Relationship between stigma, self-esteem, and quality of life in euthymic patients of bipolar disorder: A cross-sectional study

Background: As per the existing literature (mostly Western), bipolar affective disorder or bipolar disorder (BD) is associated with low self-esteem, high stigma, and poor quality of life (QOL). Aims: The current study aimed to assess stigma, self-esteem, and QOL and to examine their interrelationships in euthymic patients of BD in the Indian settings. Settings and Design: This hospital-based, cross-sectional study was conducted in a tertiary care hospital in Delhi over a period of 12 months. Subjects and Methods: Sixty-two adults with BD (as per the International Classification of Diseases-10 criteria) in remission were selected. Stigma, self-esteem, and QOL were assessed using the Internalized Stigma of Mental Illness (ISMI) scale, Rosenberg Self-esteem Rating Scale, and World Health Organization (WHO) QOL-BREF, respectively. Statistical Analysis Used: Data were analyzed using Student's t-test, Pearson's correlation coefficients, and multiple regression model. Results: Thirty-two percent of patients did not experience stigma (ISMI total score < 2.00). Mean total ISMI score for patients was 2.33 (mild stigma). Compared to controls, patients were found to have lower self-esteem (mean: 12.63) and lower scores on WHOQOL-BREF. Self-esteem scores were associated with all domains of WHOQOL-BREF, whereas ISMI total scores were not. Further, self-esteem was not found to be associated with stigma scores. Conclusions: Patients of BD in remission have low self-esteem, experience mild stigma, and have a low QOL. Lower self-esteem was strongly related to lower QOL, whereas stigma was not. Measures to improve self-esteem may benefit patients of BD in the long run.