Effect of a Psychoeducation Intervention on Affiliate Stigma among Family Caregivers of Individuals with Mental Disorders in Western Ethiopia: A Pre-test Post-test Study

Abstract Background: Mental disorders are a major Public health concern globally, with profound consequences not only for individuals but also for their family care givers, particularly in low- and middle income countries (LMIC). One often-overlooked consequence is affiliate stigma, the internalization of public stigma by caregivers, which can negatively affect their psychological well-being and caregiving effectiveness. Objective: This study aimed to assess the effect of a structured psychoeducation intervention on reducing affiliate stigma among family caregivers of individuals with mental disorders in Western Ethiopia. Methods: A quasi-experiential, pre-post controlled study was conducted between March 2021 and February 2022. The intervention group (n = 277) received a six-session psychoeducation program and routine care at Mettu Karl Comprehensive Specialized Hospital, while the comparison group (n = 279) received routine care only at Nekemte Comprehensive Specialized Hospital. The Affiliate Stigma Scale was administered at baseline and post-intervention. Linear mixed-effects models and Difference-in-Differences (DID) analyses were employed to assess the intervention's effect, while adjusting for relevant covariates. Results: The intervention group showed a significant reduction in affiliate stigma scores from the baseline to post-intervention (mean difference = –7.71, 95% CI: –12.56 to –6.80), while the change in the comparison group was not statistically significant (mean difference = –1.85, 95% CI: –4.48 to 0.78). The DID analysis confirms a significant net reduction in affiliate stigma attributable to the intervention (DID = –5.68 ± 1.96, 95% CI: –9.49 to –2.23). The net intervention effect corresponded to a moderate-to-large reduction (d = −0.63), underscoring the substantial practical significance of the psychoeducation. The adjusted model (Model 3) further supported the intervention's effect (β = –8.84, 95% CI: –10.71 to –6.96, p < 0.001). Conclusion: Psychoeducation significantly reduced affiliate stigma among family caregivers of individuals with mental disorders. Incorporating structured psychoeducation into routine mental health services may enhance caregiver resilience and improve overall care outcomes.