Self-stigma and decision about medication use among a sample of Nigerian outpatients with schizophrenia.

Objective: Self-stigma is a common barrier to maintenance therapy and recovery in schizophrenia. We investigated the prevalence of the decision not to use medication as prescribed and describe the multidimensional relationship of self-stigma with such a decision in 370 adults with schizophrenia. Method: A multivariate binary logistic regression model was used to examine the relationship between specific aspects of self-stigma (alienation, perceived discrimination, stigma resistance, stereotype endorsement and social withdrawal) and the decision not to take medication, while controlling for other clinical variables. Results: Of the total study participants, 16.5% reported high self-stigma while 39.2% decided not to use their medications. The decision not to use medication was associated with a high self-stigma global score, alienation, perceived discrimination and stigma resistance. Stereotype endorsement and social withdrawal did not demonstrate a relationship with nonuse of medication. Following regression analysis, the decision not to use medication was associated with self-stigma, especially high alienation and perceived discrimination, and other factors including medication side effects, worse psychopathology, not living alone, poor 24-hr medication use recall, and absence of medical comorbidity. Conclusions and Implications for Practice: Medication nonuse and self-stigma are prevalent and interrelated in patients on maintenance therapy for schizophrenia. Obtaining routine information during follow-up appointments about medication use including side effects, the symptom profile, and conducting a focused stigma screening can inform clinical discussions regarding medication use in a shared decision-making process.