Family Psychoeducation Reduces Stigma Among Latino Families and Their Loved Ones with Schizophrenia

Purpose: Mental illness stigma is pervasive and affects the quality of life of individuals with schizophrenia.  Although families play a critical role in the lives of individuals with schizophrenia, little is known about how family processes may facilitate or mitigate stigma experiences especially with underserved groups such as Latinos.  Due to the prevalence of family involvement among Latinos with schizophrenia, it is important to have an understanding of how Latino families perceive stigma.  Family psychoeducation, an evidence-based intervention, is associated with improved knowledge of the illness among family members.  Given that stigma can be influenced by knowledge of the illness, this study explored how participation in a culturally based family intervention helped families alter illness perceptions and reduce stigma.

Methods:  Data come from an NIMH funded randomized controlled trial of a culturally based family intervention focused on Latino families of clients with schizophrenia that employed a family group format without direct client participation.  The parent study consisted of key family members and their loved ones receiving community-based mental health services in an urban area.  Family members were primarily Spanish speaking while clients were mainly bicultural/bilingual.  Specifically, the current study used purposive sampling to obtain a diverse subset of 34 individuals (20 key family members/14 clients) from the intervention condition of the parent study.  Participants were interviewed by a bilingual/bicultural interviewer using a semi-structured interview guide.  Analysis involved developing categories and themes that addressed research questions as well as themes generated from the data; the process was therefore influenced by grounded theory.  Bilingual/bicultural team members created a list of codes after careful review of transcripts.  Once coding was complete, categories were developed representing themes and subthemes based on patterns observed in the data.  

Results:  Findings revealed that family members’ beliefs regarding explanatory models of the illness prior to the intervention tended to include stigma perceptions; however, the intervention provided knowledge that changed these negative perceptions (took away the blindfold).  Clients also expressed greater understanding from family members because of their participation in the intervention that affected perceptions of self-stigma and lead to feelings of acceptance (my mom is ok with knowing how I am).  In addition, disclosure and how it was managed individually and within the family system emerged as a salient theme among participants (gave us courage to say this is what is happening).

Implications:  Findings suggest that family psychoeducation may reduce stigma by improving knowledge of the illness.  Furthermore, benefits appear to extend to clients who experienced greater family understanding that contributed to enhanced self-perceptions.  Given that culture plays an important role in stigma and that Latino families are highly involved in providing support to clients, incorporating culturally based family psychoeducation into treatment may be an innovative way of addressing stigma that can substantially benefit client and family wellbeing.