Relationship Self Esteem, Self Efficacy Condition Patients Shizopherednia with Perceived Stigma by Patients Schizopherednia in Mental Hospital Prof HB Saanin West Sumatera

Relationship Self Esteem, Self Efficacy Condition Patients Shizopherednia with Perceived Stigma by Patients Schizopherednia in Mental Hospital Prof HB Saanin West Sumatera

Devi Mekar Sari., Dessy Merila Erizon., Amanda Trimurti

Nursing Academic YPTK Solok   

DOI: https://doi.org/10.51584/IJRIAS.2025.10060034

Received: 28 May 2025; Accepted: 05 June 2025; Published: 02 July 2025

ABSTRACT

Stigma is society’s negative view of schizophrenic clients. The stigma of society and family is strongly felt by schizophrenia sufferers regarding the sufferer’s psychosocial behavior, especially the sufferer’s self-esteem and self-efficacy. So it has an impact on recurrence. This research aims to find out more about the relationship between the psychosocial ( self esteem, self efficacy ) conditions of schizophrenia sufferers and the stigma felt (self-esteem, self-efficacy) by schizophrenia clients. This research design used a cross-sectional study with a total sample of 200 samples using a random sampling method. The results of Multivariate Logistic Regression analysis show that the factor that is most related psychosocially is self-esteem, namely self-esteem (p= 0.008). Based on the results of this research, it is recommended that clients’ psychosocial self-esteem be maintained properly by not stigmatizing sufferers so that clients’ self-esteem does not experience problems. Clients have high self-esteem when they do not experience stigma from family and society, so that the risk of recurrence will not occur. Therefore, do not stigmatize people with Schizopherenia.

Keywords: Stigma, self esteem, self efficacy

INTRODUCTION

Mental health will affect all aspects of individual’s life in interacting with each other. The prevalence of mental disorders (MDs) according to WHO, 1 out of 4 adults will experience mental health problems at one time in his life. The National Institute of Mental Health (NIMH) states that schizophrenia is 13% from the whole illnesses and it is estimated to grow up to 25% by 2030. This is a picture of future mental health problems. Over 29 million people in the world suffering from schizophrenia, and 57,8 milion mental problem  live in developing countries (WHO, 2021). The prevalence of schizophrenia in West Sumatra is 9.1 per mile. This figure indicates that the prevalence of schizophrenia in West Sumatra is quite high. Families tend to show bad attitude towards the patient. Families are confronted with various problems in caring for schizophrenic clients, especially the expense experience. There are also families who give a negative stigma upon clients that result in isolation and do not involve clients in decision-making within the family. Families tend to be prejudice and limit the clients’ space, assume that the clients are incompetent and unproductive. Families do not provide appropriate support even underestimate the ability of the clients. Families remain low-tolerance, disruptive, negative and emotional attitudes toward clients which make them do not have a sense of self-confidence. (self esteem, self efficacy)

The social burden experienced by the families including 38.5% are shunned by others, 34.4% often receive discrimination at work, 70.7% do not receive social support from the surrounding. The high emotional burden causes the families’ attitudes in caring for schizophrenia clients often indicates an excessive emotional expression and hostile attitude, also talking in a high tone and expressing their outrage. This research aims to find out more about the relationship of self self esteem,self efficacy schizophrenia patients with the perceived stigma by schizophrenia patients.

RESEARCH METHODOLOGY

This research was a cross-sectional study. It meant that the independent and dependent variable was measured at the same time. The purpose was to determine the relationship of self esteem self efficacy schizopherenia patients with the perceived stigma by schizophrenia clients. The sample in this research was 200 sample schizophrenia clients. The number of samples was based on the calculation of Lemeshow formula and taken by using random sampling technique. This research took place in Mental Hospital Prof HB Saanin west. This research used the questionnaire as the instrument. This questionnaire measured the self esteem, rosenberg self esteem scala by ( Rosenberg 1965)  self efficacy by using the Level of perceived self efficacy scale that consisted of self efficacy (zhang and schawarzer, 1995). The instrument had range scale of 1 to 4, if it had a high score then the self esteem and self efficacay will also high.

The instrument that was used regarding the stigma was the Devaluation-Discrimination Scale which developed by Links (1987) and Nicolas (1995). The instrument had range scale of 1 to 5. The perceived stigma would be high when the score value was high and vice versa. Criteria of respondents in this research were; willing to be respondents, clients were diagnosed with schizophrenia more than 6 months, able to read and write.

Bivariate analysis was used to determine the relationship of self esteem,  with the perceived stigma by schizophrenic clients by using chi-square test (p = <0.05). Multivariate analysis by using logistic regression used a value of (p = <0.008). This research had passed ethical clearance in the medical  faculty of nursing YPTK Solok.

RESEARCH RESULT

Table 1 Frequency Distribution of Schizophrenia Client Characteristics by Age and Sex in Mental Hospital Padang.

Table 1 shows that more than half of the schizophrenic clients at RSJ HB Saanin Padang (67.1%) are early adults. More than half (78.0%) were male. more than half have tertiary education (51.4%). This means that more than half of schizophrenia sufferers experience it in early adulthood.

Table 2 Frequency Distribution of self esteem, self efficacy toward Schizophrenia Clients in Mental Hospital Padang

Based on table 2 it shows that more than half of the respondents (53.2%) have low self-esteem. More than half of the respondents (63.0%) had low self-efficacy. More than half (52.6%). This means that more than half of schizophrenia sufferers have low self-esteem and more than half of schizophrenia sufferers have low self efficacy

Table 2 Frequency Distribution of Perceived Stigma by Schizophrenia Clients in Mental Hospital Prof HB Saanin Padang

More than half (53.2%) of respondents felt that the perceived stigma was low. This means that more than half of schizophrenia sufferers feel the  perceived stigma

Table 4 Analysis of the Relationship between Characteristic of Schizophrenia Clients and the Perceived Stigma by Schizophrenic Clients in Mental Hospital Prof HB Saanin Padang

In table 5.3, based on the results of the analysis, the incidence of high stigma was more frequently found in early adulthood at 52.6% compared to late adulthood (36.8%). In other words, the proportion of high stigma is found more in early adulthood compared to late adulthood. The results of the statistical test obtained a value of p = 0.119 (p> 0.05), so it can be concluded that there is no significant relationship between age and perceived stigma.

Table 5 Analysis of the Relationship between to the self esteem, self efficacy of Schizophrenia Clients and the Perceived Stigma by Schizophrenic Clients in Mental Padang.

Table 6 Starting Stages of Multivariate on the Relationship of Characteristics and Self Esteem, Sel Efficacy with the Perceived Stigma in Mental Hospital Prof HB Saanin Padang

Table 7 Starting Modeling Stages of Multivariate on the Relationship of Characteristics and self esteem, self efficacy with the Perceived Stigma in Mental Hospital Padang

Table 8 Final Modeling of Multivariate Analysis The Relationship of Characteristic self esteem, self efficacy with the Perceived Stigma

Low self-esteem actually prevents perceived stigma from occurring because 54.3% of people with high self-esteem feel higher stigma, meaning that people with low self-esteem prevent the occurrence of high perceived stigma compared to people with high self-esteem. Self-esteem has the smallest p value, p= 0.008 and OR= 0.320. So it can be concluded that people with low self-esteem prevent the occurrence of high perceived stigma compared to people with high self-esteem, 0.320 means 3-20  less perceived stigma when compared with people who have high self-esteem. This means that people who have low self-esteem are 3-20  less likely to experience the  perceived stigma.

DISCUSSION

This research analyzes the relationship between characteristic, age, sex, self esteem,self efficacy and education and the perceived stigma by schizophrenia clients. There were 173 respondents in this research.

The result of the research above showed that more than half (67.1%) of respondents were schizophrenics who were in early adulthood. This result is similar to the research conducted by We thun chien in Hong Kong which states that most people with schizophrenia are in early adulthood. Frederick also states that 77.0% of schizophrenics are in early adulthood. Lanfredis research also states that more than half (76.9%) of schizophrenics are in early adulthood. According to the researcher’s assumption, the early adulthood had a higher risk for schizophrenia compared to the late adulthood. Some of the factors that cause the early adulthood more likely to be schizophrenic are that early adulthood is a transitional period for future attainment, career, marriage, divorce, and ambition failure. These obstacles will affect psychosocial and able to cause the emerging of schizophrenia.

Based on the results of the research, more than half (78.0%) of respondents were males. The results of this research are similar to those of Nikneja and Farman in Iran, which found that more than half (76.9%) of respondents were males. This means that schizophrenia tends to emerge in males. Based on some of the existing journals, researchers found that people with schizophrenia more common in male gender.

This is in line with Stuart’s theory which states that males are genetically more susceptible to psychological stressors. According to Stuart’s theory (2014), there are seven genes that affect the development of schizophrenia. The identical twins (monozygotic) development was influenced by 28% while zygotic were influenced by 1.8-4.1%. Chromosomes that are likely to be associated with schizophrenia are 1,3,5,11 and y which are male chromosomes. This study was associated with catechol-o-methyl transferase (COMT) in dopamine encoding so that it will affect dopamine function on y chromosome. It can be concluded that males have a high risk of having schizophrenia.

Based on the results of research, the most meaningful relationship was the self esteem of the patients which was the dominant factor that related to the perceived stigma by the schizophrenia clients. Previous research has also identified that the family’s emotional attitudes are the most influential factor toward the perceived stigma by the schizophrenia clients  is Self esteem and self efficacy (Samsont, 2014; WT Young).

The results of this research revealed that more than half (52.6%) discrimination, most (57.2%) of family predjudice and labeling, more than half (50.3%) of labeling (59.5%). But the percentage difference between high to low negative attitudes is only 1%the stigmazing  towards schizophrenic clients is influenced by the difficulty of the family in giving the treatment. While in this research the differences in family attitudes toward skrizofrenia clients may be influenced by several factors such as cultural factors, religion, and level of knowledge. These factors allow the family to behave nicely to schizophrenic clients.

The high stigmatizing  towards schizophrenic clients is influenced by the difficulty of the family in giving the treatment effect to patients is the low self esteem to the high perseived stigma.

Stigmazing toward schizophrenic clients. Previous research conducted by Italiy (2014) shows that high emotional attitudes of the families and ill-treatment against schizophrenic clients self esteem low result in the increasing of perceived stigma by the clients, consequently, the clients prefer to hide their illness and refuse to do rehabilitation. This can lead to the occurrence of recurrences. Research that is conducted in China shows that high emotional attitudes of families will bring about low self-confidence, se;f esteem, self efficacy  of the clients, hence they will sense high stigmatization. This will affect the longing to socialize with others and they tend to conceal the disease.

The high stigmazing  of the family to the schizophrenics and the high burden that is felt by families in caring for the schizophrenic is a worldwide problem recently. Based on the results of the research, the high emotional attitudes are caused by the financial burden for the treatment of clients, the psychological burden in facing the clients, and inadequate of family knowledge.

Based on the results of this research, the self esteem showed a soaring percentage. This is due to the inadequate knowledge regarding the schizophrenia clients. How to deal with them when they come home from the mental hospital and also negative views of the families against people with mental disorders who are considered as a freak, a disgrace to the family and incompetent. Families tend to behave negatively about individual reactions. The evaluative response means a form of reaction which is manifested as an self esteem  and is based on the evaluation process in the individual that gives the stimulus in the form of a good-bad or positive-negative values, which then makes the self-esteem of schizophrenia sufferers problematic between low self-esteem or vice versa.

CONCLUSION

Based on the results of this study, the researcher concluded that the higher the patient’s self-esteem, the higher the perception of stigma. The stigma that is felt. and it will worsen the psychosocial condition so that (self esteem). the risk of relapse occurs. therefore do not give stigma to schizophrenia sufferers.

Suggestion

It is hoped that families and society will not give clients stigma such as discrimination, prejudice, or labeling people with mental disorders. so as not to affect the client’s self-esteem

FUNDING ACKNOWLEDGEMENT

Thank you to the Director General of Higher Education (DIKTI) who has funded this research

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