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Fox AB, Smith BN, Vogt D. How and when does mental illness stigma impact treatment seeking? Longitudinal examination of relationships between anticipated and internalized stigma, symptom severity, and mental health service use. Psychiatry Res 2018; 268:15-20. [PMID: 29986172 DOI: 10.1016/j.psychres.2018.06.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 04/13/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022]
Abstract
Although mental illness stigma has been identified as an important barrier to mental health treatment, there is little consensus regarding how and when mental illness stigma negatively impacts treatment seeking. The relationship between mental illness stigma and treatment seeking may depend on the particular stigma mechanism under investigation, as well as an individual's symptom severity. In the present study, we examined relationships between anticipated and internalized stigma, depressive symptom severity, and mental health service use using data from a two-wave longitudinal survey study of U.S. post-9/11 veterans. Mediated and moderated relationships were tested using PROCESS. Mediation analyses revealed that higher anticipated stigma led to higher levels of internalized stigma, which was associated with decreased treatment seeking. Moderation analyses revealed that anticipated stigma was only associated with treatment seeking when depressive symptoms were severe. The central role observed for internalized stigma highlights the value of stigma reduction efforts that focus on this stigma mechanism, whereas the finding that only those individuals with more severe symptoms are vulnerable to the negative effects of anticipated stigma underscores the importance of more targeted anti-stigma interventions.
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Affiliation(s)
- Annie B Fox
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA; MGH Institute of Health Professions, 36 First Avenue, Boston, MA 02129, USA.
| | - Brian N Smith
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Yang X, Lau JTF, Wang Z, Ma YL, Lau MCM. The mediation roles of discrepancy stress and self-esteem between masculine role discrepancy and mental health problems. J Affect Disord 2018; 235:513-520. [PMID: 29684866 DOI: 10.1016/j.jad.2018.04.085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 03/26/2018] [Accepted: 04/15/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Masculine role discrepancy and discrepancy stress occur when men perceive that they fail to live up to the ideal manhood derived from societal prescriptions. The present study examined the associations between masculine role discrepancy and two emotional and mental health problems (social anxiety and depressive symptoms), and potential mediation effects through discrepancy stress and self-esteem in a male general population. METHODS Based on random population-based sampling, 2000 male residents in Hong Kong were interviewed. Levels of masculine role discrepancy, discrepancy stress, self-esteem, social anxiety, and depressive symptoms were assessed by using validated scales. RESULTS Results of structural equation modeling analysis indicated that the proposed model fit the sample well. (χ2(118) = 832.34, p < .05, CFI = 0.94, NNFI = 0.91, RMSEA = 0.06). Those who were young, single and less educated were vulnerable to masculine role discrepancy, discrepancy stress, and emotional/mental health problems. We found that discrepancy stress significantly mediated the association between masculine role discrepancy and social anxiety, while self-esteem significantly mediated the associations between masculine role discrepancy and both social anxiety and depression. LIMITATIONS Study limitations mainly included the cross-sectional design and reliance on self-reported questionnaires. CONCLUSIONS The associations between masculine discrepancy and social anxiety/depressive symptoms among men may be explained by the increase in discrepancy stress and decrease in self-esteem. The findings suggest needs and directions for future research for the relationship between masculine role discrepancy and men's mental health, mechanisms involved, and interventions for improvement.
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Affiliation(s)
- Xue Yang
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Joseph T F Lau
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China.
| | - Zixin Wang
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Yee-Ling Ma
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Mason C M Lau
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Yam KKN, Lo WTL, Chiu RLP, Lau BSY, Lau CKS, Wu JKY, Wan SM. A pilot training program for people in recovery of mental illness as vocational peer support workers in Hong Kong - Job Buddies Training Program (JBTP): A preliminary finding. Asian J Psychiatr 2018; 35:132-140. [PMID: 27884479 DOI: 10.1016/j.ajp.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 08/21/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The present study reviews the delivery of a pilot curriculum-mentorship-based peer vocational support workers training in a Hong Kong public psychiatric hospital. The present paper reports (1) on the development of a peer vocational support workers training - Job Buddies Training Program (JBTP) in Hong Kong; and (2) preliminary findings from both quantitative and qualitative perspectives. METHOD The curriculum consists of 15-session coursework, 8-session storytelling workshop and 50-hour practicum to provide Supported Employment Peer Service (SEPS) under the mentorship of occupational therapists. Six trainees were assessed using three psychosocial assessments and qualitative methods. FINDINGS Compared to the baseline, the Job Buddies (JB) trainees showed an increase in awareness of their own recovery progress, occupational competence and problem-solving skills at the end of the training. Their perceived level of self-stigma was also lessened. In post-training evaluation, all Job Buddies trainees said they perceived positive personal growth and discovered their own strengths. They also appreciated the help from their mentors and gained mutual support from other trainees and from exposure with various mini-projects in the training. CONCLUSIONS AND IMPLICATIONS This pilot study provides an example of incorporating peer support and manualized training into existing work rehabilitation service for our JB trainees. Further studies on the effectiveness of service provided by peer support workers and for development on the potential use of peer support workers in other clinical and rehabilitation settings with larger subjects will be fruitful.
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Affiliation(s)
- Kevin Kei Nang Yam
- Supported Employment Service, Occupational Therapy Department, Kwai Chung Hospital, Hong Kong.
| | | | - Rose Lai Ping Chiu
- Supported Employment Service, Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | - Bien Shuk Yin Lau
- Supported Employment Service, Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | - Charles Ka Shing Lau
- Supported Employment Service, Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | - Jen Kei Yu Wu
- Supported Employment Service, Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | - Siu Man Wan
- Supported Employment Service, Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
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Zhou T, Wang Y, Yi C. Affiliate stigma and depression in caregivers of children with Autism Spectrum Disorders in China: Effects of self-esteem, shame and family functioning. Psychiatry Res 2018; 264:260-265. [PMID: 29655969 DOI: 10.1016/j.psychres.2018.03.071] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 11/25/2022]
Abstract
The present study aimed to investigate affiliate stigma and depression in caregivers of children with Autism Spectrum Disorders (ASD) in China and to examine the predictive effects of self-esteem, shame proneness and family functioning. Two hundred and sixty-three primary caregivers of children with autism in Mainland China participated in the survey. The results suggested that affiliate stigma in caregivers of children with autism was prevalent and severe; their depressive symptoms were significantly more severe than the national norm of the similar age group. Low self-esteem, high shame proneness and poor family adaptability were associated with experience of affiliate stigma and heightened depressive symptoms. Affiliate stigma partially mediated the links between self-esteem/ shame proneness/family adaptability and depression levels. This study was the first one to measure affiliate stigma on caregivers of children with ASD in mainland China using a quantitative method. The results highlight the necessity and importance of de-stigmatization for the caregivers of children with autism and suggest that interventions to improve self-esteem, reduce experience of shame and to enhance family functioning might be effective.
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Affiliation(s)
- Ting Zhou
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yiting Wang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University; #5 Yiheyuan Road, Haidian District, Beijing 100871, China
| | - Chunli Yi
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University; #5 Yiheyuan Road, Haidian District, Beijing 100871, China.
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Ho RWH, Chang WC, Kwong VWY, Lau ESK, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prediction of self-stigma in early psychosis: 3-Year follow-up of the randomized-controlled trial on extended early intervention. Schizophr Res 2018; 195:463-468. [PMID: 28888358 DOI: 10.1016/j.schres.2017.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Self-stigma represents a major barrier to recovery in people with psychotic disorders but is understudied in early illness stage. Longitudinal investigation of prediction for self-stigma is scarce and none is conducted in early psychosis. We aimed to prospectively examine baseline predictors of self-stigma in early psychosis patients in the context of a 3-year follow-up of a randomized-controlled trial (RCT) comparing 1-year extension of early intervention (EI) with step-down psychiatric care for first-episode psychosis (FEP). METHOD One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they had completed this 2-year EI service, and underwent a 12-month RCT. Participants were followed up and reassessed 3years after inclusion to the trial. Comprehensive evaluation encompassing clinical, functional, subjective quality of life and treatment-related variables were conducted. Data analysis was based on 136 participants who completed self-stigma assessment at 3-year follow-up. RESULTS Fifty patients (36.8%) had moderate to high levels of self-stigma at 3-year follow-up. Multivariate regression analysis revealed that female gender, prior psychiatric hospitalization, longer duration of untreated psychosis and greater positive symptom severity at study intake independently predicted self-stigma at the end of 3-year study period. CONCLUSION Our results of more than one-third of early psychosis patients experienced significant self-stigma underscore the clinical needs for early identification and intervention of self-stigmatization in the initial years of psychotic illness. Further research is warranted to clarify prediction profile and longitudinal course of self-stigma in the early illness phase.
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Affiliation(s)
- Ryan Wui Hang Ho
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
| | - Vivian Wing Yan Kwong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Emily Sin Kei Lau
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Gloria Hoi Kei Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Olivia Tsz Ting Jim
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
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Carrara BS, Ventura CAA. Self-stigma, mentally ill persons and health services: An integrative review of literature. Arch Psychiatr Nurs 2018; 32:317-324. [PMID: 29579531 DOI: 10.1016/j.apnu.2017.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/26/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
Integrative review about self-stigma among people with mental illness and its relationship with health services. A total of 149 articles were found in four databases. After screening, 9 articles were selected for complete reading and data extraction. The studies identified that higher levels of self-stigma result in lower levels of adherence to treatment and that lower levels of self-stigma result in greater adherence to treatment. Active participation and engagement in the aspects of care facilitate the empowerment of people with mental illness for better adherence to treatment, reduction of self-stigma and increase of recovery possibilities.
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Affiliation(s)
- Bruna Sordi Carrara
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Brazil
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David D, Zoizner G, Werner P. Self-Stigma and Age-Related Hearing Loss: A Qualitative Study of Stigma Formation and Dimensions. Am J Audiol 2018; 27:126-136. [PMID: 29379957 DOI: 10.1044/2017_aja-17-0050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/11/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study explored experiences of self-stigma among older persons with age-related hearing loss (ARHL) using Corrigan's conceptualization of self-stigma process formation and the attribution model as its theoretical framework. METHOD In-depth semistructured interviews were conducted with 11 older persons (mean age = 81 years) with ARHL. RESULTS Self-stigma was present in the lives of the participants. Analysis revealed the existence of 3 stages of self-stigma in which the 3 core dimensions of stigma (cognitive attributions: being old, stupid, and crippled; emotional reactions: shame, pity, and feeling ridiculed; and behavioral reactions: concealment, distancing, and adapting to hearing aids) were observed. Hearing devices emerged as having a significant influence on stigmatic experiences in all stages and dimensions of self-stigma. CONCLUSION The study contributes to the theoretical and practical understanding of self-stigma regarding ARHL as well as to the understanding of the role of hearing devices in the development of this stigma.
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Affiliation(s)
- Dana David
- Department of Community Mental Health, University of Haifa, Israel
| | | | - Perla Werner
- Department of Community Mental Health, University of Haifa, Israel
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Ran MS, Zhang TM, Wong IYL, Yang X, Liu CC, Liu B, Luo W, Kuang WH, Thornicroft G, Chan CLW. Internalized stigma in people with severe mental illness in rural China. Int J Soc Psychiatry 2018; 64:9-16. [PMID: 29183250 DOI: 10.1177/0020764017743999] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is unknown whether there are differences in self-stigma among persons with different types of severe mental illness (SMI) in rural communities. AIM This study was to examine the differences of self-stigma and its correlates in persons with schizophrenia, major depressive disorder or bipolar disorder in a rural community in China. METHODS A total of 453 persons with schizophrenia, major depressive disorder or bipolar disorder in a rural community participated in the study. The Internalized Stigma of Mental Illness (ISMI) was used to measure self-stigma. The t-test and analyses of variance (ANOVA) were used to examine the differences in mean scores of ISMI and subscales among the three diagnoses. Logistic regression was used to explore the contributing factors to the level of self-stigma among the three groups. RESULTS Self-stigma was moderate and severe with 94.7% of the total sample. Persons with schizophrenia had significantly higher mean scores of total ISMI, alienation and discrimination experience than those with bipolar disorders. Lower family income was significantly associated with higher levels of self-stigma in persons with schizophrenia and major depressive disorder. Factors predicting the level of self-stigma among the three groups were various. CONCLUSION Self-stigma is common and severe in persons with schizophrenia, major depressive disorder and bipolar disorder, especially those with lower income status in rural community in China. Persons with schizophrenia may have higher levels of self-stigma than those with bipolar disorder. Individual-level interventions should be developed to reduce self-stigma among persons with SMI in Chinese rural communities.
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Affiliation(s)
- Mao-Sheng Ran
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
| | - Tian-Ming Zhang
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
| | - Irene Yin-Ling Wong
- 2 School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Xin Yang
- 3 Guangyuan Mental Health Center, Guangyuan, China
| | | | - Bo Liu
- 4 Jingzhou Mental Health Center, Jingzhou, China
| | - Wei Luo
- 5 Xinjin Mental Hospital, Chengdu, China
| | - Wei-Hong Kuang
- 6 Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | - Graham Thornicroft
- 7 Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cecilia Lai-Wan Chan
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
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AlAteeq D, AlDaoud A, AlHadi A, AlKhalaf H, Milev R. The experience and impact of stigma in Saudi people with a mood disorder. Ann Gen Psychiatry 2018; 17:51. [PMID: 30498517 PMCID: PMC6258445 DOI: 10.1186/s12991-018-0221-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Stigma plays a powerful role in an individual's attitude towards mental illness and in their seeking psychiatric and psychological services. Assessing stigma from the perspective of people with mood disorders is important as these disorders have been ranked as major causes of disability. OBJECTIVES To determine the extent and impact of stigma experiences in Saudi patients with depression and bipolar disorder, and to examine stigma experiences across cultures. METHOD Ninety-three individuals with a mood disorder were interviewed at King Saud University Medical City using the Inventory of Stigmatizing Experiences (ISE). RESULTS We detected no significant differences in experiences of stigma or stigma impact in patients with bipolar vs. depressive disorder. However, over 50% of respondents reported trying to hide their mental illness from others to avoiding situations that might cause them to feel stigmatized. In comparison with a Canadian population, the Saudi participants in this study scored significantly lower on the ISE, which might be due to cultural differences. CONCLUSION More than half of the Saudi participants with a mood disorder reported avoiding situations that might be potentially stigmatizing. There are higher levels of stigma in Canada and Korea than in Saudi Arabia. Our results suggest that cultural differences and family involvement in patient care can significantly impact self-stigmatization. The ISE is a highly reliable instrument across cultures.
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Affiliation(s)
- Deemah AlAteeq
- 1Department of Psychiatry, College of Medicine, King Saud University, P.O. box 92949, Riyadh, 11683 Saudi Arabia.,2SABIC Psychological Health Research & Applications Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah AlDaoud
- 1Department of Psychiatry, College of Medicine, King Saud University, P.O. box 92949, Riyadh, 11683 Saudi Arabia
| | - Ahmad AlHadi
- 1Department of Psychiatry, College of Medicine, King Saud University, P.O. box 92949, Riyadh, 11683 Saudi Arabia.,2SABIC Psychological Health Research & Applications Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanoof AlKhalaf
- 1Department of Psychiatry, College of Medicine, King Saud University, P.O. box 92949, Riyadh, 11683 Saudi Arabia.,2SABIC Psychological Health Research & Applications Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Roumen Milev
- 3Department of Psychiatry, Queen's University, Kingston, ON Canada
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Bodner E, Palgi Y, Wyman MF. Ageism in Mental Health Assessment and Treatment of Older Adults. INTERNATIONAL PERSPECTIVES ON AGING 2018. [DOI: 10.1007/978-3-319-73820-8_15] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Comparing the mental health literacy of Chinese people in Australia, China, Hong Kong and Taiwan: Implications for mental health promotion. Psychiatry Res 2017. [PMID: 28648988 DOI: 10.1016/j.psychres.2017.06.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Using data of 200, 522, 572, and 287 Chinese from Australia, China, Hong Kong and Taiwan respectively, this study aimed at comparing the mental health literacy of Chinese people from different communities, and between Chinese communities and the Australian general public. The participants were asked questions that assessed their recognition of depression and schizophrenia. Compared with the Australians, much lower percentages of Chinese in the four Chinese communities could correctly identify depression and early schizophrenia. Commonalities in the preference for 'psychiatrist', 'psychologist', 'Chinese medical doctor', and 'Chinese traditional healer', a lack of knowledge of medications, and a higher likelihood of endorsement of traditional Chinese medicines were found among the four Chinese communities. Differences in the preference for 'general practitioner' and 'social worker', and a higher percentage of endorsement of herbal medicines were observed among the different Chinese communities. Cultural factors such as Chinese perceptions of mental illness, and socio-contextual factors such as differences in mental health care system in the four communities were offered to explain these commonalities and differences. Mental health promotion programmes for Chinese people may need to consider the above-mentioned cultural and socio-contextual factors so that specific promotion programmes can be developed.
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Shattock L, Berry K, Degnan A, Edge D. Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: A systematic review. Clin Psychol Psychother 2017; 25:e60-e85. [PMID: 28961352 DOI: 10.1002/cpp.2135] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 01/31/2023]
Abstract
Therapeutic alliance is a key predictor of therapy outcomes. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Databases were searched from inception up to April 2015. The search yielded 4,586 articles, resulting in 26 eligible studies, involving 18 independent samples. Weighted average client and therapist Working Alliance Inventory-Short Form total scores were 64.51 and 61.26, respectively. There was evidence that alliance predicts overall psychotic symptomatic outcomes and preliminary evidence for alliance predicting rehospitalization, medication use, and self-esteem outcomes. There was evidence for specific client-related factors being linked to different perspectives of alliance. For example, poorer insight and previous sexual abuse were associated with worse client-rated alliance, whereas baseline negative symptoms were associated with worse therapist-rated alliance. Therapist and therapy-related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client-rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist-rated alliance. Key clinical implications include the need to consider alliance from both client and therapist perspectives during therapy and training and supervision to enhance therapist qualities that foster good alliance. Future research requires longitudinal studies with larger samples that include pan-theoretical, well-validated alliance measures to determine causal predictor variables.
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Affiliation(s)
- Lucy Shattock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Schönfeld P, Brailovskaia J, Margraf J. Positive and negative mental health across the lifespan: A cross-cultural comparison. Int J Clin Health Psychol 2017; 17:197-206. [PMID: 30487895 PMCID: PMC6220922 DOI: 10.1016/j.ijchp.2017.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022] Open
Abstract
Mental health and well-being are closely related to age. Complete mental health includes psychopathological symptoms (negative mental health) and subjective well-being (positive mental health). The aim was to compare indicators of complete mental health across the lifespan cross-culturally. Method: We tested age trends in measures of resilience, social support and positive and negative mental health, including the subscales depression, anxiety and stress using data from national representative samples from Germany, Russia and the United States (U.S.) ranging in age from 18 to 100 (N = 6,303). Results: The effects of age differed in each country. Today's older Germans experienced more positive and less negative mental health whereas today's older Russians experienced less positive and more negative mental health than the younger people. In the U.S., positive mental health was higher among the older adults, but there was no effect of age for negative mental health. Age also had significant linear and curvilinear effects on resilience and social support. Conclusions: The pattern of mental health across the lifespan is clearly dependent on the nation.
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Affiliation(s)
- Pia Schönfeld
- Mental Health Research & Treatment Center, Ruhr-Universität Bochum, Germany
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Xu Z, Huang F, Kösters M, Rüsch N. Challenging mental health related stigma in China: Systematic review and meta-analysis. II. Interventions among people with mental illness. Psychiatry Res 2017; 255:457-464. [PMID: 28780128 DOI: 10.1016/j.psychres.2017.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 04/07/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022]
Abstract
People with mental illness often face different types of mental illness stigma that may affect their lives, including perceived stigma, self-stigma, harmful coping strategies and poor quality of life. Although anti-stigma interventions for people with mental illness from Western countries have been identified by recent systematic reviews, their efficacy in China is unknown. This review evaluates the efficacy of anti-stigma interventions among people with mental illness in Mainland China, Hong Kong, Taiwan and Macau. A systematic search of 8 electronic databases in English and Chinese yielded 17 randomized and non-randomized controlled trials. Standardized mean differences (SMDs) were calculated wherever possible. Psychoeducation was the most commonly used intervention. SMDs were large and significant for perceived/experienced/anticipated stigma, self-prejudice and coping with stigma, as well as for depression and anxiety symptoms and quality of life. Both Cognitive Behavioral Therapy and psychoeducation had positive effects on perceived/experienced/anticipated stigma. The quality of studies was modest and heterogeneity across studies was high. Anti-stigma interventions demonstrated promise to reduce stigma's negative impact on people with mental illness in China, but more high-quality intervention research is needed.
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Affiliation(s)
- Ziyan Xu
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany.
| | - Fangfang Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Markus Kösters
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany.
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Hing N, Russell AMT. Psychological factors, sociodemographic characteristics, and coping mechanisms associated with the self-stigma of problem gambling. J Behav Addict 2017; 6:416-424. [PMID: 28849669 PMCID: PMC5700730 DOI: 10.1556/2006.6.2017.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 11/21/2022] Open
Abstract
Background and aims Few studies have examined the stigma of problem gambling and little is known about those who internalize this prejudice as damaging self-stigma. This paper aimed to identify psychological factors, sociodemographic characteristics, and coping mechanisms associated with the self-stigma of problem gambling. Methods An online survey was conducted on 177 Australian adults with a current gambling problem to measure self-stigma, self-esteem, social anxiety, self-consciousness, psychological distress, symptom severity, most problematic gambling form, stigma coping mechanisms, and sociodemographic characteristics. Results All variables significantly correlated with self-stigma were considered for inclusion in a regression model. A multivariate linear regression indicated that higher levels of self-stigma were associated with: being female, being older, lower self-esteem, higher problem gambling severity score, and greater use of secrecy (standardized coefficients: 0.16, 0.14, -0.33, 0.23, and 0.15, respectively). Strongest predictors in the model were self-esteem, followed by symptom severity score. Together, predictors in the model accounted for 38.9% of the variance in self-stigma. Discussion and conclusions These results suggest that the self-stigma of problem gambling may be driven by similar mechanisms as the self-stigma of other mental health disorders, and impact similarly on self-esteem and coping. Thus, self-stigma reduction initiatives used for other mental health conditions may be effective for problem gambling. In contrast, however, the self-stigma of problem gambling increased with female gender and older age, which are associated with gaming machine problems. This group should, therefore, be a target population for efforts to reduce or better cope with the self-stigma of problem gambling.
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Affiliation(s)
- Nerilee Hing
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia
| | - Alex M. T. Russell
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, Australia
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Darraj HA, Mahfouz MS, Al Sanosi RM, Badedi M, Sabai A. The Self-Stigma of Depression Scale: Translation and Validation of the Arabic Version. J Neurosci Rural Pract 2017; 8:96-100. [PMID: 28149090 PMCID: PMC5225732 DOI: 10.4103/0976-3147.193552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Self-stigma may feature strongly and be detrimental for people with depression, but the understanding of its nature and prevalence is limited by the lack of psychometrically validated measures. This study is aimed to validate the Arabic version self-stigma of depression scale (SSDS) among adolescents. MATERIALS AND METHODS A cross-sectional study involved 100 adolescents randomly selected. The analyses include face validation, factor analysis, and reliability testing. A test-retest was conducted within a 2-week interval. RESULTS The mean score for self-stigma of depression among study participants was 68.9 (Standard deviation = 8.76) median equal to 71 and range was 47. Descriptive analysis showed that the percentage of those who scored below the mean score (41.7%) is shown less than those who scored above the mean score (58.3%). Preliminary construct validation analysis confirmed that factor analysis was appropriate for the Arabic-translated version of the SSDS. Furthermore, the factor analysis showed similar factor loadings to the original English version. The total internal consistency of the translated version, which was measured by Cronbach's alphas ranged from 0.70 to 0.77 for the four subscales and 0.84 for the total scale. Test-retest reliability was assessed in 65 respondents after 2 weeks. Cronbach's alphas ranged from 0.70 to 0.77 for the four subscales and 0.84 for the total scale. CONCLUSIONS Face validity, construct validity, and reliability analysis were found satisfactory for the Arabic-translated version of the SSDS. The Arabic-translated version of the SSDS was found valid and reliable to be used in future studies, with comparable properties to the original version and to previous studies.
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Affiliation(s)
| | - Mohamed Salih Mahfouz
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Mohammed Badedi
- Public Health Administration, Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia
| | - Abdullah Sabai
- Public Health Administration, Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia
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Nieminen I, Kaunonen M. Professionals' views on mental health service users' education: challenges and support. J Psychiatr Ment Health Nurs 2017; 24:57-68. [PMID: 28090750 DOI: 10.1111/jpm.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Mental health service users (MHSUs) may experience disruptions in their education. However, education has been shown to have a positive influence on their recovery, potentially offering them broader employment opportunities. The literature suggests that providing support for MHSUs in their educational efforts may be beneficial and is wished for by the service users themselves. However, there is a lack of mental health professionals' views on the topic in the setting of a community mental health centre. WHAT DOES THIS PAPER ADD TO THE EXISTING KNOWLEDGE?: In the perception of mental health professionals, the predominance of disease in the life of MHSUs and their marginalization may form barriers to their success in education. Professionals can support MHSUs in their educational efforts by strengthening the MHSUs' internal resources and creating a supportive environment with professional expertise available. A service user-centred education might further help MHSUs to achieve their educational goals. Our findings confirm previous knowledge of a recovery-oriented approach to supporting MHSUs' education. This study explored the topic from the professionals' perspective in the context of community mental health centres, which is a fresh view in the research literature. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest which types of support professionals perceive to be required for MHSUs to advance their studies. Knowledge of adequate forms of support can be applied in the mental health nursing practice to develop support measures for service users to advance in their studies. All levels of the community mental health centres should be aware of and adopt a recovery-oriented approach. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and the more active involvement of MHSUs in the design of their own rehabilitation process. ABSTRACT Introduction Studies show the importance of providing support for mental health service users' (MHSUs') education. However, none of these studies explored this support in the community mental health centre setting. The range of MHSUs' educational activities identified in this study varied from participation in courses at the mental health centres to independent studies at different levels of education outside the centres. Aim (1) How do mental health professionals perceive the challenges that may limit service users' potential when they apply for, and complete, their education? (2) How do the professionals describe the methods of rehabilitation aimed at supporting the service users in achieving their educational goals? Method The data were collected from 14 mental health professionals using focus group interviews. Inductive content analysis was then performed. Results Professionals perceive that the predominance of disease and marginalization may be barriers to MHSUs' success in education. Strengthening the MHSUs' internal resources, creating a supportive environment with professional expertise available and service user-centred education appeared to support the MHSUs' educational achievements. Our findings confirm previous knowledge of a recovery-oriented approach to support MHSUs' education. However, professionals' views on this topic in the context of community mental health centres have not been investigated previously. Discussion Professionals perceive that a recovery-oriented approach to rehabilitation may support MHSUs in their educational efforts. Implications for practice A recovery-oriented approach should be adopted by all levels of the community mental health centres. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and a more active involvement of MHSUs in the design of their own rehabilitation process.
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Affiliation(s)
- I Nieminen
- Doctoral student, Nursing Science, School of Health Sciences, University of Tampere, Finland
| | - M Kaunonen
- Professor, Nursing Science, School of Health Sciences, University of Tampere, General Administration Pirkanmaa Hospital District, Finland
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Picariello F, Moss-Morris R, Macdougall IC, Chilcot AJ. The role of psychological factors in fatigue among end-stage kidney disease patients: a critical review. Clin Kidney J 2016. [PMID: 28638608 PMCID: PMC5469558 DOI: 10.1093/ckj/sfw113] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Fatigue is a common and debilitating symptom, affecting 42-89% of end-stage kidney disease patients, persisting even in pre-dialysis care and stable kidney transplantation, with huge repercussions on functioning, quality of life and patient outcomes. This paper presents a critical review of current evidence for the role of psychological factors in renal fatigue. To date, research has concentrated primarily on the contribution of depression, anxiety and subjective sleep quality to the experience of fatigue. These factors display consistent and strong associations with fatigue, above and beyond the role of demographic and clinical factors. Considerably less research is available on other psychological factors, such as social support, stress, self-efficacy, illness and fatigue-specific beliefs and behaviours, and among transplant recipients and patients in pre-dialysis care. Promising evidence is available on the contribution of illness beliefs and behaviours to the experience of fatigue and there is some indication that these factors may vary according to treatment modality, reflecting the differential burdens and coping necessities associated with each treatment modality. However, the use of generic fatigue scales casts doubt on what specifically is being measured among dialysis patients, illness-related fatigue or post-dialysis-specific fatigue. Therefore, it is important to corroborate the available evidence and further explore, qualitatively and quantitatively, the differences in fatigues and fatigue-specific beliefs and behaviours according to renal replacement therapy, to ensure that any model and subsequent intervention is relevant and grounded in the experiences of patients.
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Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | | | - And Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
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Abstract
Negative attitudes toward people with mental illness are a widespread concern and may vary across countries. This study used a 36-item questionnaire to compare attitudes toward people with mental illness and beliefs about the causes of mental illness among medical students from the United States, Brazil, Ghana, Nigeria, and China (N = 1131). Exploratory factor analysis identified the underlying factor structure of the questionnaire, and analysis of covariance was then used to compare factors representing four nonstigmatized attitudes across students from the five countries. US Medical students scored highest on all four factors, followed by those from Brazil. Nigerian and Ghanaian students scored lowest on nonsupernatural etiology of mental illness, and Chinese students showed the lowest score on personal social acceptance and public policy acceptance of people with mental illness. Differences in medical student attitudes between these five countries suggest underlying sociocultural differences in attitudes with the more stigmatized attitudes in developing countries.
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70
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Karakaş SA, Okanlı A, Yılmaz E. The Effect of Internalized Stigma on the Self Esteem in Patients with Schizophrenia. Arch Psychiatr Nurs 2016; 30:648-652. [PMID: 27888954 DOI: 10.1016/j.apnu.2016.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/01/2015] [Accepted: 02/14/2016] [Indexed: 11/19/2022]
Abstract
AIM This study has been conducted to determine the relationship between internalized stigma and self-esteem in patients with schizophrenia. MATERIALS AND METHODS This study was conducted using 60 patients with schizophrenia who were diagnosed as schizophrenic according to the DSM-IV diagnostic criteria in the psychiatric clinics of hospitals in Erzurum. The data were collected using the "Questionnaire on Internalized Stigma of Mental Illness Scale" (ISMI) that determines the socio-demographic characteristics of patients, and the "Short Form of Self-Esteem Scale" (SF-SES). RESULTS The mean Internalized Stigma of Mental Illness Scale score was high; the mean of the positive dimension of the self-esteem scale score was lower than negative dimension. A negative significant relationship was found (r=-.758, p<0.01) between the ISMI and SF-SES when we examined the relationship between the mean scores of self-esteem and internalized stigma levels of the patients. There is a significantly positive relationship between the mean scores of the stigma resistance and SERS-SF (r=.339, p<0.01). CONCLUSION The findings show that the patients' self-esteem decreases with the increasing levels of internalized stigma. In particular, the high level of accepting stereotyped judgments and the low stigma resistance can be associated with low self-esteem. Based on these results, increasing psychoeducation and counseling services for patients with schizophrenia, and increasing the public awareness of this issue are recommended. Advanced quantitative studies should be conducted to determine the factors related to fighting stigma.
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Affiliation(s)
- Sibel Asi Karakaş
- Department of Psychiatric Nursing, Faculty of Health Sciences, Ataturk University, Erzurum, Turkey
| | - Ayşe Okanlı
- Department of Psychiatric Nursing, Faculty of Health Sciences, Ataturk University, Erzurum, Turkey
| | - Emine Yılmaz
- Department of Psychiatric Nursing, Faculty of Health Sciences, Bıngol University, Turkey.
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71
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Wood L, Byrne R, Varese F, Morrison AP. Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis. Schizophr Res 2016; 176:291-303. [PMID: 27256518 DOI: 10.1016/j.schres.2016.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/15/2016] [Accepted: 05/02/2016] [Indexed: 11/26/2022]
Abstract
It is acknowledged that people with a schizophrenia-spectrum diagnosis experience higher levels of stigma compared to any other mental health diagnosis. As a consequence, their experience of internalised stigma is likely to be the most detrimental and pervasive. Internalised stigma interventions have shown some benefits in those who experience serious mental illness including those with a schizophrenia-spectrum diagnosis. A systematic narrative review and meta-analysis were conducted examining the efficacy of internalised stigma interventions for people with a schizophrenia-spectrum diagnosis. Randomised Controlled Trials, controlled trials, and cohort studies were included and assessed against quality criteria. The search identified 12 studies; 7 randomised controlled trials, 3 cohort studies and 2 controlled trials. A variety of psychosocial interventions were utilised with the majority employing Cognitive Behaviour Therapy (CBT), psychoeducation and social skills training. The core outcomes used to examine the efficacy of the intervention were internalised stigma, self-esteem, empowerment, and functioning. The meta-analysis revealed an improvement in internalised stigma favouring the internalised stigma intervention but was not significant (5 RCTs, n=200). Self-efficacy and insight were significantly improved favouring the internalised stigma intervention. Internalised stigma interventions show promise in those with schizophrenia-spectrum diagnoses. Existing interventions have demonstrated small effects and employed small samples. Large scale RCTs are required to further develop the evidence base of more targeted interventions.
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Affiliation(s)
- Lisa Wood
- North East London Foundation Trust, Goodmayes Hospital, Barley Lane, Ilford IG3 8XJ, United Kingdom; University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom.
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Rico House, Prestwich, Manchester M25 9WL, United Kingdom
| | - Filippo Varese
- University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom
| | - Anthony P Morrison
- University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Rico House, Prestwich, Manchester M25 9WL, United Kingdom
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Wong-Anuchit C, Mills AC, Schneider JK, Rujkorakarn D, Kerdpongbunchote C, Panyayong B. Internalized Stigma of Mental Illness Scale - Thai Version: Translation and Assessment of Psychometric Properties Among Psychiatric Outpatients in Central Thailand. Arch Psychiatr Nurs 2016; 30:450-6. [PMID: 27455917 DOI: 10.1016/j.apnu.2016.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 01/05/2016] [Accepted: 01/17/2016] [Indexed: 12/26/2022]
Abstract
This paper reports the translation of the English Internalized Stigma of Mental Illness scale into Thai and assessment of its psychometric properties. After forward- and backward-translation, Thai experts completed the content validity index with item agreements of .86 to 1.00. Data were collected from 390 psychiatric clinic patients in central Thailand using systematic random sampling. Unweighted least squares factor analysis with Promax rotation identified five subscales. Cronbach's alpha for scale reliability was .88, and correlations for construct validity ranged from r=.55 to .69. These findings support the validity and reliability of the Thai version of the scale.
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73
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Abiri S, Oakley LD, Hitchcock ME, Hall A. Stigma Related Avoidance in People Living with Severe Mental Illness (SMI): Findings of an Integrative Review. Community Ment Health J 2016; 52:251-61. [PMID: 26668008 DOI: 10.1007/s10597-015-9957-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/06/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this integrative review is to synthesize primary evidence of the impact of internalized stigma on avoidance in adult community treatment patients living with SMI. A keyword database search of articles published through 2015 yielded 21 papers and a total of 4256 patients. Our analyses found that stigmatizing beliefs associated with avoidance are related to significant loss of self-esteem. Factors generally thought to reduce stigma internalized as self-stigmatizing beliefs, such as improved insight, increased self-awareness, and psycho-education to improve stigma coping skills, do not appear to improve self-esteem.
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Affiliation(s)
- Sadat Abiri
- MPH Program, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA.,Psychiatric Mental Health Nurse Practitioner Program, University of Wisconsin Madison School of Nursing, 4171 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA.,Fordem Connections Community Support Programs, Journey Mental Health Center, West Washington Avenue, Madison, WI, USA
| | - Linda Denise Oakley
- Psychiatric Mental Health Nurse Practitioner Program, University of Wisconsin Madison School of Nursing, 4171 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA.
| | - Mary E Hitchcock
- Department of Health Sciences Library, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Amanda Hall
- Fordem Connections Community Support Programs, Journey Mental Health Center, West Washington Avenue, Madison, WI, USA
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Dikec G, Kutlu Y. Effectiveness of Adherence Therapy for People With Schizophrenia in Turkey: A Controlled Study. Arch Psychiatr Nurs 2016; 30:249-56. [PMID: 26992879 DOI: 10.1016/j.apnu.2015.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 11/02/2015] [Accepted: 11/13/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study used a quasi-experimental design with a pretest-posttest control group and follow-up to determine the efficacy of adherence therapy in patients with schizophrenia in Turkey. METHODS The sample of this study consisted of patients with schizophrenia (n=30). The Questionnaire Form, Medication Adherence Rating Scale, Internalized Stigma of Mental Illness Scale, and Beck Cognitive Insight Scale were used. The patients were assigned to experimental (n=15) and control (n=15) groups using the randomization method. The experimental group received adherence therapy in eight sessions. RESULTS When the scores of the patients in the experimental and control groups were compared at the pretest, posttest, and 3- and 6-months follow ups, a significant difference was only found in the Medication Adherence Rating Scale posttest scores. CONCLUSION Adherence therapy is effective in improving adherence to treatment but is not effective with regard to insight and internalized stigma in patients with schizophrenia.
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Affiliation(s)
- Gul Dikec
- Izmir University, School of Health, Nursing Department, Izmir, Turkey.
| | - Yasemin Kutlu
- Istanbul University, Florence Nightingale Nursing Faculty, Mental Health and Psychiatric Nursing Department, İstanbul, Turkey.
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75
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Effects of nurse-led child- and parent-focused violence intervention on mentally ill adult patients and victimized parents: A randomized controlled trial. Int J Nurs Stud 2016; 60:79-90. [PMID: 27297370 DOI: 10.1016/j.ijnurstu.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 02/29/2016] [Accepted: 03/04/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Child-to-parent violence is an often hidden serious problem for parental caregivers of mentally ill adult children who experience violence toward them. To date, the comprehensive dyadic parent-adult child intervention to manage child-to-parent violence is scarce. OBJECTIVE To evaluate the effect of Child- and Parent-focused Violence Program, an adjunctive intervention involved with both violent adult children with mental illness and their victimized biological parent (parent-adult child dyads) on violence management. DESIGN Open-label randomized controlled trial. SETTING A psychiatric ward in a teaching hospital and two mental hospitals in Southern Taiwan. PARTICIPANTS Sixty-nine patients aged ≥20 years, with thought or mood disorders, having violent behavior in the past 6 months toward their biological parent of either gender were recruited. The violent patients' victimized biological parents who had a major and ongoing role in provision of care to these patients, living together with and being assaulted by their violent children were also recruited. The parent-adult child dyads were selected. METHODS The intervention was carried out from 2011 to 2013. The parent-adult child dyads were randomly assigned to either the experimental group (36 dyads), which received Child- and Parent-focused Violence Intervention Program, or to the control group (33 dyads), which received only routine psychiatric care. The intervention included two individualized sessions for each patient and parent, separately, and 2 conjoint sessions for each parental-child dyad for a total of 6 sessions. Each session lasted for at least 60-min. Data collection was conducted at 3 different time frames: pre-treatment, post-treatment, and treatment follow-up (one month after the completion of the intervention). RESULTS Occurrence of violence prior to intervention was comparable between two groups: 88.9% (n=32) parents in the experimental group versus 93.9% (n=31) in the control group experienced verbal attack, and 50% (n=18) versus 48.5% (n=16) received body attack and were injured. The intervention significantly reduced violence, improved impulsivity, changed patients' and parents' violence attributions, and fostering active coping processes in the experimental group as compared to the control group (p<0.05). No significant reductions were found in verbal aggression, cognitive and social reactions in the parent's reactions to assault, attentional subscale of impulsivity and wishful thinking (p>0.05). CONCLUSIONS Child- and Parent-focused Violence Intervention Program is effective on child-to-parent violence management in parent-adult child dyads. Thus, the intervention can be helpful for patients who have just been diagnosed with mental illness and had an episode of violence toward their parents within a narrow time frame.
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76
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Young DKW, Ng PYN. The prevalence and predictors of self-stigma of individuals with mental health illness in two Chinese cities. Int J Soc Psychiatry 2016; 62:176-85. [PMID: 26582785 DOI: 10.1177/0020764015614596] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although self-stigma is found to have adverse effects on the lives of persons with mental illness, little is known on the self-stigma of these individuals in Chinese societies. OBJECTIVE This research study explores the prevalence rate and predicting factors of self-stigma of consumers in two Chinese cities, Hong Kong and Guangzhou. METHODS A cross-sectional research design is adopted which involves a random sample of 266 consumers from Hong Kong and a convenient sample of 208 consumers from Guangzhou. These individuals have been assessed in terms of their self-stigma, recovery, self-esteem and quality of life by using standardized assessment scales. RESULTS In all, 38.3% of the Hong Kong participants and 49.5% of the Guangzhou participants report to have self-stigma. Also, self-stigma is found to be negatively related to self-esteem and quality of life. A logistic regression analysis shows that hope and well-being are predicting factors of self-stigma. CONCLUSION Self-stigma is found to be higher in Guangzhou, probably due to the influence of traditional cultural values. Also, as hope and well-being are found to be predicting factors of self-stigma, suitable recovery-orientated interventions that facilitate hope and well-being should be developed so as to reduce self-stigma of consumers in Chinese societies.
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Affiliation(s)
- Daniel Kim-Wan Young
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Petrus Yat-Nam Ng
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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77
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Ndetei DM, Mutiso V, Maraj A, Anderson KK, Musyimi C, McKenzie K. Stigmatizing attitudes toward mental illness among primary school children in Kenya. Soc Psychiatry Psychiatr Epidemiol 2016; 51:73-80. [PMID: 26154242 DOI: 10.1007/s00127-015-1090-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 06/29/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Literature describing stigmatizing attitudes towards people with mental illness by children in the developing world is lacking. Children's mental health issues in the Kenyan context are especially pertinent due to the increased likelihood of exposure to risk factors and the high prevalence of mental disorders. The objective of the current study was to examine socio-demographic factors associated with the endorsement of stigmatizing attitudes towards people with mental illness among Kenyan school children. METHODS We analyzed cross-sectional survey data from 4585 primary school-aged children in standards one through seven in the Eastern Province of Kenya. We examined relationships between the endorsement of stigmatizing attitudes and age, gender, district, religion, being in the standard appropriate for one's age, and parental employment status. RESULTS Stigma scores decreased with increasing age (β = -0.83; 95 % CI = -0.99 to -0.67). Boys had higher stigma scores compared to girls (β = 1.55; 95 % CI = 0.86-2.24). Students from the rural district had higher average stigma scores as compared to those from the peri-urban district (β = 1.14; 95 % CI = 0.44-1.84). Students who were not in the standard appropriate for their age had lower stigma scores than those who were in the standard typical for their age (β = -1.60; 95 % CI = -2.43 to -0.77). CONCLUSIONS Stigmatizing attitudes toward the mentally ill exist among primary school children in Kenya; thus, anti-stigma interventions are needed, and our findings highlight particular subgroups that could be targeted.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Anika Maraj
- Medical Director & Director of Health Equity, Centre for Addiction and Mental Health, 80 Workman Way, 6th Floor, Rm. 6302, Toronto, ON, M6J 1H4, Canada.
| | - Kelly K Anderson
- Medical Director & Director of Health Equity, Centre for Addiction and Mental Health, 80 Workman Way, 6th Floor, Rm. 6302, Toronto, ON, M6J 1H4, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | | | - Kwame McKenzie
- Medical Director & Director of Health Equity, Centre for Addiction and Mental Health, 80 Workman Way, 6th Floor, Rm. 6302, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Schönfeld P, Brailovskaia J, Bieda A, Zhang XC, Margraf J. The effects of daily stress on positive and negative mental health: Mediation through self-efficacy. Int J Clin Health Psychol 2016; 16:1-10. [PMID: 30487845 PMCID: PMC6225043 DOI: 10.1016/j.ijchp.2015.08.005] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/24/2015] [Indexed: 11/29/2022] Open
Abstract
Daily stressors, compared to traumatic events, are increasingly recognized as important risk factors for mental health. The role of general self-efficacy on the relationship between daily stress and aspects of mental health has not yet been examined. Taking into account the dual factor model of mental health, which postulates that mental health is more than the absence of psychopathological symptoms, we tested mediation effects of self-efficacy separately for positive and negative mental health. Total, direct and indirect effects were estimated using data from a large nationally representative German population sample (N = 1,031) by bootstrapped mediation analyses providing 95% bias corrected bootstrap confidence intervals. Results indicated self-efficacy as a mediator of the effects of daily stressors on mental health, with superior effect sizes for positive compared to negative mental health. Mediation effects were replicated in student samples from Germany (N = 394), Russia (N = 604) and China (N = 8,669). Findings suggest that self-efficacy operates as a buffer of daily stress. However, a full mediation model was not supported as multiple psychological resources can have protective effects. This study provides the first transnational evidence for different stress-buffer effects for the two dimensions of mental health.
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Can G, Tanrıverdi D. Social functioning and internalized stigma in individuals diagnosed with substance use disorder. Arch Psychiatr Nurs 2015; 29:441-6. [PMID: 26577560 DOI: 10.1016/j.apnu.2015.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/09/2015] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
Abstract
The aim of this descriptive study was to determine social functioning and internalized stigma in individuals with substance use disorder. The study sample consisted of 105 patients diagnosed with substance use disorder according to the DSM-IV-TR diagnostic criteria. A Descriptive Information Form, Internalized Stigma of Mental Illness Scale (ISMI) and Social Functioning Scale (SFS) were used for data collection. Average total SFS score of the patients was 103.25±25.09 points, indicating an intermediate level of social functioning. Average total ISMI score of patients was 2.92±0.48 points, reflecting a high level of internalized stigma. A negative significant association was observed between the internalized stigma levels and social functioning of patients. These results suggest that rehabilitation of substance users should include counseling services in order to reduce internal perception of stigma and improve their social functioning.
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Affiliation(s)
- Ganime Can
- University of Atatürk, Faculty of Health Science, Department of Psychiatric Nursing, Erzurum, Turkey.
| | - Derya Tanrıverdi
- Gaziantep University, Faculty of Health Science, Department of Psychiatric Nursing, Gaziantep, Turkey.
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80
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Denenny D, Bentley E, Schiffman J. Validation of a brief implicit association test of stigma: schizophrenia and dangerousness. J Ment Health 2015; 23:246-50. [PMID: 25222367 DOI: 10.3109/09638237.2014.951482] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Background: Public perception of the link between schizophrenia and violence is exaggerated, and interventions are emerging that attempt to educate the public about the actual relationship between violence and schizophrenia. The effectiveness of programs targeting this dangerousness stereotype is unknown, however, as existing instruments do not capture a complete, unbiased picture of stigma. AIMS To report on the properties of the Brief Implicit Association Test-Schizophrenia Danger (BIAT-SD), which we developed to capture the implicit perception that people with schizophrenia are dangerous. METHODS We used a multi-trait, multi-method protocol to validate the BIAT-SD based on convergent and discriminant data from undergraduates (n = 97) at baseline and 4-weeks. RESULTS Preliminary evidence was found for construct validity, internal consistency, and 30-min retest stability. CONCLUSIONS Potential benefits and implications of the measure to improving the accuracy of stigma measurement are discussed.
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Affiliation(s)
- Danielle Denenny
- Department of Psychology, University of Maryland , Baltimore County, MD , USA
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81
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Yılmaz E, Okanlı A. The Effect of Internalized Stigma on the Adherence to Treatment in Patients With Schizophrenia. Arch Psychiatr Nurs 2015; 29:297-301. [PMID: 26397432 DOI: 10.1016/j.apnu.2015.05.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 05/02/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
This study was conducted to determine the effect of internalized stigma on the adherence to the treatment of patients with schizophrenia. The population of the study consisted of patients who were diagnosed with schizophrenia according to the DSM IV diagnostic criteria and compatible with the study criteria. The study was completed with 63 patients overall. The researcher used Demographics Questionnaire, Morisky Medication Adherence Scale, Drug Attitude Inventory and Internalized Stigma of Mental Illness Scale to gather data. Among the patients, 11.1% adhered to the treatment, and 54.0% did not. The mean score for the internalized stigma level of patients was 76.39±14.30. A positive significant relationship was found among the scales (p<0.05). The level of internalized stigma of patients with schizophrenia was determined to be high, and the internalized stigma had a negative impact on the adherence and attitude toward the treatment.
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Affiliation(s)
- Emine Yılmaz
- Department of Psychiatric Nursing, Faculty of Health Sciences, Ataturk University, 25100, Erzurum, Turkey
| | - Ayşe Okanlı
- Department of Psychiatric Nursing, Faculty of Health Sciences, Ataturk University, 25100, Erzurum, Turkey.
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83
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Ho AHY, Potash JS, Fong TCT, Ho VFL, Chen EYH, Lau RHW, Au Yeung FSW, Ho RTH. Psychometric properties of a Chinese version of the Stigma Scale: examining the complex experience of stigma and its relationship with self-esteem and depression among people living with mental illness in Hong Kong. Compr Psychiatry 2015; 56:198-205. [PMID: 25284279 DOI: 10.1016/j.comppsych.2014.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stigma of mental illness is a global public health concern, but there lacks a standardized and cross-culturally validated instrument for assessing the complex experience of stigma among people living with mental illness (PLMI) in the Chinese context. AIM This study examines the psychometric properties of a Chinese version of the Stigma Scale (CSS), and explores the relationships between stigma, self-esteem and depression. METHODS A cross-sectional survey was conducted with a community sample of 114 Chinese PLMI in Hong Kong. Participants completed the CSS, the Chinese Self-Stigma of Mental Illness Scale, the Chinese Rosenberg Self-Esteem Scale, and the Chinese Patient Health Questionnaire-9. An exploratory factor analysis was conducted to identify the underlying factors of the CSS; concurrent validity assessment was performed via correlation analysis. RESULTS The original 28-item three-factor structure of the Stigma Scale was found to be a poor fit to the data, whereas a revised 14-item three-factor model provided a good fit with all 14 items loaded significantly onto the original factors: discrimination, disclosure and positive aspects of mental illness. The revised model also displayed moderate to good internal consistency and good construct validity. Further findings revealed that the total stigma scale score and all three of its subscale scores correlated negatively with self-esteem; but only total stigma, discrimination and disclosure correlated positively with depression. CONCLUSION The CSS is a short and user-friendly self-administrated questionnaire that proves valuable for understanding the multifaceted stigma experiences among PLMI as well as their impact on psychiatric recovery and community integration in Chinese communities.
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Affiliation(s)
- Andy H Y Ho
- Division of Psychology, School of Humanities and Social Sciences, Nanyang Technological University, Singapore; Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Jordan S Potash
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Art Therapy Program, The George WA University, Washington, DC, USA
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China
| | - Vania F L Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Robert H W Lau
- Lok Hong Intergrated Community Centre for Mental Wellness, Tung Wah Group of Hospital, Hong Kong, China
| | - Friendly S W Au Yeung
- The Providence Garden for Rehab, Hong Kong Sheng Kung Hui Welfare Council, Hong Kong, China
| | - Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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84
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Li D. Should self-stigma reduction program be regarded as the first and foremost psychosocial intervention for people with schizophrenia? Int J Soc Psychiatry 2014; 60:720-1. [PMID: 25336197 DOI: 10.1177/0020764014540897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Da Li
- Wuxi Mental Health Center, Wuxi Tongren International Rehabilitation Hospital, Nanjing Medical University, Nanjing, China
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85
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Abstract
PURPOSE This study aimed to clarify the phenomenon and definition of self-stigma in schizophrenia. CONCLUSION Self-stigma in schizophrenia affects patients' well-being and attitudes to treatment. Although stigma and self-stigma have interactive and different characteristics, theses definitions are not clearly distinguished. Mental illnesses may have different stereotypes but are treated equally in some studies. Lack of awareness of illness is a common feature in schizophrenia but has not been focused in self-stigma studies. PRACTICE IMPLICATION Further studies are needed to clarify the phenomenon of self-stigma in people with schizophrenia and to develop interventions targeted at reducing self-stigma.
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Affiliation(s)
- Yoshimi Omori
- University of Tsukuba, Tsukuba, Ibaraki, Japan; University of Southern Indiana, Evansville, Indiana, USA
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86
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Abstract
BACKGROUND Up to 75% of patients suffering from schizophrenia do not take their antipsychotic medication in the way it is prescribed. Nonadherence has been shown to be associated with poorer therapy outcomes, higher hospitalization rates, and increased costs for health care systems. One important contributing factor to negative attitudes toward medication adherence may be self-stigmatization. METHODS 23 inpatients with a schizophrenia spectrum disorder, all receiving antipsychotic treatment, were assessed for attitude toward medication adherence (using the Rating of Medication Influences [ROMI] scale), subjective well-being under medication (using the Subjective Well-Being under Neuroleptics Scale), and self-stigmatization (using the Internalized Stigma of Mental Illness Inventory). Multiple linear regression analyses were used to predict attitude toward medication adherence from demographic and clinical data and level of self-stigmatization. RESULTS Patients' gender and their level of self-stigmatization explained 29% of the variance in total attitude toward medication. Inclusion of the self-stigmatization subscore for alienation resulted in an increase of explained variance to 36%. Follow-up analyses of the ROMI pro-adherence subscale scores revealed no correlations with any assessed variables. In contrast, 70% of the variance in the ROMI nonadherence subscale scores was explained by greater alienation, higher number of experienced side effects, less subjective well-being under medication, and female gender. CONCLUSIONS Our findings imply that reducing the extent of self-stigmatization, especially the feeling of being alienated from society, could improve a negative attitude toward medication adherence in psychosis patients. Cognitive-behavioral therapy offers a variety of therapeutic strategies that could support patients in developing a more positive self-image and in more readily accepting antipsychotic medication as a tool for reaching personal life goals.
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87
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Mosanya TJ, Adelufosi AO, Adebowale OT, Ogunwale A, Adebayo OK. Self-stigma, quality of life and schizophrenia: An outpatient clinic survey in Nigeria. Int J Soc Psychiatry 2014; 60:377-86. [PMID: 23828766 DOI: 10.1177/0020764013491738] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stigma is a major obstacle to the treatment and recovery of people with mental illness. In Nigeria, there is a dearth of information on internalization of stigma and its effect on treatment outcome measures such as quality of life. AIM AND OBJECTIVES The aim of the study was to assess self-stigma among patients with schizophrenia attending a psychiatric hospital outpatient clinic, and the relationship of self-stigma to the socio-demographic, clinical characteristics and quality of life of the patients. METHOD Two hundred and fifty-six consecutive outpatient attendees of the Neuropsychiatric Hospital, Aro, Abeokuta in Nigeria with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of schizophrenia were recruited for the study. The diagnosis of schizophrenia was established with the Structured Clinical Interview Schedule for DSM-IV Axis I disorder (SCID), while item 17 of the Present State Examination was used to ascertain the presence of insight into the illness. The subjects were interviewed with a socio-demographic questionnaire, the Internalized Stigma of Mental Illness (ISMI) scale, the Brief Psychiatric Rating Scale (BPRS) and the World Health Organization's Quality of Life (WHOQOL-Bref) questionnaire. RESULTS The mean age of the subjects was 39.5 (SD = 10.6) years with males constituting 52.0% of the sample. High self-stigma was found in 18.8% of the subjects. The socio-demographic and clinical correlates of high self-stigma found using univariate analysis were low educational level (χ(2) = 22.69, p < .001), unemployment (χ(2) = 15.9, p < .001), low income (χ(2) = 25.03, p < .001), source of income (χ(2) = 12.52, p = .007) and severity of psychopathology (t = 8.245, p < .001). High self-stigma was associated with poor quality of life in all the domains of WHOQOL-Bref. CONCLUSION This study revealed that self-stigma was common among subjects with schizophrenia. It is associated with poor treatment outcome, highlighting the need to incorporate stigma intervention strategies into mental health care delivery.
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Affiliation(s)
- Temilola J Mosanya
- Department of Psychiatry, Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria
| | - Adegoke O Adelufosi
- Department of Psychiatry, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
| | | | | | - Olaide K Adebayo
- Department of Psychiatry, Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria
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88
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Ren Z, Wang H, Feng B, Gu C, Ma Y, Chen H, Li B, Liu L. A cross-sectional study on perception of stigma by Chinese schizophrenia patients. Neuropsychiatr Dis Treat 2014; 10:535-40. [PMID: 24707179 PMCID: PMC3971935 DOI: 10.2147/ndt.s54115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE In this cross-sectional study, we sought to assess the extent of internalized stigma among inpatients and outpatients with schizophrenia in the People's Republic of China and to investigate whether education level correlated with the experience of stigma. METHODS Schizophrenia patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions-Severity of Illness (CGI-S) scale and the Stigma Scale for Mental Illness (SSMI-C). Patients were categorized into high education and low education groups, according to their educational levels. RESULTS One hundred thirty-three subjects were included in the study. Their mean course of illness was 4.32±6.14 years (range: 1 month to 15 years). Their mean BPRS score was 19.87±5.46, their mean PANSS score was 44.11±13.1, and their mean CGI-S score was 2.22±0.81. In addition, their mean SSMI-C score was 6.49±0.9. The mean SSMI-C score of patients who have received high school education or above was 7.15±0.98, which was markedly higher than that of patients who have received middle school education or below, which was 5.75±0.79 (P<0.05). Before the study most patients (92.5%, 123/133) took atypical drugs. CONCLUSION Education level impacts on the perception of stigma by schizophrenia patients, and more psychoeducation should be undertaken to improve patients' knowledge about schizophrenia.
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Affiliation(s)
- Zhibin Ren
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Heqiu Wang
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Bin Feng
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Chenyu Gu
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Yongchun Ma
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Hong Chen
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Bingling Li
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Lanying Liu
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Oshodi YO, Abdulmalik J, Ola B, James BO, Bonetto C, Cristofalo D, Van Bortel T, Sartorius N, Thornicroft G. Pattern of experienced and anticipated discrimination among people with depression in Nigeria: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:259-66. [PMID: 23851703 DOI: 10.1007/s00127-013-0737-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Stigma is commonly encountered by individuals with mental illness and leads to discrimination. These phenomena restrict access to and use of mental health care services. This study evaluated the impact of stigma and discrimination among individuals with major depression in Nigeria. METHODS A cross-sectional study was conducted across four tertiary psychiatric facilities located in different regions of Nigeria. Consenting adults attending the psychiatric units in the participating sites with a diagnosis of a major depressive disorder and having an episode within the past 12 months were recruited. Interviews were conducted using a socio-demographic questionnaire, the Discrimination and Stigma Scale, the Internalized Stigma of Mental Illness Scale, the Boston University Self Empowerment Scale, and the Rosenberg Self Esteem Scale. RESULTS One hundred and three interviews were completed. The mean age of the participants was 35.5 years. The most frequent item for experienced discrimination was being unfairly treated in dating or intimate relationships (13.6%), while concealment of mental illness was the most common for anticipated discrimination (51.5%). Younger people (age less than 40 years) with a higher level of education appear to be at high risk for experienced discrimination. CONCLUSIONS Important suggestions may be derived for clinicians, caregivers, and policy makers to appreciate the role of stigma in the burden, treatment, and rehabilitation of individuals with depression, especially for younger people with higher level of education.
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Affiliation(s)
- Yewande O Oshodi
- Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
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90
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Çuhadar D, Çam MO. Effectiveness of psychoeducation in reducing internalized stigmatization in patients with bipolar disorder. Arch Psychiatr Nurs 2014; 28:62-6. [PMID: 24506989 DOI: 10.1016/j.apnu.2013.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 10/11/2013] [Accepted: 10/15/2013] [Indexed: 12/15/2022]
Abstract
This research was conducted as an experiment-control experimental study which aimed to determine the effectiveness of a psychoeducation program prepared to reduce internalized stigmatization. The study included 47 patients (24 experimental, 23 control) who had been diagnosed with bipolar disorder. At the end of the psychoeducation program, a significant decrease was observed in the total ISSMI mean scores, as well as in the ISSMI subscale mean scores for subscales such as alienation, approval of stereotypes, perceived discrimination and social withdrawal (p<0.05). The results demonstrated that a psychoeducation program designed for internalized stigmatization may have positive effects on the internalized stigmatization levels of patients with bipolar disorder.
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Affiliation(s)
- Döndü Çuhadar
- Gaziantep University, Health Science Faculty, Şahinbey, Gaziantep, Turkey.
| | - M Olcay Çam
- Ege University, Nursing Faculty, Psychiatric Nursing Department, Bornova, Izmir Turkey.
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91
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Silverman MJ. Effects of music therapy on self- and experienced stigma in patients on an acute care psychiatric unit: a randomized three group effectiveness study. Arch Psychiatr Nurs 2013; 27:223-30. [PMID: 24070990 DOI: 10.1016/j.apnu.2013.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/04/2013] [Accepted: 06/12/2013] [Indexed: 11/24/2022]
Abstract
Stigma is a major social barrier that can restrict access to and willingness to seek psychiatric care. Psychiatric consumers may use secrecy and withdrawal in an attempt to cope with stigma. The purpose of this study was to determine the effects of music therapy on self- and experienced stigma in acute care psychiatric inpatients using a randomized design with wait-list control. Participants (N=83) were randomly assigned by cluster to one of three single-session group-based conditions: music therapy, education, or wait-list control. Participants in the music therapy and education conditions completed only posttests while participants in the wait-list control condition completed only pretests. The music therapy condition was a group songwriting intervention wherein participants composed lyrics for "the stigma blues." Results indicated significant differences in measures of discrimination (experienced stigma), disclosure (self-stigma), and total stigma between participants in the music therapy condition and participants in the wait-list control condition. From the results of this randomized controlled investigation, music therapy may be an engaging and effective psychosocial technique to treat stigma. Limitations, suggestions for future research, and implications for clinical practice and psychiatric music therapy research are provided.
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92
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Stein-Shvachman I, Karpas DS, Werner P. Depression Treatment Non-adherence and its Psychosocial Predictors: Differences between Young and Older Adults? Aging Dis 2013; 4:329-36. [PMID: 24307966 DOI: 10.14336/ad.2013.0400329] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 11/01/2022] Open
Abstract
Depression is a common disease among young and older adults. Although it can be treated, non-adherence is very common among individuals of different ages. The aim of the present paper is to review and summarize research findings regarding depression among young and older adults, with a special focus on the phenomenon of treatment non-adherence among young and older adults with depression. The first section of the review focuses on describing the characteristics of depression in young and older adults. The second section focuses on treatment non-adherence of young and older adults, the prevalence of this phenomenon, and its consequences. The third section focuses on several factors (illness beliefs, treatment beliefs, self-stigma, and self-esteem) that were identified as having a significant association with treatment non-adherence of individuals with depression, with special attention focused on age differences. Results of the review of the literature reveal that research in the area of depression treatment non-adherence and its predictors among young and older adults has received, to date, very minor and limited attention. Thus, there is a need to expand the current body of knowledge and promote future interventions geared towards the unique characteristics of depression among young and older adults, in order to increase their treatment adherence.
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Affiliation(s)
- Ifat Stein-Shvachman
- Department of Gerontology, University of Haifa, IsraelMt. Carmel, Haifa 31905, Israel
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93
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Abstract
Recent mental illness stigma research has almost exclusively studied community and family responses to the stigmas of mental illness. Too little has been done to understand the current subjective experience of psychiatric patients. Our study explores the influence of self-stigma on the quality of life of mentally disabled people. Participating in the survey were 100 people diagnosed with schizophrenia. Using Ritsher's internalized stigma of mental illness scale, which incorporates alienation, stereotype endorsement, discrimination experience, social withdrawal, and social resistance subscales, along with the standard SF-12, helped us evaluate the subjective experience of mental illness stigma. According to our survey data, self-stigma correlates negatively with all of the quality of life measures except the Internalized Stigma of Mental Illness subscale's 'stigma resistance', which did not correlate significantly. Improved stigma resistance requires an understanding of one's sociocultural background and a strong social network to provide the sense of comfort and security that enables a fulfilling life.
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Affiliation(s)
- I-Chen Tang
- School of Medical Sociology and Social Work, Chung Shan Medical University, 110, Sec. 1, Jianguo N. Road, Taichung, 402, Taiwan.
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94
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Self-stigma of mental illness scale--short form: reliability and validity. Psychiatry Res 2012; 199:65-9. [PMID: 22578819 PMCID: PMC3439592 DOI: 10.1016/j.psychres.2012.04.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/26/2012] [Accepted: 04/12/2012] [Indexed: 01/20/2023]
Abstract
The internalization of public stigma by persons with serious mental illnesses may lead to self-stigma, which harms self-esteem, self-efficacy, and empowerment. Previous research has evaluated a hierarchical model that distinguishes among stereotype awareness, agreement, application to self, and harm to self with the 40-item Self-Stigma of Mental Illness Scale (SSMIS). This study addressed SSMIS critiques (too long, contains offensive items that discourages test completion) by strategically omitting half of the original scale's items. Here we report reliability and validity of the 20-item short form (SSMIS-SF) based on data from three previous studies. Retained items were rated less offensive by a sample of consumers. Results indicated adequate internal consistencies for each subscale. Repeated measures ANOVAs showed subscale means progressively diminished from awareness to harm. In support of its validity, the harm subscale was found to be inversely and significantly related to self-esteem, self-efficacy, empowerment, and hope. After controlling for level of depression, these relationships remained significant with the exception of the relation between empowerment and harm SSMIS-SF subscale. Future research with the SSMIS-SF should evaluate its sensitivity to change and its stability through test-rest reliability.
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95
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Wong DFK, Xuesong H, Poon A, Lam AYK. Depression literacy among Chinese in Shanghai, China: a comparison with Chinese-speaking Australians in Melbourne and Chinese in Hong Kong. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1235-42. [PMID: 21901401 DOI: 10.1007/s00127-011-0430-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 08/23/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study reported in this paper was aimed at developing understanding of depression-related knowledge and preferences surrounding professional help, medication, and treatment methods among Chinese living in Shanghai, China. METHODS A multi-stage cluster sampling method in which participants were taken from 6 of the 20 districts in Shanghai was adopted for this study. The 522 Shanghai Chinese participants were presented with a vignette describing an individual with depression before being asked questions designed to assess both their understanding of depression and their preferences surrounding professional help, medication, and treatment methods. A comparative approach was adopted to identify similarities and differences between our findings and those of two previous studies on the mental health literacy of Chinese living in Melbourne, Australia, and Hong Kong, respectively. RESULTS A similarly low percentage of Chinese people in each of Shanghai, Hong Kong, and Australia recognized depression. Fewer Shanghai Chinese than Chinese living in Hong Kong and Australia ascribed the 'anxiety/stress' label to the depression vignette and endorsed professionals and informal network members as helpful. Although a far lower percentage of Shanghai Chinese endorsed the use of counseling professionals, a much higher percentage of the same group endorsed Chinese medical doctors and herbal medication. A lower percentage of Shanghai Chinese endorsed 'lifestyle changes' as a strategy for combating depression than did Chinese subjects living in Australia and Hong Kong. On the other hand, a higher percentage of Shanghai residents endorsed psychiatric treatment and the traditional Chinese practices of 'eating nutritious food/taking supplements' and 'qigong' than among the other two groups of Chinese. CONCLUSIONS This study underlines the need for campaigns aimed at improving the mental health literacy of Chinese in Shanghai. Such campaigns must take into consideration the socially and culturally driven beliefs to facilitate the development of specific education programs.
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Affiliation(s)
- Daniel Fu Keung Wong
- Department of Applied Social Studies, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Hong Kong.
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96
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van Brakel WH, Sihombing B, Djarir H, Beise K, Kusumawardhani L, Yulihane R, Kurniasari I, Kasim M, Kesumaningsih KI, Wilder-Smith A. Disability in people affected by leprosy: the role of impairment, activity, social participation, stigma and discrimination. Glob Health Action 2012; 5:GHA-5-18394. [PMID: 22826694 PMCID: PMC3402069 DOI: 10.3402/gha.v5i0.18394] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/19/2012] [Accepted: 06/19/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy-related disability is a challenge to public health, and social and rehabilitation services in endemic countries. Disability is more than a mere physical dysfunction, and includes activity limitations, stigma, discrimination, and social participation restrictions. We assessed the extent of disability and its determinants among persons with leprosy-related disabilities after release from multi drug treatment. METHODS We conducted a survey on disability among persons affected by leprosy in Indonesia, using a Rapid Disability Appraisal toolkit based on the International Classification of Functioning, Disability and Health. The toolkit included the Screening of Activity Limitation and Safety Awareness (SALSA) scale, Participation Scale, Jacoby Stigma Scale (anticipated stigma), Explanatory Model Interview Catalogue (EMIC) stigma scale and Discrimination assessment. Community members were interviewed using a community version of the stigma scale. Multivariate linear regression was done to identify factors associated with social participation. RESULTS Overall 1,358 persons with leprosy-related disability (PLD) and 931 community members were included. Seventy-seven percent of PLD had physical impairments. Impairment status deteriorated significantly after release from treatment (from 59% to 77%). Around 60% of people reported activity limitations and participation restrictions and 36% anticipated stigma. As for participation restrictions and stigma, shame, problems related to marriage and difficulties in employment were the most frequently reported problems. Major determinants of participation were severity of impairment and level of education, activity and stigma. Reported severity of community stigma correlated with severity of participation restrictions in the same districts. DISCUSSION The majority of respondents reported problems in all components of disability. The reported physical impairment after release from treatment justifies ongoing monitoring to facilitate early prevention. Stigma was a major determinant of social participation, and therefore disability. Stigma reduction activities and socio-economic rehabilitation are urgently needed in addition to strategies to reduce the development of further physical impairment after release from treatment.
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Affiliation(s)
- Wim H. van Brakel
- Royal Tropical Institute (KIT), Amsterdam, Netherlands
- Athena Institute, VU University Amsterdam, Amsterdam, Netherlands
| | - Benyamin Sihombing
- Sub Directorate for Leprosy and Yaws, MOH, Jakarta, Indonesia
- Department of Medicine, National University of Singapore, Singapore
| | - Hernani Djarir
- Sub Directorate for Leprosy and Yaws, MOH, Jakarta, Indonesia
| | - Kerstin Beise
- Sub Directorate for Leprosy and Yaws, MOH, Jakarta, Indonesia
| | | | - Rita Yulihane
- Sub Directorate for Leprosy and Yaws, MOH, Jakarta, Indonesia
| | | | | | | | - Annelies Wilder-Smith
- Department of Medicine, National University of Singapore, Singapore
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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97
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Wong DFK, Lam AYK, Poon A, Chow AYM. Gender differences in mental health literacy among Chinese-speaking Australians in Melbourne, Australia. Int J Soc Psychiatry 2012; 58:178-85. [PMID: 21307086 DOI: 10.1177/0020764010390431] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study attempted to understand gender differences in knowledge of mental illness, preference for professional help, and medications and treatment methods among Australians of Chinese-speaking background. METHODS This study adopted a cluster convenience sampling method in which subjects were taken from the four major areas in cosmopolitan Melbourne where most Chinese people are living. A total of 200 Chinese-speaking Australians participated in the study. They were presented with two vignettes describing an individual with acute depression or acute schizophrenia and then questions were asked to assess their understanding of the conditions, preference for professional help, medications and treatment methods. RESULTS More female than male respondents could correctly identify the conditions in the two vignettes. Female participants also perceived medications to be relatively more harmful than their male counterparts. In contrast, there were significantly more males than females who adhered to traditional views on the causation of mental illness; had significantly higher percentages of endorsement of 'deal with it alone'; believed 'traditional Chinese medical doctor' and 'Chinese herbal medicines' to be helpful to the person in the schizophrenia vignette; and significantly endorsed 'psychiatric ward', 'electro-convulsive treatment', 'changing fungshui' and 'traditional Chinese worship' to be helpful for the persons in both vignettes. A combination of factors, which included age, duration of migration and traditional Chinese cultural values, were put forward to explain the above differences. CONCLUSIONS Campaigns to improve the mental health literacy of Chinese-speaking Australians must take into account the gender differences between male and female Chinese-speaking Australians so that culturally relevant and gender-specific education programmes can be developed.
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98
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Liang Y, Gong YH, Wen XP, Guan CP, Li MC, Yin P, Wang ZQ. Social determinants of health and depression: a preliminary investigation from rural China. PLoS One 2012; 7:e30553. [PMID: 22276213 PMCID: PMC3261904 DOI: 10.1371/journal.pone.0030553] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 12/19/2011] [Indexed: 01/12/2023] Open
Abstract
Background In the last several years, research related to social determinants of health (SDH) has begun to resonate in the medical, behavioral, social and political sciences arena. The aim of the present study was to explore the relationship between SDH and depression, and to provide new evidences and clues for depression control and prevention. Methodology/Principal Findings This research was a cross-sectional survey executed door to door from October 2006 to April 2008, with a sample of 3,738 individuals aged 18 and older in rural China. The three variables of SDH were socioeconomic status (years of schooling and self-reported economic status of family), social cohesion and negative life events. Demographic variables and self-perceived physical health were taken as potential confounders. The cross-table analysis showed that variations in levels of depression were associated with variations in SDH, and logistic regression analysis confirmed the association even after adjusting for potential confounding variables. Conclusions Although there were some limitations, the current study provides initial evidence of the importance of SDH in depression. Findings indicate that social inequity and the role of policy action emphasized by SDH should be considered high priorities when addressing the issue of depression. In addition, cell-to-society and pill-to-policy approaches should be encouraged in the future.
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Affiliation(s)
- Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Hong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Piao Wen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao-Ping Guan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming-Chuan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
| | - Zhi-Qing Wang
- Department of Clinical Epidemiology, the Suicide Research and Training Center of World Health Organization & Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
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99
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Stylianos S, Kehyayan V. Advocacy: critical component in a comprehensive mental health system. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2012; 82:115-20. [PMID: 22239401 DOI: 10.1111/j.1939-0025.2011.01143.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although rights protection and best interest perspectives are frequently viewed as diametric opposites, mental health advocacy is an important strategy in pursuit of both civil rights and therapeutic goals for people with mental illness. Independent, client-centered advocacy supports the attainment of consumer-identified goals for recovery, equality, and social inclusion and mitigates the negative consequences of stigma and discrimination. Advocacy strives to return decision-making authority to consumers and thus to empower them to play a more central role in their own care, treatment, rehabilitation, and life choices.
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Affiliation(s)
- Stanley Stylianos
- Psychiatric Patient Advocate Office Ministry of Health and Long-Term Care, 55 St. Clair Avenue W., Toronto, Ontario, Canada.
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100
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Fung KMT, Tsang HWH, Cheung WM. Randomized controlled trial of the self-stigma reduction program among individuals with schizophrenia. Psychiatry Res 2011; 189:208-14. [PMID: 21377738 DOI: 10.1016/j.psychres.2011.02.013] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 02/15/2011] [Accepted: 02/15/2011] [Indexed: 02/05/2023]
Abstract
Research evidence suggests that individuals with schizophrenia are prone to self-stigmatization, which reduces their psychosocial treatment adherence. A self-stigma reduction program was developed based on a theoretical framework proposed by our team. The effectiveness of such program to reduce self-stigma, enhance readiness for change, and promote adherent behaviors among individuals with schizophrenia was investigated. This program consisted of 12 group and four individual follow-up sessions. An integrative approach including psychoeductaion, cognitive behavioral therapy, motivational interviewing, social skills training, and goal attainment program was adopted. Sixty-six self-stigmatized individuals with schizophrenia were recruited. They were randomly allocated to the self-stigma reduction program (N=34; experimental protocol) or the newspaper reading group (N=32; comparison protocol). Measures on participants' level of self-stigma, readiness for change, insight, general self-efficacy, and treatment adherence were taken for six assessment intervals. The findings suggested that the self-stigma reduction program has potential to reduce self-esteem decrement, promote readiness for changing own problematic behaviors, and enhance psychosocial treatment adherence among the self-stigmatized individuals with schizophrenia during the active interventional stage. However, there was a lack of therapeutic maintenance effects during the 6-month follow-up period. Recommendations for further improving the effectiveness of self-stigma reduction program are suggested.
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Affiliation(s)
- Kelvin M T Fung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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