Study of understanding the internalized stigma of schizophrenia in psychiatric nurses in Japan


Setsuko Hanzawa, RN, PhD, School of Nursing, Jichi Medical University, Yakushiji 3311-159, Shimotsuke-shi, Tochigi 329-0498, Japan. Email:


Aim:  ‘Internalized stigma’ is a construct that reflects the degree to which a person accepts beliefs endorsed by society about mental illness. Among people with schizophrenia spectrum disorders, internalized stigma has been found to moderate the associations between insight and social function, hope, and self-esteem. Among families of patients with schizophrenia, internalized stigma may not only hinder help-seeking but also result in the families attempting to provide care themselves, without assistance from mental health services. Little is known about internalized stigma among service providers, especially psychiatric nurses in Japan. Therefore, we investigated the correlation between internalized stigma and ‘beliefs about the most appropriate form of hospitalization’ among psychiatric nurses.

Methods:  The subjects were 215 psychiatric nurses employed in psychiatric hospitals who completed the personal stigma scale, perceived stigma scales, and Difficulty of Community Living Scale (DCLS) with respect to a chronic schizophrenia case vignette.

Results:  Internalized stigma was positively correlated with greater ‘beliefs about the most appropriate form of hospitalization’ among psychiatric nurses. We also showed that stronger ‘beliefs about the social disadvantages of schizophrenia patients in the community’ was positively correlated with stronger ‘beliefs about the most appropriate form of hospitalization’.

Conclusion:  The present findings suggest that the psychiatric nurses employed at Japanese psychiatric hospitals have a pessimistic view of the community living of people with schizophrenia and their families. And these psychiatric nurses' beliefs were related to their understanding of the deeply dependent relationship between patients and families, and was related to the Confucian ideal.