ill and psychiatric patient are used interchangeably. In the context of this work, a psychiatric patient is an individual who is unable to maintain satisfying personal relationships, has an exaggerated normal mental state and is unable to contribute for the well-being of his or her community.

Psychiatric patients with physical illness do not have access to same quality health services in comparison to other patients. The reason is the stigmatizing attitude of health care workers (Corrigan & Penn, 1999). Health care worker refers to all people delivering health services. For the purpose of this work the researcher is interested in health care workers such as psychiatric resident doctors, psychiatric nurses, clinical psychologist, pharmacists, laboratory scientists, consultant psychiatrist, and social welfare staff. Related studies in several parts of the world suggest that health workers stigmatize psychiatric patients. Healthcare workers in Neuropsychiatric Hospital, Enugu may not be completely free from these unfavourable dispositions towards psychiatric patients. It is in line with the above views that the researcher seeks to determine whether the health care workers stigmatize and socio-demographic variables that are likely to contribute to the stigmatization of psychiatric patients by the Health Care Workers in Neuropsychiatric Hospital, Enugu. There are many socio-demographic factors that are likely to contribute to health care workers stigmatization of psychiatric patients.

The present study is concerned with demographic factors of gender, age, level of education, and religion, marital status, specialization, and rank. Socio according to Hornby (2007) is connected with society or the study of society. Weeks (1999) noted that demography is concerned with virtually everything that influences or can be influenced by population size, distribution, processes, structure or characteristics. Correlation involves establishing if any relationship exists between two or more variables......

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