Stigma in psychosis: A thematic synthesis of current qualitative evidence.

Aims: This study aimed to conduct a systematic review of the qualitative literature to understand stigma from a service-user perspective. Method: A thematic synthesis of nine studies examining service-users’ experiences of stigma was conducted. Studies were included if they used a qualitative methodology to examine experiences of stigma as a primary research question with participants who have personal experience of psychosis. Results: Two overarching themes were identified; the stigma system and stigma processes. The stigma system highlighted the multi-layered social system which can cause and maintain stigma. Five sub-circles of the stigma system were detailed including the individual, family, friends, community and society. Stigma processes are the mechanisms which contribute to the development of stigma and to how it can be overcome. Eight sub-themes of stigma processes were included broadly pertaining to acceptance, kindness, communication, education and understanding within all areas of the individuals’ social system. Conclusion: Stigma is embedded in the individual’s social system and involves a number of distinct processes. While individualised interventions may be effective in preventing or alleviating the internalisation of stigma, it is clear that wider systemic or societal interventions are also required.