Internalized stigma in working adults with bipolar disorder : an analysis of contributing risk factors
F. E. Boujmil, G. Bahri, Y. Yaich, G. Amri, Y. Tebourbi, S. Chemingui, M. Mersni, D. Brahim, M. Bani, R. Ghachem, N. LadhariIntroduction
Bipolar disorder (BD) is a chronic psychiatric condition characterized by recurrent mood relapses. It represents the 6 th leading cause of disability according to the World Health Organization. During the clinical course, patients with BD may experience internalized stigma (IS). Within a working population, it may contribute in frequent absences and professional exclusion. Its prevalence remains under-assessed despite the availability of validated instruments for its measurement.
Objectives
To assess the overall IS among working adults with BD using a validated questionnaire and to identify its main associated risk factors.
Methods
This cross-sectional study was conducted over a one-year period (2024-2025) among consenting BD patients who were referred for a fitness-for-work evaluation at Charles Nicole Hospital in Tunisia. Socio-demographic, medical and professional data were collected using a self-administered questionnaire. Self-stigma was assessed using the Internalized Stigma of Mental Illness (ISMI) scale, a validated instrument comprising 29 items and five dimensions rated on a four-point Likert scale. A total score ≥ 2.5 was fixed to indicate clinically significant IS.
Results
A total of 106 patients were enrolled. The mean age was 43.8 ± 10.3 years with a gender ratio of 0.53 (F/H). Fifty six percent (n=59) were married and had at least one child. The majority had an average socio-economic status (72.6%). Among the patients, 41.5% (n=44) were active smokers and 12.3% (n=13) misused alcohol. The most common occupational categories were nurses (18.9%) and laborers (14.2%). The average length of service was 17.41 ± 8.7 years. Only 9.4% of patients (n=10) had a history of redundancy. Amid the patients, 33.9% (n=36) had atypical working hours. A history of long-term sick leave for psychiatric reasons was present in 88.7% of cases (n=94). Sixty-eight patients were being treated for type 2 BD (64.2%) with an average age of onset of 29.7 ± 4.9 years. The mean number of mood episodes was 6.5 ± 3.5. The average length of hospitalization was 6.4 ± 14 days. The majority of patients (n=93, 86.9%) were receiving anticonvulsants and atypical antipsychotics. The mean total ISMI was 2,58 ± 0,87. More than half of our patients (56,6%) were self-stigmatized. Social withdrawal and alienation were found in 78,3% and 55,7% of cases, followed by assimilation of stereotypes (43,4%), discrimination (39,6%) and resistance to stigma (32,1%). Univariate analysis has revealed statistically significant associations between higher self-stigma scores and gender (p = 0,038), single or divorced status (p = 0,012), low socio-economic level (p = 0,002) and atypical working hours (p <0,001).
Conclusions
Preventive strategies including workplace accommodations and psychoeducation are essential to reduce stigma and support functional outcomes.
Disclosure of Interest
None Declared