What matters most’: stigma towards severe mental disorders in Chile, a theory-driven, qualitative approach

Franco Mascayano, Josefina Toso-Salman, Bernalyn Ruiz, Kathleen Warman, Ana Jofre Escalona, Ruben Alvarado Muñoz, Kathleen Janel Sia, Lawrence Hsin Yang

Resumen


Abstract
Background: Stigma towards severe mental illness manifests in different ways across cultures and only recently has a theoretical perspective emerged to understand such cultural differences. The ‘What Matters Most’ framework identifies culturally specific dimensions of stigma by identifying the interactions between cultural norms, roles, and values that impact personhood.
Objective: This study explores the cultural underpinnings that create and maintain stigmatizing attitudes towards severe mental illness in Chile.
Methods: In-depth interviews developed using the ‘Scale of Perceived Discrimination and Devaluation’, and the ‘What Matters Most’ framework were conducted with twenty people identified as having a severe mental illness. Interviews were coded and discussed until agreement was reached, then analyzed by an independent reviewer to determine inter-rater reliability.
Results: A key factor shaping stigma among women was the loss of capacity to accomplish family roles (i.e. take care of children).or men, cultural notions of ‘Machismo’ prevented them from disclosing their psychiatric diagnosis as a means to maintain status and ability to work. A protective factor against stigma for men was their ability to guide and provide for the family, thus fulfilling responsibilities attributable to ‘Familismo’. Social appearances could play either a shaping or protecting role,contingent on the social status of the individual.
Discussion: In Chilean culture, stigma is rooted in gendered social characteristics and shared familial roles. Interventions should aim to address these norms and incorporate culturally salient protective factors to reduce stigma experienced by individuals with serious mental illness in Chile and other Latin American settings.

 


Resumen
Antecedentes: Estigma hacia la enfermedad mental se manifiesta en diferentes formas dependiendo de la cultura, sin embargo solo recientemente se ha desarrollado una perspectiva teórica para entender dichas diferencias culturales. El abordaje de ‘what matter most’ es capaz de identificar dimensiones culturalmente específicas relativas al estigma por medio de la identificación y extracción de las normas culturales, roles y valores que impactan la identidad de las personas.
Objetivo: El presente estudio explora los cimientos culturales que crean y mantienen las actitudes estigmatizantes hacia las enfermedades mentales en Chile.
Métodos: Se desarrollaron 20 entrevistas en profundidad en personas con trastorno mental severo utilizando la ‘Escala de Discriminación y Devaluación Percibida’ y orientadas por el enfoque ‘What Matter Most’. Las entrevistas fueron codificadas y discutidas hasta alcanzar grados de acuerdo apropiados, cuestióndeterminada por un revisor independiente que calculó el grado de acuerdo inter-jueces.
Resultados: Un aspecto clave para moldear la expresión del estigma entre mujeres fue la pérdida de la capacidad para cumplir con su rol de dueña de casa (i.e. cuidar de sus hijos), mientras en los hombres nociones culturales asociadas al ‘Machismo’ impidieron que ellos develaran sus respectivos diagnósticos psiquiátricos para mantener su estatus social y habilidad para trabajar. Por otra parte, un factor protector en contra del estigma en hombres fue mantener su habilidad para guiar y proveer a su familia, y así cumplir plenamente con las responsabilidades atribuidas al ‘Familismo’. Finalmente, las apariencias sociales pueden jugar tanto un rol moldeador o protector en contra del estigma, y esto parece ser contingente al estatus social del individuo.
Discusión: Estigma se asocia a características sociales y roles familiares enraizadas en la cultura Chilena. Intervenciones deberían abordajes éstas dimensiones e incorporar aquellos factores protectores que son potenciales recursos para reducir el estigma hacia la enfermedades mentales en Chile y en otros contextos Latinoamericanos.


Palabras clave


salud mental; trastorno mental; estigma social

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