Measurement of Clinical Risk of Stigma and Discrimination of Mental Illnesses using: ‘Quantification of Stigma’ scale: preliminary findings Short title: Quantifying clinical risk of stigma for clinical practice Authors: Amresh Shrivastava1, Yves Bureau2, Nitika Rewari3, & Megan Johnston4 ……..5 Nilesh Shah 6 Affiliations 1. Executive Director: Mental Health Foundation of India (PRERANA Charitable trust) and Silver Mind Hospital, Mumbai, India; Currently at The University of Western Ontario, Dept. of Psychiatry; and Associate Scientist at Lawson Health Research Institute, London, Canada. 2. Research Scientist (Associate Scientist/Director of Inferential Statistics-Imaging) Lawson Health Research Institute 268 Grosvenor Street, Room E5-136 London, Ontario, Canada N6A 4V2 Assistant Professor (Psychology), University of Western Ontario 3. Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada. 4. Department of Psychology, University of Toronto, Canada 5. 5..Mumbai 6. ..Mumbai Correspondence: Amresh Shrivastava Physician team leader, Prevention and early intervention of psychosis programme; Regional Mental Health Care, 467 Sunset Drive, St.Thomas, Ontario, Canada, N5P 3V9 Phone: 1-519-631-8510 Fax: 1-519-631-2512 E mail: dr.amresh@gmail.com Abstract Background: Stigma and discrimination continue to be a reality in the lives of people suffering from mental illness, particularly schizophrenia, and prove to be some of the greatest barriers to access care, continue to remain under care, and regain a normal lifestyle and health. Research advances have defined stigma, assessed its implications and have even examined intervention strategies for dealing with stigma. The delay in treatment due to stigma causes potential complications like suicide, violence, harm to others and deterioration in capacity to look after one’s physical health. These are preventable clinical complications. In order to deal with the impact of stigma on an individual basis, it needs to be [1] assessed during routine clinical examination, [2] assessed for quantification in order to obtain measurable objective deliverables, and [3] examined if treatment can reduce stigma and its impact on individuals. Purpose and hypothesis: We are of the opinion that stigma has several domains: personal, social, cultural, illness-related, treatment-related, and environmental. Each of these domains has several factors, which may or may not contribute to the degree of stigma affecting a given individual. Components of these domains can be used to design a tool, which can then be standardized and validated in controlled studies. Quantifying stigma in terms of its impact and consequences requires attention to four different components: 1) events of discrimination that have taken place, 2) the real-life experience, 3) the patients’ perception of this discrimination, and 4) how has the patient coped to live with discrimination. A reasonable quantification of stigma would be to measure the consequences and its perception in an individual. We hypothesize that the efficacy of an intervention can be successfully measured by comparing it before and after treatment. Method: We have constructed a 39-item scale for quantification of stigma for clinical utility, based upon the above principle. In this study we present the constructs of the scale and preliminary findings based on a field trial done in Mumbai, India with a cohort of 30 individuals suffering from schizophrenia. Results: A total score of stigma and discrimination was computed from four subscales: psychological consequences, social consequences, illness-related consequences, and coping strategies. These total scores correlated negatively with age, duration of illness, and duration of treatment. The number of previous hospitalizations was not related to stigma, although there was a trend towards a greater number of relapses predicting higher scores of stigma. Levels of violence did not predict stigma scores, nor did knowledge of other patients. However, a greater presence of suicide risk was associated with more consequences of stigma and discrimination, and non-compliance was also positively related to stigma. Conclusion: Longer durations of illness, and particularly treatment, were associated with fewer consequences of stigma and discrimination. Higher levels of consequences related to stigma and discrimination were found to relate to a greater likelihood of non-compliance and to a greater risk for suicide. By assessing and quantifying stigma in this way, there is a better chance of these consequences being reduced and addressed. References 1. Sirey J, Bruce ML, Alexopoulus GS, Perlick DA, Raue P, Friedman SJ, et al. Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. Am J Psychiatry 2001;158:479-481. 2. Shrivastava A, Johnston Megan, Bureau Yves. Stigma of Mental Illness-1: Clinical Reflections. Mens Sena Monograph, 2011; 9(1) 3. Shrivastava A, Johnston Megan, Bureau Yves. Stigma of Mental Illness-2: Non-compliance and Intervention, Mens Sena Monograph, 2011; 9(1) 4. Loganathan, S., & Murthy, S.R. (2008). Experiences of stigma and discrimination endured by people suffering from schizophrenia. Indian Journal of Psychiatry, 50, 39-46. doi: 10.4103/0019-5545.39758

5. NORMAN SARTORIUS, fighting stigma: Theory and Practice, World Psychiatry 2002 February; 1(1) 26-27