PREVALENCE AND FACTOR ASSOCIATED WITH INTERNALIZED STIGMA

AMONG OUTPATIENTS WITH SCHIZOPHRENIA AT AMANUEL MENTAL

SPECIALIZED HOSPITAL, ADDIS ABABA, ETHIOPIA, 2023

BY

ESRAEL NIGUSSIE

ETETU TILAHUN

EYERUSALEM ADISU

FEVEN GETENET

A PROPOSAL SUBMITTED TO MENELIK II MEDICAL AND HEALTH SCIENCES

COLLEGE DEPARTMENT OF PSYCHIATRY FOR PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR DEGREE IN PSYCHIATRIC NURSING

ADVISORS- DR ZEWDU SHEWANGIZAW

MR. MIKIYAS TULLU

DECEMBER 2023 G.C

ADDIS ABABA, ETHIOPIA

I
ACKNOWLEDGEMENT
First and foremost, we would like to express our deepest gratitude to Almighty God for His
blessings, guidance, and unwavering support throughout the entire research process. Without His
divine intervention, this research would not have been possible.

We would also like to extend our sincere appreciation to Menelik II Medical and Health Science
College for providing us with the opportunity to undertake this research project. The invaluable
knowledge and skills we have acquired during our time at this esteemed institution have played a
crucial role in shaping our research proposal.

We are truly grateful to our advisors, Dr. Zewdu Shewangizaw and Mr. Mikiyas Tullu, for their
guidance, expertise, and unwavering support. Their valuable insights and suggestions have
significantly contributed to the refinement of our research objectives and methodology.

Furthermore, we would like to acknowledge and thank the dedicated staff and administrators of
St. Amanuel Mental Specialized Hospital for their assistance and support throughout the research
process. Their cooperation and willingness to provide us with the necessary resources have
greatly facilitated the smooth execution of our study.

Lastly, we would like to express our heartfelt appreciation to all the individuals who participated
in this research project, including the patients and their families. Their willingness to share their
experiences and insights has been instrumental in enhancing our understanding of the subject
matter.

II
Table of Contents
ACKNOWLEDGEMENT..............................................................................................................II

ACCRONYMS AND ABBREVIATION......................................................................................V

LIST OF TABLES........................................................................................................................VI

LIST OF FIGURES......................................................................................................................VII

SUMMARY................................................................................................................................VIII

1. INTRODUCTION.......................................................................................................................1

1.1 Background............................................................................................................................1

1.2 Statement of The Problem.....................................................................................................2

1.3 Literature Review..................................................................................................................4

1.3.1 Prevalence of Internalized Stigma Among Schizophrenia Patients...............................4

1.3.2 Socio-demographic Factors Associated with Internalized Stigma Among

Schizophrenia Patients.............................................................................................................6

1.3.3 Clinical and Other Associated Factors of Internalized Stigma Among Schizophrenic
Patients.....................................................................................................................................7

1.3.4 Conceptual Framework of the Literature Review........................................................10

1.4 Justification of the Study.....................................................................................................11

2. OBJECTIVE OF THE STUDY.................................................................................................12

2.1 General Objective................................................................................................................12

2.2 Specific Objective................................................................................................................12

3. METHODS AND MATERIALS..............................................................................................13

3.1 Study Setting........................................................................................................................13

3.2 Study Design and Period.....................................................................................................13

3.3 Population............................................................................................................................13

3.3.1 Source Population.........................................................................................................13

3.3.2 Study Population...........................................................................................................13

III
 3.4 Eligibility Criteria................................................................................................................13

3.4.1 Inclusion Criteria..........................................................................................................13

3.4.2 Exclusion Criteria.........................................................................................................14

3.5 Sample Size and Sampling Technique................................................................................14

3.5.1 Sample Size..................................................................................................................14

3.5.2 Sampling Technique.....................................................................................................14

3.6 Data Collection Tools..........................................................................................................15

3.7 Study Variables....................................................................................................................16

3.7.1 Independent Variable....................................................................................................16

3.7.2 Dependent Variable......................................................................................................16

3.8 Operational Definition.........................................................................................................17

3.9 Data Collection Procedure...................................................................................................17

3.10 Quality Assurance..............................................................................................................18

3.11 Data Analysis.....................................................................................................................18

4. ETHICAL ISSUE......................................................................................................................19

5. DISSEMINATION....................................................................................................................20

6. TIME SCHEDULE....................................................................................................................21

7. BUDGETBREAKDOWN.........................................................................................................22

REFERENCE................................................................................................................................23

ANNEX-I Informed Consent........................................................................................................26

ANNEX-II English Version of The Questionnaire.......................................................................27

ANNEX-III -AMHARIC VERSION OF THE QUESTIONNAIRE............................................31

የጥያቄመጠይቁአባሪ-II የእንግሊዝኛቅጂ..................................................................................................32

IV
ACCRONYMS AND ABBREVIATION
AMSH…………………………………Amanuel Mental Specialized Hospital

E.C……………………………………. Ethiopian Calendar

G.C……………………………………Gregorian Calendar

ISMI……………………………………Internalized Stigma for Mental Illness

MMAS-4………………………………Morisky Medication Adherence Scale

OSSS-3………………………………….Oslo Social Support Scale

SPSS……………………………………. Statistical Package for social Science

V
LIST OF TABLES
Table 1:Time schedule of the study...............................................................................................29
Table 2: Budget breakdown of the study.......................................................................................30

LIST OF FIGURES

VI
Figure 1:Conecptual framework of the literature review..............................................................18

VII
SUMMARY
Background: The cultural context in Ethiopia often attributes mental illness, including
schizophrenia, to supernatural or spiritual causes, leading to stigma and marginalization within
communities. The concept of internalized stigma, or self-stigma, remains relatively unexplored
in the local schizophrenia population. Studies conducted in other countries have shown varying
levels of internalized stigma among individuals with schizophrenia. Understanding the
prevalence and factors associated with internalized stigma is crucial for developing targeted
interventions and support strategies.

Objective: To assess the prevalence and factors associated with internalized stigma among
outpatients with schizophrenia at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia,
in 2023.

Methods: This research proposal will utilize an institution-based cross-sectional study design.
The study will be conducted at Amanuel Mental Specialized Hospital in Addis Ababa, Ethiopia,
from December 20 to January 20, 2023. The target population will consist of outpatients with
schizophrenia who receive care at the hospital. A sample size will be 239 and a sampling
technique of systematic random sampling will be used. Data will be collected using structured
questionnaires that cover internalized stigma, socio-demographic factors, clinical factors, and
other associated factors. Descriptive statistics will be utilized to examine the frequency, mean,
standard deviation, and percentages of the characteristics. Binary logistic regression will be
employed to assess the relationship between the independent variables and the dependent
variable, while multivariate logistic regression will be utilized to control for the effect of
potential confounders.

Budget Breakdown: The research study is allocated a budget of 50,000 ETB, which will cover
expenses related to research materials, data collection tools,

Key Words: Schizophrenia, Stigma

VIII
1. INTRODUCTION
1.1 Background
Schizophrenia is a severe and chronic mental disorder characterized by a range of symptoms,
including hallucinations, delusions, disorganized thinking, and impaired social functioning. It
affects individuals worldwide, and its impact on individuals, families, and communities is
substantial. (1) In Ethiopia, limited research has been conducted specifically on the prevalence of
schizophrenia. However, several studies have explored the broader topic of mental health in the
country, shedding some light on the burden of schizophrenia within the population. (2)

In Ethiopian culture, mental illness is often attributed to supernatural or spiritual causes rather
than being considered as a medical condition. Traditional explanatory models may include
beliefs in witchcraft, evil spirits, or the influence of ancestors. This perspective is deeply rooted
in cultural, religious, and spiritual beliefs that have been passed down through generations. As a
result, individuals with mental illnesses, including schizophrenia, may be stigmatized and
marginalized within their communities. (3)

Stigma can be broadly categorized into external or public stigma and internalized stigma.
External stigma refers to negative attitudes, beliefs, and behaviors held by the general public
towards individuals with schizophrenia. However, internalized stigma, also known as self-
stigma, remains relatively unexplored among local schizophrenia populations in Ethiopia.
Internalized stigma refers to the process by which individuals with mental health conditions
internalize and believe the negative stereotypes and prejudices associated with their condition.
This can lead to feelings of shame, low self-esteem, and diminished self-worth. Internalized
stigma can have significant implications for the well-being and quality of life of individuals with
schizophrenia, potentially leading to reduced help-seeking behaviors, decreased adherence to
treatment, and social withdrawal. (4)

An institution-based cross-sectional study conducted in Qatar among schizophrenia patients

revealed that 9.8% of the participants experienced internalized stigma. The study did not provide
further details about the specific aspects or dimensions of internalized stigma. (5) A study
conducted in Lagos, Nigeria, found that the prevalence of high self-stigma among schizophrenia
patients was 16.5%. The study also revealed that high experience of discrimination was reported

1
more frequently compared to high alienation, high stereotype endorsement, and high social
withdrawal. Only 28.1% of participants scored high on stigma resistance. (6)

A facility-based cross-sectional study conducted at Amanuel Mental Specialized Hospital in

Ethiopia showed that nearly all participants (97.4%) agreed with at least one stigma item
contained in the Internalized Stigma of Mental Illness (ISMI) scale. Approximately 46.7% of the
participants had a moderate to high mean stigma score, indicating a significant problem of
internalized stigma among individuals with schizophrenia in the outpatient setting in Ethiopia. (4)

Understanding the prevalence and factors associated with internalized stigma is crucial for
developing targeted interventions and support strategies for individuals with schizophrenia. The
findings of this study will help mental health professionals, policymakers, and healthcare
providers in developing targeted interventions and support strategies to mitigate the impact of
internalized stigma on the mental health outcomes and overall well-being of individuals with
schizophrenia

2
1.2 Statement of the Problem
Schizophrenia is one of the most serious and frightening mental illnesses. It is characterized by
symptoms such as auditory hallucinations delusions, thought disorder, and negative symptoms.
65 primary studies conducted between 1990 and 2013. The findings revealed that the estimated
12-month prevalence of schizophrenia ranged from 0.26% to 0.51%, with a median estimate of
0.33%. For lifetime prevalence, the estimates ranged from 0.34% to 0.85%, with a median
estimate of 0.48% (7). Several factors were found to be associated with an increased risk among
people with schizophrenia. These factors include being single, attending secondary education,
poor social support, co-morbid depression, feelings of hopelessness, and having a family history
of suicide, and Stigma play a significant role in schizophrenia and has far-reaching consequences
for individuals with the condition (8).

Stigma refers to an attribute or characteristic that marks a person as different and leads to their
devaluation in the eyes of others. Stigma can be associated with visible or invisible marks,
controllable or uncontrollable attributes, and can be linked to appearance, behavior, or group
membership. Stigma is not inherent in the person but rather exists in a social context. Stigma
involves negative evaluations, stereotypes, and exclusion or avoidance of individuals based on
their stigmatized attribute. Stigma is a social construction and can vary across time and cultures,
but there are also commonalities in what attributes are stigmatized across cultures. Stigma affects
the thoughts, feelings, behavior, and health of its targets (9).

There are several dimensions of stigma, including public stigma, self-stigma, stigma by
association, and structural stigma. Public stigma refers to negative beliefs and stereotypes held
by the general population, such as views of incompetence, violence, and dangerousness. Self-
stigma involves the internalization of negative beliefs and feelings by individuals with
schizophrenia themselves. Stigma by association pertains to social and psychological reactions
towards people associated with someone with schizophrenia, such as family members and
friends. Structural stigma encompasses discriminatory practices and policies perpetuated by
society's institutions and ideological systems. (10).

The impact of internalized stigma among outpatients with schizophrenia is significant and can
have detrimental effects on individuals' lives. Internalized stigma refers to the acceptance and
internalization of negative stereotypes and beliefs about oneself that are associated with mental

3
illness. In the context of schizophrenia, individuals may internalize societal views that they are
dangerous, unpredictable, or incapable of leading a fulfilling life. This self-stigmatization can
lead to feelings of shame, low self-esteem, social withdrawal, and reduced motivation to seek
help or engage in treatment. (11).

The impact of stigma on individuals with schizophrenia is significant and poses a major barrier
to accessing proper care and support. The stigma surrounding schizophrenia can result in long
delays in seeking treatment, which can have detrimental effects on the individuals' overall well-
being and recovery. This stigma is universal but varies in nature, source, and impact across
different cultures and regions (12).

Internalized stigma poses a significant problem among individuals with schizophrenia in

Ethiopia, as highlighted by a cross-sectional facility-based study conducted at a specialist
psychiatric hospital in Addis Ababa. The study aimed to determine the extent, domains, and
correlates of internalized stigma among outpatients with schizophrenia. The findings revealed
that nearly all participants expressed agreement with at least one stigma item, and 46.7% had a
moderate to high mean stigma score. Factors such as rural residence, single marital status, and
prominent psychotic symptoms were associated with higher stigma scores. It was also observed
that a considerable number of individuals discontinued their treatment due to perceived stigma.
Additionally, those who had attempted suicide were more likely to have a high stigma score. The
experience of stigma was primarily influenced by factors such as social withdrawal, perceived
discrimination, alienation, and stereotype endorsement. Internalized stigma has the potential to
significantly impact medication adherence and hinder the recovery process for individuals with
schizophrenia in Ethiopia. These findings underscore the need for targeted interventions and
support to address and mitigate the effects of internalized stigma in this population (13).

Mental health services in Ethiopia are shifting towards primary healthcare and community-based
settings, it becomes essential to address the stigma and discrimination experienced by individuals
with schizophrenia. By conducting this research, valuable insights can be gained to guide the
training of community health workers and the development of anti-stigma campaigns that are
culturally sensitive and contextually relevant. there has been no previous assessment of
internalized stigma among individuals with schizophrenia themselves. By filling this gap in
knowledge, the research will contribute to a better understanding of the stigma-related challenges

4
faced by individuals with schizophrenia in Ethiopia and provide a foundation for targeted
interventions and support programs.

5
1.3 Literature Review
Internalized stigma, or self-stigma, is a pervasive and distressing phenomenon experienced by
individuals with schizophrenia, which can significantly impact their mental health outcomes and
overall quality of life. Understanding the prevalence and factors associated with internalized
stigma is crucial for developing targeted interventions and support strategies for this vulnerable
population. This literature review aims to explore the existing research on the prevalence and
factors associated with internalized stigma among outpatients with schizophrenia.

1.3.1 Prevalence of Internalized Stigma among Schizophrenia Patients

A cross-sectional study design that was conducted that aimed to examine the prevalence of self-
stigma, stigma resistance, empowerment, and perceived discrimination among individuals with
schizophrenia or other psychotic disorders across 14 European countries. The sample size in the
study was 1229 people. Data were collected from these individuals through a postal survey
conducted among members of mental health non-governmental organizations in 14 European
countries. According to the study, almost half (41.7%) of the participants reported moderate or
high levels of self-stigma. Additionally, 49.2% reported moderate or high stigma resistance,
49.7% reported moderate or high empowerment, and 69.4% reported moderate or high perceived
discrimination. (14)

A mixed method study was conducted in India among 282 individuals with schizophrenia. The
study aimed to understand the subjective experiences of stigma and discrimination and identify
factors that influence negative discrimination. The quantitative findings of the study revealed
that 79% of the individuals with schizophrenia had internalized stigma. In addition to the
quantitative analysis, the study also conducted in-depth interviews with 36 individuals with
schizophrenia and 36 caregivers. Thematic analysis of these interviews highlighted the
significant impact of stigma on the lives of individuals with schizophrenia. (15)

A cross-sectional study that was conducted in Poland comprising 152 schizophrenic subjects
with the intension of investigating to assess the extent of stigma experienced by patients with
schizophrenia. The study managed to establish stigmatization experiences were common among
the respondents, according to the findings 63% of the study subjects feel subjective experiences
of stigma many reported concealing their illness, witnessing offensive remarks about the
mentally ill, worrying about being viewed unfavorably, and being treated as less competent. (16)

6
A hospital based cross-sectional study was conducted in Nepal among 114 subjects of
schizophrenia which aimed to assess the internalized stigma of mental illness in patients with
schizophrenia visiting a psychiatry outpatient department in Kathmandu, Nepal. The findings of
the study revealed that almost 90% of patients with schizophrenia reported moderate to high
levels of internalized stigma. The subscale with the highest mean score was stereotype
endorsement, indicating that patients endorsed stereotypes associated with mental illness. The
subscale with the lowest mean score was stigma resistance, suggesting that patients had lower
resistance towards being stigmatized. (17)

A cross-sectional study design that was conducted in New York City to investigate the
prevalence of internalized stigma among individuals with schizophrenia and other severe mental
disorders A total of 144 participants took part in the study, with 79.9% males and 20.1% females.
The study managed to figure out that the results of the study showed that 36% of the sample had
elevated internalized stigma scores based on a cutoff criterion. It highlights the impact that
stigmatizing attitudes and beliefs can have on individuals' self-perception and well-being. (18)

An institution based cross-sectional study that was conducted in Qatar among 417 subjects of
schizophrenia with the intensions of examining the prevalence of internalized stigma among
schizophrenia patients. The study managed to figure out that 9.8 of the study participants have
internalized stigma. (19)

A cross-sectional study that was conducted in Lagos, Nigeria to investigate the extent of
internalized stigma among outpatients with schizophrenia and its impact on their treatment and
overall outcomes. A total of 370 adult outpatients diagnosed with schizophrenia were involved in
the study the findings of the study revealed that the prevalence of high self-stigma among the
participants was 16.5%. The ISMI subscales indicated that high experience of discrimination was
reported more frequently compared to high alienation, high stereotype endorsement, and high
social withdrawal. Only 28.1% of participants scored high on stigma resistance. (20)

A facility based cross-sectional study that was conducted at Amanuel Mental Specialized
Hospital Addis Ababa Ethiopia, the study aimed to determine the extent, domains, and correlates
of internalized stigma among outpatients with schizophrenia in the country. The researchers
collected data from 212 individuals diagnosed with schizophrenia who were receiving outpatient
care at the hospital. The results of the study showed that nearly all participants (97.4%)

7
expressed agreement with at least one stigma item contained in the ISMI scale. About 46.7% of
the participants had a moderate to high mean stigma score. The study highlights that internalized
stigma is a significant problem among individuals with schizophrenia in the outpatient setting in
Ethiopia. It emphasizes the potential impact of internalized stigma on medication adherence and
the recovery process (21)

An institution based cross-sectional study that was conducted at Amanuel Mental Specialized
Hospital to investigate the prevalence of perceived stigma and associated factors among 411
individuals with schizophrenia attending the Outpatient Department of Amanuel Mental
Specialized Hospital. The study managed to reveal that the prevalence of perceived stigma
among the participants to be 83.5%. (22)

1.3.2 Socio-demographic Factors Associated with Internalized Stigma Among

Schizophrenia Patients
A cross-sectional study that was conducted in Poland revealed that younger age of illness onset
was associated with higher levels of stigma. On the other hand, a hospital based cross-sectional
study that was conducted among schizophrenia patients revealed that Farmers, and professionals’
legislatives were more likely to experience internalized stigma. (journal pone). Another study
conducted in New York revealed that the middle-aged participants had the highest scores on the
stigma scale. (18)

An institution-based study conducted in Qatar revealed that patients with no formal education
had a significantly higher level of internalized stigma compared to those with formal education.
(19)
. On the other hand, a study that was conducted in Lagos, Nigeria revealed that participants
who were unmarried were more susceptible have to internalized stigma more than those who
were not married. In addition to that Participants who had not received a formal education were
more likely to experience self-stigma. (20)

A cross-sectional study that was conducted at Amanuel Mental Specialized Hospital revealed
that being single was associated with a higher stigma score. Participants who were single had a
higher likelihood of experiencing internalized stigma compared to those who were married or in
a committed relationship. Participants living in rural areas had a greater likelihood of
experiencing internalized stigma compared to those living in urban areas. (21)A cross-sectional
study that was conducted at Amanuel Mental Specialized Hospital, Ethiopia revealed that

8
Participants who were not able to read and write had a higher likelihood of experiencing
perceived stigma compared to those with higher education levels. (22)

1.3.3 Clinical and Other Associated Factors of Internalized Stigma Among Schizophrenic
Patients
A cross-sectional study that was conducted among schizophrenia subjects in Poland managed to
figure out that higher levels of stigma were related to lower subjective quality of life. Patients
currently under hospital care and those with more previous hospitalizations (especially
involuntary admissions) were more likely to experience stigma. Furthermore, Stigma experiences
were more frequently reported by patients with more severe drug side effects. (1016). In another
study that was conducted in Nepal stated that duration of illness particularly 1 to 5 years and 5 to
10 years were more likely to experience internalized stigma (17)

Furthermore, in another cross-sectional study that was conducted in Qatar revealed that Higher
levels of internalized stigma have been observed in individuals with more severe symptoms of
schizophrenia. The presence of prominent symptoms, such as hallucinations or delusions, can
contribute to self-stigmatization. Longer duration of illness has been associated with higher
levels of internalized stigma. Over time, individuals with schizophrenia may internalize societal
negative beliefs and develop self-stigmatizing attitudes. Lack of social support or perceived
social rejection can contribute to higher levels of internalized stigma. Individuals who face
stigma in their social relationships, including family, friends, and community, may internalize
negative attitudes and feel ashamed of their condition. (19)

Another cross-sectional study that was conducted in Lagos, Nigeria revealed that the absence of
strong social support was associated with higher levels of self-stigma. In addition to that the
findings indicated that higher levels of psychopathology, as measured by the BPRS-18, were
associated with increased self-stigma. This suggests that individuals with more severe symptoms
and psychological distress are more likely to internalize negative beliefs and stereotypes
associated with schizophrenia. (20)

A cross-sectional study that was conducted in Ethiopia revealed that Participants with prominent
psychotic symptoms had a higher stigma score This suggests that individuals experiencing more
severe psychotic symptoms may be more susceptible to internalized stigma. Nearly half of the
participants who discontinued their treatment reported doing so because of perceived stigma.

9
This indicates that stigma has a significant impact on treatment adherence among individuals
with schizophrenia. (21)

On the other hand, a cross-sectional study that was conducted at Amanuel Mental Specialized
Hospital established that Individuals who faced challenges in adhering to their antipsychotic drug
regimen had a higher likelihood of perceiving stigma. In addition to that Participants with a
duration of illness less than one year were more likely to experience perceived stigma compared
to those with a longer duration of illness. (22)

Several factors have been identified as associated with higher levels of internalized stigma
among schizophrenia patients. Younger age of illness onset, being unmarried, lower education
levels, living in rural areas, more severe symptoms of schizophrenia, longer duration of illness,
absence of strong social support, and challenges in adhering to antipsychotic medication have
been consistently linked to increased internalized stigma. However, it is important to note that
these factors have been primarily investigated in studies conducted in Western countries, and
their applicability to the Ethiopian context remains unclear. Furthermore, the literature review
highlights the need to investigate additional factors that may contribute to internalized stigma
among schizophrenia patients. Factors such as socio-economic status, family support, access to
mental health services, and cultural beliefs surrounding mental illness have been identified as
potential contributors to internalized stigma. The proposed research can explore these factors
within the Ethiopian context and enrich the existing literature.

In conclusion, this literature review demonstrates the importance of understanding the prevalence
and associated factors of internalized stigma among schizophrenia patients. The proposed
research at Amanuel Mental Specialized Hospital in Ethiopia will address the existing gaps by
providing context-specific insights, exploring internalized stigma within a hospital setting, and
investigating additional factors that may contribute to the phenomenon. This research will
contribute to the development of targeted interventions and support strategies to mitigate the
impact of internalized stigma and improve the well-being of schizophrenia patients in Ethiopia.

10
1.3.4 Conceptual Framework of the Literature Review

Sociodemograp
Clinical Fators hic
Symptom Severity Age
Medication Internalize Sex
Adherence d Stigma Marital Staus
Duration of illness
Treatment hx Educational
Status

Psychosocial
Factors
Lack of Social
suppoert
Life stressors

Figure 1: Conceptual framework of the literature review

11
1.4 Justification of the Study
The proposed study on the prevalence and associated factors of internalized stigma among
individuals with mental illness at Amanuel Mental Specialized Hospital in Addis Ababa,
Ethiopia, is of significant importance for several reasons. Firstly, internalized stigma is a
pervasive issue that can have detrimental effects on the well-being and recovery of individuals
with mental illnesses, including schizophrenia. Internalized stigma has been associated with poor
treatment adherence and outcomes among individuals with mental illness. However, there is a
research gap on what extent of through which internalized stigma affects treatment adherence
and outcomes among schizophrenia patients attending outpatient departments. Internalized
stigma can have long-term consequences for the social integration of individuals with
schizophrenia. However, there is a research gap regarding the enduring effects of internalized
stigma on social relationships, employment opportunities, and community inclusion among
schizophrenia patients attending outpatient departments. While there have been studies on stigma
related to mental illness in general, including schizophrenia, there is a need for more
comprehensive studies specifically examining internalized stigma. Internalized stigma refers to
the self-acceptance of negative societal attitudes, which can be distinct from perceived and
enacted stigma. Understanding the prevalence of internalized stigma in this specific context is
essential for identifying the scale of the problem and implementing targeted interventions.
Secondly, by identifying the associated factors contributing to internalized stigma, such as socio-
demographic characteristics, illness-related factors, and social support, this study can provide
valuable insights into the complex dynamics that perpetuate stigma within the Ethiopian society.
Furthermore, Amanuel Mental Specialized Hospital serves as a critical mental health care
institution in Addis Ababa, catering to a significant number of individuals with mental illnesses,
including schizophrenia. Conducting this research within this specific setting allows for a
focused examination of internalized stigma among outpatients, providing relevant and practical
insights that can directly inform the hospital's policies, interventions, and support services.

12
2. OBJECTIVE OF THE STUDY
2.1 General Objective
 To assess the prevalence and factors associated with internalized stigma among
outpatients with schizophrenia at Amanuel Mental Specialized Hospital, Addis Ababa,
Ethiopia, in 2023.

2.2 Specific Objectives

 To determine the prevalence of internalized stigma among outpatients with schizophrenia
at Amanuel Mental Specialized Hospital.
 To identify characteristics associated with internalized stigma among outpatients with
schizophrenia at Amanuel Mental Specialized Hospital.

13
3. METHODS AND MATERIALS
3.1 Study Setting
St. Amanuel Mental Specialized Hospital is a renowned mental healthcare facility situated in
Addis Ababa, the capital city of Ethiopia. It is one of the oldest hospitals established in 1930 E.C
during the Ethio-Italian war and it is the only mental Hospital in Ethiopia. In the Hospital the
health service had been given up in 1940 by low level psychiatric professionals. Starting from
1946-1970 the treatment was given by doctors came from Russia, Bulgaria, and Cuba. Amanuel
Hospital provides both inpatient and outpatient care. Inpatient services are available for
individuals who require intensive treatment and monitoring, while outpatient services cater to
those who can receive treatment while living in the community. On average 46,520 people with
schizophrenia are seen as outpatients are treated each year and approximately 160 patients are
admitted to the wards each month. The hospital has 13 OPDs, with almost 3900 schizophrenic
clients visiting each month.

3.2 Study Design and Period

 An institution based cross-sectional study will be employed for this study. From
December 20-January 20 2023 G.C

3.3 Population
3.3.1 Source Population
 All schizophrenia patients who are receiving their treatment at St. Amanuel Mental
Specialized Hospital in Addis Ababa, Ethiopia

3.3.2 Study Population

 The group of schizophrenia patients at St. Amanuel Mental Specialized Hospital in Addis
Ababa, Ethiopia who will be present during the study period.

3.4 Eligibility Criteria

3.4.1 Inclusion Criteria
 Study subjects who are diagnosed as schizophrenia and who are 18 years old or older will
be included in the study.

14
3.4.2 Exclusion Criteria
 Study subjects who are in the acute phase of their illness which eventually makes the
communication difficult, those with hearing impairment will be excluded from the study.

3.5 Sample Size and Sampling Technique

3.5.1 Sample Size
The minimum number of samples required for the study will be determined by using the formula
to estimate single population proportion, an institution based cross-sectional study that was
conducted at Amanuel Mental Specialized Hospital established that the prevalence of
internalized stigma to be 83%, this will be utilized for the single proportion formula as a P value

n= minimum sample size required for the study

z= standard normal* distribution with confidence interval of 95%, z=1.96

d= absolute precision or tolerable margin of error, d=0.05

p= is the anticipated population proportion, which in this case is 0.83

Considering a 95 %confidence interval and 5 % degree of precision

With the above we would obtain the sample size of 217 adding a contingency or non-response
rate of 10%, it becomes 239.

3.5.2 Sampling Technique

The sampling that will be utilized for this study will be systematic random sampling. The source
population for this research consists of 3,900 individuals diagnosed with schizophrenia and
receiving treatment at Amanuel Mental Specialized Hospital in Ethiopia. The sample size for the
study is determined to be 239 participants.

15
To select the sample, a sampling interval (K value) will be calculated by dividing the total source
population (3,900) by the desired sample size (239). The K value can be calculated as follows:

K = Total source population / Desired sample size

K = 3,900 / 239

K ≈ 16

Using a random start, the first participant will be randomly selected from the first 16 individuals
from the source population. Subsequently, every 16th individual in the source population will be
included in the sample until the desired sample size is reached.

This systematic random sampling technique ensures that each individual in the source population
has an equal chance of being included in the sample. It provides a representative sample of
individuals with schizophrenia at Amanuel Mental Specialized Hospital, enabling
generalizability of findings to the larger population of interest. The systematic approach helps to
reduce potential bias and enhance the efficiency of the sampling process.

3.6 Data Collection Tools

Internalized Stigma of Mental Illness (ISMI) scale The Internalized Stigma of Mental Illness
(ISMI) scale is a self-report measure consisting of 29 items. It assesses five dimensions of
internalized stigma: alienation, stereotype endorsement, perceived discrimination, social
withdrawal, and stigma resistance. Each item is rated on a 4-point Likert scale. Higher scores
indicate higher levels of internalized stigma. The ISMI scale is widely used in research and
clinical settings to examine the impact of stigma on individuals with mental illness and guide
intervention strategies. It provides valuable insights into the psychological and social
consequences of internalized stigma.

The Oslo Social Support Scale (OSSS-3) is a standardized tool designed to assess social
support in the general population. It consists of three items that measure the perceived
availability of different types of social support, including emotional, instrumental, and
informational support. The OSSS-3 provides a concise and reliable measure of social support,
allowing researchers to assess the level of support individuals perceive in their social networks.

16
By utilizing the OSSS-3 in this study, we aim to examine the role of social support in the lives of
schizophrenia patients and its impact on their mental well-being and recovery process.

The MMAS-4, or the 4-item Morisky Medication Adherence Scale, is a validated tool used to
assess medication adherence in various populations, including individuals with schizophrenia. It
consists of four questions that evaluate the patient's behavior and beliefs related to medication
adherence. The MMAS-4 provides a quick and reliable measure of medication adherence, aiding
researchers in understanding the extent to which schizophrenia patients adhere to their prescribed
medications.

3.7 Study Variables

3.7.1 Independent Variable
 Sociodemographic Factors

 Age

 Sex

 Marital Status

 Educational Level

 Job

 Clinical Factors

 Duration of illness

 Symptom Severity

 Medication Adherence

 Psychosocial Factors

 Lack of social support

 Life stressors

3.7.2 Dependent Variable

 The level of internalized stigma among schizophrenia patients at AMSH.
17
3.8 Operational Definition
Internalized Stigma of Mental Illness (ISMI) scale with the exception of the stigma resistance
domain, a higher score on the remaining four subscales of the Internalized Stigma of Mental
Illness (ISMI) scale indicates a greater level of internalized stigma. Participants who score 2.5
and above on the Likert scale questions of the ISMI are considered to have high internalized
stigma. On the other hand, participants who score below 2.5 points on the ISMI are categorized
as having no internalized stigma.

The Oslo Social Support Scale (OSSS-3): Low Social Support: Scores ranging from 3 to 9
indicate a relatively low level of perceived social support. Moderate Social Support: Scores
ranging from 10 to 12 suggest a moderate level of perceived social support. High Social Support:
Scores ranging from 13 to 15 indicate a high level of perceived social support.

The MMAS-4 or the 4-item Morisky Medication Adherence Scale: High Adherence: A score
of 0 indicates high adherence, suggesting that the individual reported not engaging in any of the
non-adherent behaviors assessed by the MMAS-4. Moderate Adherence: Scores of 1 or 2 may
indicate moderate adherence, suggesting occasional instances of non-adherent behavior. Low
Adherence: Scores of 3 or 4 may indicate low adherence, suggesting frequent or consistent non-
adherent behavior.

3.9 Data Collection Procedure

Data will be collected by second-year regular psychiatry nursing students by utilizing an
interview-guided structured questionnaire that will be prepared in English and translated to
Amharic. Furthermore, the information obtained from the patient profile will also be
documented. For the data collection process, several steps will be followed, including the
distribution of questionnaires and collection of the instrument. Prior to data collection, the
understandability, reliability, and validity of the instrument will be assessed. After receiving the
green light from our advisors, an informed consent will be prepared, and data collection will
commence from the selected participants. Subsequently, after the collection is completed, we
will check for any constraints in the questionnaire that might have been missed or resulted in
unanswered questions. Following the checking for data completion, we will be ready for data
entry and analysis.

18
3.10 Quality Assurance
The research proposal will prioritize the implementation of a robust quality assurance framework
to ensure the credibility and reliability of the study. To achieve this, careful attention will be
given to various aspects of the research process. To maintain consistency and accuracy in data
collection, standardized procedures will be developed and followed diligently. The research
team, specifically the second-year regular psychiatry nursing students, will receive
comprehensive training on the data collection process. Special attention will be given to their
familiarity with the interview-guided structured questionnaire to minimize potential bias and
errors. Efficient management of data will be prioritized to ensure its security and integrity. All
collected data will be securely stored with restricted access to authorized personnel only. Data
entry and analysis will be conducted using reliable software or statistical tools, adhering to
standardized procedures to enhance the accuracy and validity of the results. Regular monitoring
and quality checks will be implemented throughout the research process to identify any potential
constraints, missed or unanswered questions, and data completion issues. This proactive
approach will allow for timely corrections and adjustments, ensuring that the data collected is
comprehensive and reliable.

3.11 Data Analysis

The data will be checked by the investigators for completeness, and it will be coded and entered
into Epi Data version 3.1. Subsequently, the data will be exported to Statistical Package for
Social Sciences version 26 (SPSS-26) for further analysis. Descriptive statistics will be utilized
to examine the frequency, mean, standard deviation, and percentages of the characteristics.
Binary logistic regression will be employed to assess the relationship between the independent
variables and the dependent variable, while multivariate logistic regression will be utilized to
control for the effect of potential confounders. All variables with a p-value ≤ 0.2 will be included
in the multivariable model to account for all possible confounders. The strength of the
association will be determined by calculating odds ratios with 95% confidence intervals. A p-
value less than 0.05 will be considered statistically significant.

19
4. ETHICAL ISSUE
Prior to initiating the study, ethical approval will be obtained from the relevant institutional
review board or ethics committee at St. Amanuel Mental Specialized Hospital. The research
protocol, including the study design, data collection methods, and participant confidentiality
measures, will be reviewed to ensure adherence to ethical guidelines and the protection of
participants' rights. Informed consent will be obtained from all participants involved in the study.
Participants were provided with detailed information about the research objectives, procedures,
potential risks, and benefits. They will be assured of their right to refuse participation or
withdraw from the study at any time without consequences. Written consent will be obtained
from participants, and their anonymity and confidentiality will be strictly maintained throughout
the research process.

20
5. DISSEMINATION
A comprehensive research report will be prepared, including the methodology, findings, and
recommendations. This report will be shared with the management and relevant departments
within Amanuel Mental Specialized Hospital, such as the Psychiatry Department, Research
Department, and Quality Assurance Department. Additionally, efforts will be made to
disseminate the report to other mental health institutions in Addis Ababa and Ethiopia. Seek
collaborations with other mental health institutions in Addis Ababa or Ethiopia to share the
research findings. The research findings will also be reported to Menelik II Medical and Health
Science College Research Department. This can involve joint meetings or workshops where
experiences and best practices can be shared. Collaborating with other institutions will facilitate
a broader reach and promote the adoption of the research findings.

21
6. TIME SCHEDULE
Table 1: Time schedule of the study

November December January

Activity w- w- w- w- w- w- w- w- w- w w- w-
1 2 3 4 1 2 3 4 1 -2 3 4

Literature review

Proposal preparation

Proposal draft submission

Comment incorporation

data collection

February March April

Activity w- w- w- w- w- w- w- w- w- w w- w-
1 2 3 4 1 2 3 4 1 -2 3 4

Data coding

Data entry

Data analysis VITY

Report writing

Thesis draft submission

Comment incorporation

Thesis final submission

Dissemination

22
7. BUDGETBREAKDOWN
Table 2: Budget breakdown of the study

Type Items/person Unit quantity Unit price Total price

Supplies Printing Page 400 5 2000

Audio-visual Number 1 2000 200

recorder
Flash 8GB 1 300 300

Note book Number 1 200 200

Binding Number 2 300 600

Data collection Survey Person 1 3000 3000

Interviews Person 1 2000 2000

Other direct cost Unforeseen 4350

cost

Reserve /10% 4545

Total 17,195

23
 REFERENCE
1. Meltzer HY, Alphs L, Green AI, Altamura ; A Carlo, Anand R, Bertoldi A, et al. Clozapine
Treatment for Suicidality in Schizophrenia International Suicide Prevention Trial (InterSePT).

2. Mohammed F, Geda B, Yadeta TA, Dessie Y. Profiles and factors associated with schizophrenia
in eastern Ethiopia: A matched case-control study. Front Psychiatry. 2022 Oct 13;13.

3. Monteiro NM, Balogun SK. Perceptions of mental illness in Ethiopia: A profile of attitudes,
beliefs and practices among community members, healthcare workers and traditional healers. Int
J Cult Ment Health. 2014;7(3):259–72.

4. Assefa D, Shibre T, Asher L, Fekadu A. Internalized stigma among patients with schizophrenia
in Ethiopia: A cross-sectional facility-based study. BMC Psychiatry. 2012 Dec 29;12.

5. Kehyayan V, Mahfoud Z, Ghuloum S, Marji T, Al-Amin H. Internalized Stigma in Persons With

Mental Illness in Qatar: A Cross-Sectional Study. Front Public Health. 2021;9:685003.

6. Ogunnubi OP, Aina FO, Busari CO, Fatiregun O, Fadipe B, Adegbohun AA, et al. South African
Journal of Psychiatry. 2022; Available from: https://doi.

7. Simeone JC, Ward AJ, Rotella P, Collins J, Windisch R. An evaluation of variation in published
estimates of schizophrenia prevalence from 1990-2013: A systematic literature review. BMC
Psychiatry. 2015 Aug 12;15(1).

8. Nassir Hussien Z, Solomon H, Yohannis Z, Ahmed AM, Hussien ZN. Prevalence and Associate
Factors of Suicidal Ideation and Attempt among People with Schizophrenia at Amanuel Mental
Specialized Hospital Addis Ababa, Ethiopia. 2014;

9. Major B, O’Brien LT. The social psychology of stigma. Vol. 56, Annual Review of Psychology.
2005. p. 393–421.

10. Valery KM, Prouteau A. Schizophrenia stigma in mental health professionals and associated
factors: a systematic review. 2020.

11. Link BG, Phelan JC. CONCEPTUALIZING STIGMA [Internet]. 2001. Available from:
www.annualreviews.org

24
12. Shrivastava A, Johnston ME, Thakar M, Shrivastava S, Sarkhel G, Sunita I, et al. Impact and
Origin of Stigma and Discrimination in Schizophrenia: Patient Perceptions. Stigma Res Action.
2011 Feb 28;1(1).

13. Assefa D, Shibre T, Asher L, Fekadu A. Internalized stigma among patients with schizophrenia
in Ethiopia: A cross-sectional facility-based study. BMC Psychiatry. 2012 Dec 29;12.

14. Brohan E, Elgie R, Sartorius N, Thornicroft G. Self-stigma, empowerment and perceived

discrimination among people with schizophrenia in 14 European countries: The GAMIAN-
Europe study. Schizophr Res. 2010 Sep;122(1–3):232–8.

15. Koschorke M, Padmavati R, Kumar S, Cohen A, Weiss HA, Chatterjee S, et al. Experiences of
stigma and discrimination of people with schizophrenia in India. Soc Sci Med. 2014 Dec
1;123:149–59.

16. Świtaj P, Wciórka J, Smolarska-Świtaj J, Grygiel P. Extent and predictors of stigma experienced
by patients with schizophrenia. European Psychiatry. 2009 Dec;24(8):513–20.

17. Dhungana S, Tulachan P, Chapagai M, Pant SB, Lama PY, Upadhyaya S. Internalized stigma in
patients with schizophrenia: A hospital-based cross-sectional study from Nepal. PLoS One. 2022
Mar 1;17(3 March).

18. West ML, Yanos PT, Smith SM, Roe D, Lysaker PH. Prevalence of Internalized Stigma among
Persons with Severe Mental Illness. Stigma Res Action. 2011 Feb 28;1(1).

19. Kehyayan V, Mahfoud Z, Ghuloum S, Marji T, Al-Amin H. Internalized Stigma in Persons With
Mental Illness in Qatar: A Cross-Sectional Study. Front Public Health. 2021;9:685003.

20. Fadipe B, Adebowale TO, Ogunwale A, Fadipe YO, Ojeyinka AHA, Olagunju AT. Internalized
stigma in schizophrenia: a cross-sectional study of prevalence and predictors. Int J Cult Ment
Health. 2018 Oct 2;11(4):583–94.

21. Assefa D, Shibre T, Asher L, Fekadu A. Internalized stigma among patients with schizophrenia
in Ethiopia: A cross-sectional facility-based study. BMC Psychiatry. 2012 Dec 29;12.

25
22. Bifftu BB, Dachew BA. Perceived Stigma and Associated Factors among People with
Schizophrenia at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: A Cross-
Sectional Institution Based Study. Psychiatry J. 2014;2014:1–7.

ANNEX-I Informed Consent

Dear Participant,

You are invited to participate in a research study conducted by second-year psychiatry nursing
students at Amanuel Mental Specialized Hospital in Addis Ababa, Ethiopia. The purpose of this
study is to investigate the prevalence and associated factors of internalized stigma among
individuals diagnosed with schizophrenia.

26
Your participation in this study is voluntary, and you have the right to decline or withdraw at any
time without facing any negative consequences. Confidentiality will be maintained throughout
the study, and all data collected will be anonymized to ensure your privacy.

By taking part in this research, you will contribute to expanding our understanding of
internalized stigma among schizophrenia patients. This may help improve the care and support
provided to individuals with this condition.

If you have any questions or concerns about the study, please feel free to contact the research
team using the provided contact information. Your decision to participate or not will not affect
your current or future medical care.

Thank you for considering being a part of this important research.

Sincerely,

1. EsraelNigussie

2. EtetuTilahun

3. EyesusalemAdisu

4. FevenGetenet

ANNEX-II English Version of The Questionnaire

Section-1 Sociodemographic Characteristics

No. Questionnaire Alternative

Q1 Sex 1.Male
2.Female
Q2 Age Age in years--------------
Q3 Marital status? 1.single
2.Married

27
 3.divorced
4.widowed
Q4 Religion? 1.Orthodox
2.protestant
3.muslim
4.Catholic
5.others(specify)---------------
Q5 Job? 1.governmet employed
2.private business
3.farmer
4.daily laborer
5.student
6.house hold worker
7.Jobless
8.others
Q6 Educational level? 1. Primary
2. .secondary,
3. diploma,
4. First degree
0ther…………………..
Q7 Place of residence? 1. rural
2.urban
Section two: Measurement of social support

The following three questions ask about how you experience your social relationships. The
inquiry is about your immediate personal experiences. Please indicate the option that represents
your experience

Q503 How many people are so close to None 1 or 2 3-5 More

you that you can count on them it 1 2 3 than 5
you have great personal problems 4
(choose one option)?
Q504 How much concern do people show A lot of Some Uncertain Little No
in what you are doing (choose one concern concern 3 concern concern

28
 option)? and and interest and and
interest 4 interest interest
5 2 1
Q505 How easy is it to get practical help Very Easy Possible Difficult Very
from neighbors if you should need it easy 4 3 2 difficult
(choose one option)? 5 1

Section-3 Morisky Medication-Taking Adherence Scale-MMAS

NO ITEMS YES NO

1 . Do you ever forget to take your

(name of health condition) medicine?

2 Do you ever have problems

remembering to take your (name of
health condition) medication?
3 When you feel better, do you
sometimes stop taking your (name of
health condition) medicine?
4 Sometimes if you feel worse when
you take your (name of health
condition) medicine, do you stop
taking it?

SECTION-4 Internalized stigma of mental illness (ISMI)

29
 Strongly Disagree Agree Strongly
disagree agree
1.IfeeloutofplaceintheworldbecauseIhaveamental illness. 1 2 3 4
2.Mentallyillpeopletendtobe violent. 1 2 3 4
3.PeoplediscriminateagainstmebecauseIhaveamentalillness. 1 2 3 4
4.Iavoidgettingclosetopeoplewhodon’thaveamentalillnessto avoid rejection.
1 2 3 4
5.IamembarrassedorashamedthatIhaveamental illness. 1 2 3 4
6.Mentallyillpeopleshouldn’tgetmarried. 1 2 3 4
7.Peoplewithmentalillnessmakeimportantcontributionstosociety. 1 2 3 4
8.Ifeelinferiortootherswhodon’thaveamentalillness. 1 2 3 4
9.Idon’tsocializeasmuchasIusedtobecausemymentalillness might make me
1 2 3 4
look or behave “weird.”
10.Peoplewithmentalillnesscannotliveagood,rewarding life. 1 2 3 4
11.Idon’ttalkaboutmyselfmuchbecauseIdon’twanttoburden others with my
1 2 3 4
mental illness.
12.Negativestereotypesaboutmentalillnesskeepmeisolatedfrom
the“normal”world. 1 2 3 4
13.Beingaroundpeoplewhodon’thaveamentalillnessmakesme feel out of place
1 2 3 4
or inadequate.
14.Ifeelcomfortablebeingseeninpublicwithanobviouslymentally
illperson. 1 2 3 4
15.Peopleoftenpatronizeme,ortreatmelikeachild,justbecauseI have a mental
1 2 3 4
illness.
16.Iamdisappointedinmyselfforhavingamentalillness. 1 2 3 4
17.Havingamentalillnesshasspoiledmylife. 1 2 3 4
18.PeoplecantellthatIhaveamentalillnessbythewayI look. 1 2 3 4
19.BecauseIhaveamentalillness,Ineedotherstomakemost decisions for me.
1 2 3 4
20.Istayawayfromsocialsituationsinordertoprotectmyfamily or
friendsfromembarrassment. 1 2 3 4
21.Peoplewithoutmentalillnesscouldnotpossiblyunderstandme. 1 2 3 4
22.PeopleignoremeortakemelessseriouslyjustbecauseIhavea mental illness.
1 2 3 4
23.Ican’tcontributeanythingtosocietybecauseIhaveamental illness.
1 2 3 4
24.Livingwithmentalillnesshasmademeatoughsurvivor. 1 2 3 4
25.Nobodywouldbeinterestedingetting closetomebecauseIhave a mental
1 2 3 4
illness.
26.Ingeneral,I amabletolivemylifethewayI wantto. 1 2 3 4
27.Icanhaveagood,fulfillinglife,despitemymentalillness. 1 2 3 4
28.OthersthinkthatIcan’tachievemuchinlifebecauseIhavea mental illness.
1 2 3 4
29.Stereotypesaboutthementallyillapplytome. 1 2 3 4
J.Ritsher,UniversityofCalifornia,SanFrancisco.ritsher@itsa.ucsf.edu

30
ANNEX-III -AMHARIC VERSION OF THE QUESTIONNAIRE
በመረጃ የተደገፈ ስምምነት

ውድ ተሳታፊ፣

በአማኑኤል የአእምሮ ስፔሻላይዝድ ሆስፒታል የሁለተኛ ዓመት የአዕምሮ ነርሲንግ ተማሪዎች ባደረጉት የምርምር

ጥናት ላይ እንድትሳተፉ ተጋብዘዋል። የዚህ ጥናት አላማ ራስን የመግደል ሃሳብ እና በስኪዞፈሪን ያበተመረመሩ ግለሰቦች

መካከል ያለውን ስርጭት እና ተያያዥ ምክንያቶችን መመርመርነው።

የእርስዎ ተሳትፎ በፈቃደኝነት ነው, እና በማንኛውም ጊዜ ያለምንም አሉታዊ ውጤት ጥናቱን ላለመቀበል ወይም

ከትምህርት የመውጣት መብት አለዎት . የእርስዎ ምላሾች በሚስጥ ርይያዛሉ፣እና ሁሉም የተሰበሰቡ መረጃዎች

የእርስዎን ግላዊነት ለማረጋገጥስም-አልባይሆናሉ።

31
በዚህ ጥናት ውስጥ በመሳተፍ በስኪዞፈሪን ያህመምተኞች መካከል ራስን የመግደል ሃሳብን እና ሙከራዎችን በመረዳት

እና በመፍታት እውቀትን ለማዳበር አስተዋፅዎ እያደረጉ ነው፣ይህም ችግር ላለባቸው ግለሰቦች የተሻለ እንክብካቤ እና

ድጋፍ ሊሰጥ ይችላል።

ይህንን ጥናት በተመለከተ ማንኛቸውም ጥያቄዎች ወይም ስጋቶች ካሉዎት፣እባክዎን የቀረበውን የእውቂያ መረጃ

ተጠቅመው የምርምር ቡድኑን ለማነጋገር ነፃነት ይሰማዎ።ለመሳተፍ ወይም ላለመሳተፍ ውሳኔዎ የአሁኑን ወይም

የወደፊት የሕክምና እንክብካቤዎን አይጎዳውም.

የዚህ ጠቃሚ ምርምር አካል ለመሆን ስላሰቡ እናመሰግናለን።

ከሰላምታጋር

1. እስራኤልንጉሴ

2. እቴቱጥላሁን

3. ኢየሱስዓለምአዲሱ

4. ፌቨንጌቴኔት

የጥያቄመጠይቁአባሪ-II የእንግሊዝኛቅጂ
ክፍል-1 የሶሺዮዲሞግራፊባህሪያት

አይ. መጠይቅ አማራጭ

ጥ1 ጾታ 1. ወንድ

2. ሴት

ጥ2 ዕድሜ እድሜበዓመታት -----------

ጥ3 የጋብቻሁኔታ? 1. ነጠላ

2. ያገባ

3.የተፋታ

4.የሞተባት

32
ጥ4 ሃይማኖት? 1.ኦርቶዶክስ

2.ፕሮቴስታንት

3.ሙስሊም

4. ካቶሊክ

5.ሌሎች (ይግለጹ) -----------

ጥ5 ሥራ? 1.መንግስትተቀጠረ

2.የግልንግድ

3.ገበሬ

4.የእለትሰራተኛ

5.ተማሪ

6. የቤትሰራተኛ

7. ሥራየሌለው

8.ሌሎች

ጥ6 የትምህርትደረጃ? 1. ዋና

2. .ሁለተኛደረጃ፣

3. ዲፕሎማ፣

4. የመጀመሪያዲግሪ 0 ሌላ
…………………………
……….
ጥ7 የመኖሪያቦታ? 1. ገጠር

2.ከተማ
ክፍልሁለት: የማህበራዊድጋፍመለካት

የሚከተሉትሶስትጥያቄዎችማህበራዊግንኙነቶችዎንእንዴትእንደሚለማመዱይጠይቃሉ።ጥያቄውስለእርስዎየቅርብግላ

ዊልምዶችነው።እባክዎየእርስዎንተሞክሮየሚወክልአማራጭያመልክቱ

Q ምንያህልሰዎችከእርስዎጋርበጣምቅርብስ ምንም 1 ወይም 3-5 ከ 5 በላይ

50 2 3
ለሆኑበእነሱላይእምነትመጣልይችላሉትል 1 4
3 2

33
 ቅየግልችግሮችአሉዎት

(አንድአማራጭይምረጡ)?
Q ሰዎችበምታደርጉትነገርላይምንያህልአሳቢ ብዙትኩ አንዳንድአ እርግ ትንሽጭ ምንምፍላጎ
50
ነትያሳያሉ (አንድአማራጭይምረጡ)? ረትእናፍ ሳሳቢእናፍ ጠኛያ ንቀትእና ትእናጭንቀ
4
ላጎት ላጎት ልሆነ ፍላጎት ትየለም
5 4 3 2 1
Q ከፈለጉከጎረቤቶችተግባራዊእርዳታማግኘ በጣምቀ ቀላል ይቻላ አስቸጋሪ በጣምከባድ
50
ትምንያህልቀላልነው ላል 4 ል 2 1
5
(አንድአማራጭይምረጡ)? 5 3

ክፍል-3 ሞሪስኪመድሃኒት-የመታዘዝመለኪያ-ኤምኤምኤኤስ

አይ ITEMS አዎ አይ

1 . የእርስዎን (የጤናሁኔታስም) መድሃኒትመውሰድዎንይረሳሉ?

2 የእርስዎን (የጤናሁኔታስም)

መድሃኒትመውሰድዎንበማስታወስላይችግሮችአጋጥመውዎትያውቃሉ?

3 ጥሩስሜትሲሰማዎትአንዳንድጊዜ (የጤናሁኔታስም)

መድሃኒትዎንመውሰድያቆማሉ?

4 አንዳንድጊዜ (የጤናሁኔታስም) መድሃኒትሲወስዱየከፋስሜትከተሰማዎት,

መውሰድያቆማሉ?

34
 በጣምአል አልስማማ ተስማማ በጠንካራ
ስማማም ም። ሁኔታተ
። ስማማ
1.በአለማችንላይከቦታቦታመውጣትምክንያቱምበህመምምክንያት። 1 2 3 4
2. የአዕምሮህመምሰዎችጠበኛይሆናሉ። 1 2 3 4
3. ሰዎችበአካልሕመምምክንያትአድልዎያደርጋሉ። 1 2 3 4
4. አለመቀበልንለማስወገድጤናንየማይጎዱሰዎችንመዘጋት።
1 2 3 4
5.IamembarrassedorashamedthatIhaveamental ሕመም. 1 2 3 4
6. የአእምሮሕመምተኞችማግባትየለባቸውም። 1 2 3 4
7. የአዕምሮህመምያለባቸውሰዎችለህብረተሰቡጠቃሚአስተዋፅዖያደርጋሉ። 1 2 3 4
8.የጤናማህመምየሌላቸውሌሎች። 1 2 3 4
9.አይጠቅምምምክንያቱምአእምሮዬመታመም “አስገራሚ”
1 2 3 4
እንድመስልወይምእንዳደርግሊያደርገኝይችላል።
10. የአዕምሮህመምያለባቸውሰዎችጥሩ፣የሚክስህይወትመኖርአይችሉም። 1 2 3 4
11. በአእምሮሕመሜሌሎችንሸክምማድረግስለማልፈልግራሴንአላስብም።
1 2 3 4
12.አሉታዊ stereotypes ስለአእምሮአዊሕመምመጠበቅከየተገለሉ
"የተለመደው" ዓለም. 1 2 3 4
13.
1 2 3 4
ከበሽታውየማይታመምሰዎችመሆኔቦታየሌላቸውወይምበቂእንዳልሆኑእንዲሰማቸ
ውያደርጋል።
14.በግልጽበአእምሮአዊበሆነመልኩበሕዝብዘንድመመቻቸትአለበት።
የታመመሰው. 1 2 3 4
15.
1 2 3 4
ሰዎችብዙውንጊዜደጋፊያደርጉልኛል፣ወይምሕፃናትንያክማሉ፣ምክንያቱምየአእምሮ
ሕመምስላለኝነው።
16. ለአእምሮህመምበራሴተስፋቆርጫለሁ። 1 2 3 4
17. የአእምሮሕመምሕይወቴንአበላሽቶታል። 1 2 3 4
18. ሰዎችበዚህመንገድየጤንነትሕመምንሊናገሩይችላሉ። 1 2 3 4
19. ለጤንነቴሕመም, ለእኔበጣምአስፈላጊየሆኑሌሎችውሳኔዎችናቸው.
1 2 3 4
20. ከማህበራዊሁኔታየጠፋቤተሰብንማዘዝወይም
ከአሳፋሪጓደኞች። 1 2 3 4
21. የአእምሮሕመምየሌላቸውሰዎችሊረዱኝአልቻሉም. 1 2 3 4
22. ሰዎችየአእምሮሕመምስላለባቸውበቁምነገርቸልይላሉ።
1 2 3 4
23. ለህብረተሰቡምንምማበርከትአልችልምምክንያቱምበህመምምክንያት።
1 2 3 4
24. ከአእምሮህመምጋርመኖር። 1 2 3 4
25. የአእምሮሕመምስላለብኝማንምሰውመቅረብአይፈልግም።
1 2 3 4
26. አጠቃላይ፣በፈለኩትመንገድህይወቴንኖራለሁ። 1 2 3 4
27. Icanhaveagood, ፍጻሜሕይወት, spitemymental ሕመም. 1 2 3 4
28.የአእምሮሕመምስላለበትሕይወትንማሳካትአልችልም።
1 2 3 4

35
29. ስለአእምሮአዊአስተሳሰብበእኔላይተጽዕኖያሳድራል። 1 2 3 4

36