The stigma of severe mental illness: Beliefs and experiences of tunisian patients

Background: Stigmatization of patients with mental illness is a worldwide phenomenon which can jeopardize help seeking and treatment adherence and contribute to low self-esteem and quality of life. The aim of our study was to assess stigmatization as perceived and experienced by patients with severe mental illness in Tunisia. Methods: This is a cross-sectional descriptive study conducted at Razi Hospital La Manouba, Tunisia in clinically stabilized patients with bipolar disorder and schizophrenia followed at our outpatient clinic. Patients gave their opinion on a total of 31 statements related to stigma relevant to the Tunisian cultural context. Results: The study sample consisted of 105 patients with an average age of 38.3 years and a sex ratio of 1.5. Negative perceptions or experiences prevailed in 19 out of 31 statements, mostly referring to received and endorsed stigma. Study participants expressed apprehension about disclosure of mental illness, mainly due to fears about family reputation and job opportunities, however, a large majority actually disclosed their mental illness to their surroundings. Male participants had less positive opinions than women regarding former mental patients becoming teachers and experienced more stigma than women in the professional field. Conclusions: Besides actions towards public attitudes, patient-centered-approaches, both tailored to the Tunisian cultural context, are necessary to raise awareness of the public and to reduce endorsed stigma in this vulnerable group of the population.