Social stigma is an underestimated contributing factor to unemployment in people with mental illness or mental health issues: position paper and future directions

Social Isolation and Psychosis: Perspectives from People with Psychosis, Family Caregivers and Mental Health Professionals

This paper explores the subjective experiences of mental health practitioners, people with psychosis and carers, on social isolation and community integration of people with psychosis. Focus groups and one-to-one interviews with 80 adult participants across three sites in the UK were conducted. Audio recordings were transcribed and analysed using thematic analysis. Participants commented on various aspects that may cause social isolation or enable community integration, including institutional factors (lack of resources, hospitalisation impact), illness symptoms (e.g., paranoia; over-pathologising vs individual choice), stigma (particularly the psychosis label), and the importance of communities that foster agency and embrace change. Hospitalisation maybe be a cause for isolation and psychiatric wards should consider allowing for socialisation as a therapeutic tool. Initiatives should consider the social fabric of our communities, socioeconomic inequalities and stigmatisation. Building communities that are accepting, kind and flexible can create opportunities that could lead to independence from mental health services.

The Influence of Stigma Perceptions on Employees' Claims Experiences for Psychological Injuries: Re-Examination of a Cross-Sectional Survey among Australian Police and Emergency Service Personnel

While a large body of research assessed the contribution of mental health stigma on disclosure, treatment seeking, and recovery, limited research exists seeking to identify the relative contribution of stigma beliefs on workers' compensation claims for psychological injury. Survey data of ambulance, fire and rescue, police, and state emergency service personnel (N = 1855, aged 45-54 years, 66.4% male) was re-examined to assesses the unique and combined associations of self-, personal, and workplace stigma with workers' compensation claims experiences and recovery. Participants responded to self-report stigma items (predictor variables), perceived stress, fairness, and support perceptions of going through the claims process and its impact on recovery (outcome variables). Multiple regression analyses revealed that the combined stigma dimensions predicted about one fifth of the variance of claims and recovery perceptions. Organisational commitment beliefs and the self-stigma dimension of experiences with others were the two most important, albeit weak, unique predictors across outcomes. Given the small but consistent influences of organisational commitment beliefs and the self-stigma dimension of experiences with others, it seems warranted to apply workplace interventions that are looking to establish positive workplace contact and a supportive organisational culture to alleviate negative effects attributable to mental health stigma.

Mental health and quality of life in patients with craniofacial movement disorders: A cross-sectional study

Background

Facial appearance and expressions influence social interaction. Hemifacial spasm (HFS), blepharospasm (BPS), and blepharospasm-oromandibular dystonia (BOD) are common forms of craniofacial movement disorders. Few studies have focused on the mental burden and quality of life (QoL) in patients with craniofacial movement disorders. Therefore, this study investigated mental health and QoL in these patients.

Methods

This cross-sectional study included 90 patients with craniofacial movement disorders (HFS, BPS, and BOD; 30 patients per group) and 30 healthy individuals without craniofacial movement disorders (control group) recruited from October 2019 to November 2020. All participants underwent QoL and mental health evaluations for depression, anxiety, and stigma using the 36-item Short Form Health Survey (SF-36), Hamilton Anxiety Rating Scale (HAMA), Hamilton Rating Scale for Depression-24 (HAMD-24) and a questionnaire related to stigma.

Results

Depression was diagnosed in 37 (41.11%) patients, whereas 30 patients (33.33%) had anxiety. HAMA scores were significantly higher in the BPS and BOD groups than in the control group. Nineteen patients (21.11%) experienced stigma and SF-36 scores were lower in various dimensions in the movement disorders groups compared to healthy controls. The role-physical and social function scores were significantly lower in the movement disorders groups than in the control group all p < 0.05. The vitality scores of the BPS group and mental health scores of the BPS and BOD groups were significantly lower than those of the control group. Correlation analysis showed that the eight dimensions of SF-36 correlated with education level, disease duration, HAMD score, and HAMA score (all p < 0.05). Regression analysis demonstrated that the HAMD score correlated with general health, vitality, social function, role-emotional, and mental health (all p < 0.05). The HAMA score correlated with body pain after adjusting for education level and disease duration.

Conclusion

This study highlights the significant frequency of mental symptoms, including depression, anxiety, and stigma, which lower QoL in patients with craniofacial movement disorders.

PROTOCOL: Group-based community interventions to support the social reintegration of marginalised adults with mental illness

This is the protocol for a Campbell systematic review. The main objective is to explore the general efficacy of group-based community interventions aimed at supporting marginalised adults with mental illness and related problems on outcomes such as problem behaviour, subjective well-being, homelessness, poverty and employment. Furthermore, the objective is to explore the potential advantages/disadvantages of using a group-based versus an individual intervention when targeting specific problems or when using specific types of interventions.

In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review

PURPOSE

Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities.

METHODS

Using a multiphase screening process, this review is based on a comprehensive literature search (2000-2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar.

RESULTS

7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found.

CONCLUSION

Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.

Perspectives of Nursing Students towards Schizophrenia Stigma: A Qualitative Study Protocol

Aim: This study aims to explore fourth-year nursing students’ knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia. Design: This will be a descriptive qualitative study using focus-group interviews. Methods: Fourth-year nursing students on clinical placement in a hospital in Hunan province will be invited for focus-group interviews. Snowball and purposive sampling will be used to recruit nursing students for this study. Five focus-group interviews, each including six participants, will be conducted to explore participants’ knowledge, attitudes, intentional behaviours, and empathy towards schizophrenia. The interview will be conducted through the online Tencent video conference platform and the interview data will be collected through the same platform. All interviews will be recorded and transcribed verbatim and analysed with the approach of the content analysis supported by NVivo 12. Simultaneous data collection and analysis will be performed, and the interviews will be continued until data saturation is met. The findings of this study will be helpful in developing effective interventions to decrease the stigma toward schizophrenia among nursing students and those who study healthcare disciplines.

Rasch Modeling and Differential Item Functioning of the Self-Stigma Scale-Short Version among People with Three Different Psychiatric Disorders

Self-stigma is prevalent in individuals with psychiatric disorders and can profoundly affect people. A unified assessment with sound psychometric properties is needed for evaluating self-stigma across psychiatric conditions. The aim of this study was to examine the psychometric properties of the Self-Stigma Scale-Short version (SSS-S) using Rasch modeling. Six-hundred and twelve participants with substance use disorders (n = 319), attention-deficit/hyperactivity disorder (n = 100), and schizophrenia (n = 193) completed the SSS-S. Rasch results confirmed the unidimensionality of the nine items of the SSS-S. The four-point Likert scale of the SSS-S reflected monotonical increases along the self-stigma continuum. No ceiling or floor effects were detected. Among the three subdomains of the SSS-S, cognitive items appeared to be the most robustly endorsed, and behavioral items were the least endorsed. Two items in the SSS-S displayed differential item functioning across the three diagnoses. Additionally, SSS-S scores showed weak to moderate correlation with depression, anxiety, and stress scale scores. The SSS-S had overall satisfactory psychometric properties. Healthcare professionals may use this assessment to assess self-stigma in multiple psychiatric groups, and information gained may facilitate improved care.

The Stigma and Self-Stigma Scales for attitudes to mental health problems: Psychometric properties and its relationship to mental health problems and absenteeism

The Stigma and Self-Stigma scales (SASS) measure multiple aspects of stigmatic beliefs about mental health problems, including cognitive aspects of stigma towards others (Stigma to Others) and emotional stigma toward others (Social Distance), anticipated stigma by others, self-stigma, avoidant coping strategies, and help-seeking intentions, alongside an index of social desirability. The properties of the SASS were investigated by employees of a large UK government organization. With minor exceptions, each of the SASS scales had strong psychometric properties, good internal reliability, and test-retest reliability. Social Distance, Anticipated Stigma, Self-Stigma, and Avoidant Coping were all strongly associated with a lack of help-seeking for mental health problems. Similarly, Stigma to Others, Self-Stigma, and Avoidant Coping were all associated with current mental health problems. Finally, absenteeism from the workplace was found to be negatively related to Stigma to Others, and positively related to Avoidant Coping and Anticipated Stigma. In conclusion, the SASS was able to measure several different forms of stigma about mental health simultaneously in people both with and without a history of mental health problems. The SASS can be used to monitor changes in mental health attitudes outcomes following intervention programs to investigate stigmatic attitudes to mental health problems across different samples.

The Stigma and Self-Stigma Scales for attitudes to mental health problems: Psychometric properties and its relationship to mental health problems and absenteeism

The Stigma and Self-Stigma scales (SASS) measure multiple aspects of stigmatic beliefs about mental health problems, including cognitive aspects of stigma towards others (Stigma to Others) and emotional stigma toward others (Social Distance), anticipated stigma by others, self-stigma, avoidant coping strategies, and help-seeking intentions, alongside an index of social desirability. The properties of the SASS were investigated by employees of a large UK government organization. With minor exceptions, each of the SASS scales had strong psychometric properties, good internal reliability, and test-retest reliability. Social Distance, Anticipated Stigma, Self-Stigma, and Avoidant Coping were all strongly associated with a lack of help-seeking for mental health problems. Similarly, Stigma to Others, Self-Stigma, and Avoidant Coping were all associated with current mental health problems. Finally, absenteeism from the workplace was found to be negatively related to Stigma to Others, and positively related to Avoidant Coping and Anticipated Stigma. In conclusion, the SASS was able to measure several different forms of stigma about mental health simultaneously in people both with and without a history of mental health problems. The SASS can be used to monitor changes in mental health attitudes outcomes following intervention programs to investigate stigmatic attitudes to mental health problems across different samples.

Ethical aspects of the coordination of return-to-work among employees on sick leave due to common mental disorders: a qualitative study

PURPOSE

Identify ethical issues that arise in the coordination of return-to-work (RTW) among employees on sick leave due to common mental disorders (CMDs).

MATERIAL AND METHODS

41 semi-structured individual interviews and one focus group interview with stakeholders (n = 46) involved in RTW: employees on sick leave due to CMDs, coordinators and physicians at primary health care centres, managers, representatives of the Swedish social insurance agency and occupational health services. A six-step thematic analysis focused on the ethical values and norms related to autonomy, privacy, resources and organization, and professional values.

RESULTS

Five themes were identified: (1) autonomous decision-making versus the risk of taking over, (2) employee rights versus restrictions to self-determination, (3) respect for employee privacy versus stakeholders' interests, (4) risk of unequal inclusion due to insufficient organizational structure and resources, (5) risk of unequal support due to unclear professional roles and responsibilities.

CONCLUSION

The main ethical issues are the risks of unequal access to and unequal support for the coordination of RTW. For the fair and equal provision of coordination, it is necessary to be transparent on how to prioritize the coordination of RTW for different patient groups, provide clarity about the coordinator's professional role, and facilitate ongoing boundary work between stakeholders. IMPLICATIONS FOR REHABILITATIONUnfair and arbitrary criteria for inclusion to the coordination of RTW implicate risks of unequal access for the employee on sick leave due to CMDs.Unclear professional roles and responsibilities among stakeholders in the coordination of RTW implicate risks of unequal support for the employee on sick leave due to CMDs.Coordination of RTW should be transparently prioritized on policy and organisational levels to secure fair and equal inclusion.The coordinator's professional role should be clearly defined to facilitate boundary work between stakeholders and improve the competence around the coordination of RTW.

Commercial Use of Emotion Artificial Intelligence (AI): Implications for Psychiatry

PURPOSE OF REVIEW

Emotion artificial intelligence (AI) is technology for emotion detection and recognition. Emotion AI is expanding rapidly in commercial and government settings outside of medicine, and will increasingly become a routine part of daily life. The goal of this narrative review is to increase awareness both of the widespread use of emotion AI, and of the concerns with commercial use of emotion AI in relation to people with mental illness.

RECENT FINDINGS

This paper discusses emotion AI fundamentals, a general overview of commercial emotion AI outside of medicine, and examples of the use of emotion AI in employee hiring and workplace monitoring. The successful re-integration of patients with mental illness into society must recognize the increasing commercial use of emotion AI. There are concerns that commercial use of emotion AI will increase stigma and discrimination, and have negative consequences in daily life for people with mental illness. Commercial emotion AI algorithm predictions about mental illness should not be treated as medical fact.

Seeking treatment for mental illness and substance abuse: A cross-sectional study on attitudes, beliefs, and needs of military personnel with and without mental illness

BACKGROUND

Often, military personnel do not seek treatment for mental illness or wait until they reach a crisis point. Effective, selective, and indicated prevention is best achieved by seeking treatment early.

AIMS

We aimed to examine military personnel's attitudes, beliefs, and needs around seeking treatment for mental illness. We compared those who sought treatment to those who did not and those with and without the intention to seek treatment. Finally, we examined factors associated with intentions of not seeking treatment.

METHOD

We conducted a cross-sectional questionnaire study of military personnel with (N = 324) and without (N = 554) mental illness. Descriptive and regression analyses (logistic and ordinal) were performed.

RESULTS

The majority of the personnel believed treatment was effective (91.6%); however, most preferred to solve their own problems (66.0%). For personnel with mental illness, compared to those who sought treatment, those who did not had a higher preference for self-management and found advice from others less important. For those without mental illness, those with no intention to seek treatment indicated a higher preference for self-management, stigma-related concerns, denial of symptoms, lower belief in treatment effectiveness and found it less important to be an example, compared to those with treatment-seeking intentions. A clear indication of where to seek help was the most reported need (95.7%). Regression analyses indicated that not seeking treatment was most strongly related to preference for self-management (OR(95%CI) = 4.36(2.02-9.39); no intention to seek treatment was most strongly related to a lower belief that treatment is effective (OR(95%CI) = .41(0.28-0.59) and with not having had positive earlier experiences with treatment seeking (OR(95%CI) = .34(0.22-0.52).

CONCLUSIONS

To facilitate (early) treatment seeking, interventions should align with a high preference for self-management, mental illness stigma should be targeted, and a clear indication of where to seek treatment is needed.

A Conceptual Framework to Design Connected Mental Health Solutions in the United Arab Emirates: Questionnaire Study

Background

Connected mental health (CMH) is a field presenting information and communications technology–based mental care interventions that could help overcome many mental care delivery barriers. Culture and background influence people’s attitudes, preferences, and acceptance of such solutions. Therefore, the suitability of CMH solutions to the targeted population is an important factor in their successful adoption.

Objective

The aim of this study is to develop a framework for the design and creation of CMH solutions suitable for the UAE context. The framework is based on investigating enablers and barriers of CMH adoption in the United Arab Emirates, from the mental health professional's (MHP) perspective and from related literature.

Methods

A survey of literature on relevant studies addressing the use of technology for mental care in Arab countries, and a web-based questionnaire-based survey with 17 MHPs practicing in the United Arab Emirates investigating their attitudes and views toward CMH was conducted. Results from the questionnaire and from related studies were analyzed to develop the design framework.

Results

On the basis of findings from the literature survey and analyzing MHP answers to the web-based survey, a framework for the design of CMH solutions for the UAE population was developed. The framework presents four types of recommendation categories: favorable criteria, which included blended care, anonymity, and ease of use; cultural factors including availability in multiple languages, mainly Arabic and English, in addition to religious and cultural considerations; technical considerations, including good-quality communication, availability in formats compatible with mobile phones, and providing technical support; and users’ health and data safety considerations, including users’ suitability testing, confidentiality, and ensuring MHP integrity.

Conclusions

CMH has the potential to help overcome many mental care barriers in the United Arab Emirates in particular and in the Arab world in general. CMH adoption in the United Arab Emirates has a potential for success. However, many factors should be taken into account, mainly cultural, religious, and linguistic aspects.

Quality of life, symptom severity and level of functioning in people with severe mental illness ready for hospital discharge

WHAT IS KNOWN ON THE SUBJECT?: The quality of life (QoL) of people with severe mental illness (SMI) is a growing international concern. Many earlier studies report the determinants and correlates of QoL and functioning in people with SMI in Western countries. The QoL and functioning of Asian inpatients with SMI are largely unknown, particularly at the point where they have been assessed as being ready for hospital discharge. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Physical health, social functioning and community living skills, and negative symptoms are important areas of concern immediately pre-discharge. Social relationship related QoL, overall symptoms, unemployment, education level, living situation, physical illness and treatment duration predict functioning levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should consider interventions beyond the traditional focus on psychopathology to improve functioning outcomes in people with SMI recently discharged from hospital. Inpatient services should utilise the opportunity to monitor and address physical health problems before discharge from inpatient care. Abstract Introduction There is a lack of evidence on quality of life (QoL) and functioning in Asian people with severe mental illness (SMI) immediately prior to hospital discharge. This information could have major implications for treatment. Aim To profile perceived quality of life, symptom severity and level of functioning among people with SMI. Methods A cross-sectional study involving 347 adult inpatients with SMI. QoL (WHO Quality of Life - Brief Form), symptom severity (Positive and Negative Syndrome Scale) and level of functioning (Specific Level of Functioning) were measured immediately pre-discharge. Results Participants reported low social relationship-related QOL. Weak correlations were found between functioning, QoL and symptoms. Regression analysis identified the social relationship QoL domain, employment status, education level, living situation, physical illnesses, overall symptoms and the duration of receiving psychiatric services were statistically significant predictors of functioning levels. Discussion The findings may highlight a need for interventions beyond the traditional emphasis on psychiatric symptoms in order to improve functioning following an inpatient admission. Implications for practice Interventions to improve functioning in recently discharged people with SMI may need to be specifically designed to improve patients' social relationships, support return to employment and minimise the risk of physical illness.

Predictors of competitive employment in individuals with severe mental illness: results from an observational, cross-sectional study in Germany

BACKGROUND

Employment is of great importance as it is associated with various positive effects. Individuals with severe mental illness (SMI) are often excluded from competitive employment. Current data on employment of individuals with mental illness are rare, and influencing factors are under-researched. The present study examines possible predictors of competitive employment among individuals with SMI.

METHODS

This was a cross-sectional and multicentered study of 300 individuals with SMI aged 18 to 65 years. The following inclusion criteria were used: (I) diagnosis of schizophrenia, schizotypal and delusional disorders (ICD-10 F2x), or affective disorders (ICD-10 F3x), (II) duration of psychiatric illness ≥ 2 years, and (III) substantial impact of illness on social functioning. Participants were interviewed by trained staff using standardised instruments. The relationship between potential predictors (age, sex, education, marital status, living situation, migration background, psychosocial functioning, age at first mental problem, physical illness, work ability) and employment was analysed using a hierarchic binary logistic regression model.

RESULTS

Only one-third (34%) of participants were competitively employed. Almost one-third were unemployed (30%), and 28% reported early retirement due to mental illness. Psychosocial functioning was positively associated with competitive employment (OR = 1.09, 95% CI: 1.05 - 1.13, p < 0.001); concurrent chronic physical illness was negatively associated with competitive employment (OR = 0.38, 95% CI: 0.21 - 0.71, p = 0.002).

CONCLUSIONS

Findings confirm a high risk of exclusion from competitive employment among individuals with SMI. Nonetheless, a substantial proportion of individuals are employed. Findings call for efforts to maintain or enhance workforce participation among individuals with SMI. A special focus should be placed on improving physical health and strengthening psychosocial functioning.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Register (DRKS) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019).

The Stigma and Self-Stigma Scales for attitudes to mental health problems: Psychometric properties and its relationship to mental health problems and absenteeism

The Stigma and Self-Stigma scales (SASS) measure multiple aspects of stigmatic beliefs about mental health problems, including cognitive aspects of stigma towards others (Stigma to Others) and emotional stigma toward others (Social Distance), anticipated stigma by others, self-stigma, avoidant coping strategies, and help-seeking intentions, alongside an index of social desirability. The properties of the SASS were investigated by employees of a large UK government organization. With minor exceptions, each of the SASS scales had strong psychometric properties, good internal reliability, and test-retest reliability. Social Distance, Anticipated Stigma, Self-Stigma, and Avoidant Coping were all strongly associated with a lack of help-seeking for mental health problems. Similarly, Stigma to Others, Self-Stigma, and Avoidant Coping were all associated with current mental health problems. Finally, absenteeism from the workplace was found to be negatively related to Stigma to Others, and positively related to Avoidant Coping and Anticipated Stigma. In conclusion, the SASS was able to measure several different forms of stigma about mental health simultaneously in people both with and without a history of mental health problems. The SASS can be used to monitor changes in mental health attitudes outcomes following intervention programs to investigate stigmatic attitudes to mental health problems across different samples.

Dual process model of farmers' mindfulness and sustainable economic behavior: Mediating role of mental health and emotional labor

Mindful awareness of our interconnection with the natural environment could help to redeem our lost environmentally entrenched identity and help us to act more sustainably, concluding the predictable gaps between mindfulness and sustainable behavior. We propose more precisely that mindful attentiveness may be essential to establishing sustainable economic behavior through understanding emotional labor and enhanced mental health. Likewise, with an ever-rising concern related to mental health and emotional labor, recent industrialization and commoditization of agricultural products have stressed the need for mindfulness, and causing sustainable economic behavior of farmers that is imminent. Hence, the study will not only explore the connection between mindfulness and sustainable economic behavior, but there is a need to examine the mediating role of emotional labor and the mental health of farmers in China. The study selected the farmers because mindful awareness, emotional labor, and mental health of a farmer can significantly contribute to sustainable economic behavior and bring a connection with the natural environment. The data of 358 responses were analyzed using SPSS-AMOS. The results revealed that mindfulness, mental health, and emotional labor have a significant connection with the sustainable economic behavior of farmers in China. The results also indicated that mental health and emotional labor mediate between mindfulness and sustainable economic behavior. The results set the tone for the policy-makers to create awareness among all the stakeholders about the importance of mindfulness to help farmers manage their emotional labor and mental health for better, sustainable performance outcomes.

Mental health-related stigma discrimination and prejudices among Greek healthcare professionals

INTRODUCTION

Research shows that mental health-related stigma, stereotypes, and prejudices have a negative impact on the patients themselves as well as on their families and social entourage. Healthcare professionals, whose expertise and professional ethos are historically acknowledged by public opinion, are expected to play a major role in combating discrimination against psychiatric patients. In this study, we aimed to assess the attitudes of Greek healthcare professionals toward mental illness and people suffering from it.

MATERIALS AND METHODS

It is a non-interventional, analytic study, in which 479 health workers from a tertiary hospital in Thessaloniki, Greece, participated. Every single hospital service -except the personnel of the Psychiatric Clinic- was included in our study: from the cleaning service to the administrative staff and the auxiliary staff such as stretcher carriers, food and nutrition services' staff, and social workers, the nursing staff, and finally the attending physicians, taking into consideration that the psychiatric patient, from the moment he/she enters the hospital, consecutively gets in contact with every work grade of the healthcare establishment. Participants' attitudes concerning mental illness have been evaluated using the Opinions about Mental Illness Scale (OMI), the Social Distance Scale (SDS), and the Level of Contact Report (LCR-12).

RESULTS

Despite the high level of familiarity [as evaluated with LCR-12; mean score (μ): 8.82 ± 1.73], the employees displayed a rather poor willingness to interact with psychiatric patients (as measured with SDS; μ:11.68 ± 4.28), and endorsed significant prejudice toward individuals with mental disorders (assessed using OMI subscales; Social Discrimination μ: 22.99 ± 12.08, Social Restriction μ: 17.45 ± 9.07, Social Care μ: 21.04 ± 4.12, Social Integration μ: 16.38 ± 4.68, Etiology μ: 9.80 ± 4.95). Age and education stood out as the main determinants of participants' attitudes, with younger and highly educated participants to have shown a relatively refined profile.

CONCLUSION

These results are not significantly improved compared to those of previous decades in Greek healthcare professionals and call for critical reflection and targeted stigma-reduction efforts.

As if it weren't hard enough already: Breaking down hiring discrimination following burnout

Hiring discrimination towards (former) burnout patients has been extensively documented in the literature. To tackle this problem, it is important to understand the underlying mechanisms of such unequal hiring opportunities. Therefore, we conducted a vignette experiment with 425 genuine recruiters and jointly tested the potential stigma against job candidates with a history of burnout that were mentioned earlier in the literature. We found candidates revealing a history of burnout elicit perceptions of requiring work adaptations, likely having more unpleasant collaborations with others as well as diminished health, autonomy, ability to work under pressure, leadership capacity, manageability, and learning ability, when compared to candidates with a comparable gap in working history due to physical injury. Led by perceptions of a reduced ability to work under pressure, the tested perceptions jointly explained over 90 % of the effect of revealing burnout on the probability of being invited to a job interview. In addition, the negative effect on interview probability of revealing burnout was stronger when the job vacancy required higher stress tolerance. In contrast, the negative impact of revealing burnout on interview probability appeared weaker when recruiters were women and when recruiters had previously had personal encounters with burnout.

Implicit and Explicit Attitudes of Employers Toward Hiring People Who Have Experienced Depression

Purpose Depression is the most common mental disorder worldwide, yet many individuals with this disorder still face labor market marginalization. To our knowledge, this study is the first to explore both implicit and explicit attitudes of human resources directors/employers regarding potential employees who have experienced depression. Methods 219 human resources directors/employers answered a semi-structured interview, as well as self-report questionnaires, assessing their implicit and explicit attitudes on hiring people who have experienced depression. Explicit attitudes were assessed with self-report measures (questionnaire), whereas implicit attitudes were measured by qualitatively rating automatic mental associations (free associations). Qualitative and quantitative analyses were conducted on implicit and explicit attitudes. Results For implicit attitudes, both stereotypes and normalization attitudes were mentioned by employers. In order to ensure the validity of the explicit attitudes measure, a confirmatory factor analysis was conducted, and revealed that employers and HR's attitudes were, as expected, described by the 12 items spread out on three conceptual dimensions-Stereotypes, Organizational Burden, and Normalization, with satisfactory alpha coefficients for all subscales. ANOVA results showed that implicit and explicit attitudes of employers were not related. Finally, ANOVA results on employers' implicit attitudes showed that hiring apprehensions regarding depression were higher for employers depicting more stereotypes, whereas regression analysis on explicit attitudes showed that Organizational Burden and Normalization were only the significant predictors of employers' hiring apprehensions. Conclusion The results were consistent with previous findings from the general population underlying the ambivalence of attitudes associated with depression. Indeed, stereotypes, organizational burden, and normalization attitudes appear as distinct and complementary facets of depression stigma at work. We suggest anti-stigma training targeting employers' hiring apprehensions and encompassing both explicit and implicit attitudes regarding depression.

Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

OBJECTIVES

Many workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing mental health conditions and substance abuse (MHC/SA). Disclosure can lead to both positive (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives.

DESIGN

Qualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach.

SETTING

The study took place within the Dutch military.

PARTICIPANTS

In total, 46 people participated in 8 homogeneous focus groups, including 3 perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16).

RESULTS

Five barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent.

CONCLUSIONS

Almost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being and sustainable employment for soldiers with MHC/SA. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing MHC/SA.

Effects of online stigma-reduction programme for people experiencing mental health conditions: A systematic review and meta-analysis

Despite the increased awareness of mental health-related issues, people experiencing mental health conditions have continued to face stigmatization worldwide. The literature on help-seeking behaviours has frequently highlighted the development of self-stigma because of public stigma and emphasized the need to address public stigmatization faced by them. Given the increasing acceptance of digital services in recent years, this systematic review aimed to examine the effects of online and face-to-face anti-stigma interventions in reducing public stigma towards people experiencing mental health conditions. A search was conducted on the Cochrane Library, CINAHL, PubMed, Embase, PsycInfo, and ProQuest from inception of the databases to October 2020. Studies were included in this review if they have explored: (i) public stigmatization towards people of all ages with different types of mental health conditions; (ii) online interventions; and (iii) face-to-face interventions. Nine studies were included in this review, of which only five were included in the meta-analysis as the remaining four had incomplete data. The meta-analysis included an aggregate of 1203 participants while the four excluded studies included 713 participants. Results revealed that online interventions performed favourably with small effect sizes in comparison to face-to-face, wait-list control, and no-intervention groups. Results from the studies excluded from the meta-analysis also found a significant reduction of public stigmatization with online interventions. Such findings provide insightful evidence for the effectiveness of online interventions in reducing public stigmatization. Hence, mental health organizations and groups can consider adopting online interventions suitable for their target audience and type of mental health conditions.

Participation of Older Persons With Mental Health Conditions and Psychosocial Disabilities in the Labor Market

This paper discusses the right to work as a basic human right that should be granted unrelated to chronological age, health or mental health status and disability including declining cognitive functioning. The benefits of continued employment are both at the individual level and at the organizational and societal levels. Nonetheless, there are multiple barriers that prevent older people and particularly older people with mental conditions and psychosocial disabilities from remaining in the workforce and/or from rejoining the workforce. We outline interventions at the organizational, national, and international levels to ensure the full participation of people of all ages and abilities in the workforce. Such interventions should address the intersection between disabilities and advanced age at the global, regional, and country levels.

Unpacking stigma: Meta-analyses of correlates and moderators of personal stigma in psychosis

Personal stigma entails perceived, experienced and internalised stigmatisation. Mental Health stigma has been widely researched across a range of countries and a meta-analysis of their associations and moderators in psychosis is timely. Meta-analyses were conducted examining the correlates and moderators of personal stigma in terms of: (1) demographic variables (2) illness related variables (3) symptoms/negative outcomes, and (4) aspects of wellbeing. Associations were obtained from a total of 216 records. Several demographic factors including age, economic status, employment, and rural residence had small associations with aspects of personal stigma (r's = 0.12 to -0.13). Personal stigma aspects were inversely related to medication adherence (r's = -0.20, -0.21), and positively associated with insight and number of hospitalisations (r's = 0.09-0.19). Most symptoms were positively associated with personal stigma (r's = 0.10-0.43), whereas inverse relations with wellbeing variables were identified (r's = -0.13 to -0.54). Moderator effects emerged including that of cultural setting and sex, age and education level, highlighting the role of cultural and demographic factors in shaping personal stigma aspects in psychosis. The present study also highlights the importance of recognizing the negative effect of actual stigma and discrimination experiences; particularly its detrimental impact on self-image and its complex role in shaping the internalisation of societal stigma.

Return to Work After a Disabling Mental Disorder: Predictors From a Brazilian 1-Year Longitudinal Study

OBJECTIVE

This study aims to analyze factors that influence return to work (RTW) among workers on sickness absence due to mental disorders.

METHODS

A longitudinal study conducted between 2014 and 2017 in São Paulo, Brazil. The 385 participants answered a questionnaire including sociodemographics, habits/lifestyle, job characteristics, and clinical information. Survival analysis was performed to identify factors influencing the RTW.

RESULTS

Most of participants were females (74.5%), worked in jobs dealing with public (44.2%) and were depressed (52.4%). RTW occurred for 68.3% participants over 1-year follow-up. Mean duration of absence was 163.83 days. The risk profile for remaining absent was heavy smokers, be abstainer, obese, deal with the public, perceived great effort at work, and low self-efficacy.

CONCLUSIONS

These findings can contribute in discussion about disability prevention and interventions to assure mental health care for workers.

Late effects of cancer (treatment) and work ability: guidance by managers and professionals

BACKGROUND

The prevalence of the group of workers that had a cancer diagnosis in the past is growing. These workers may still be confronted with late effects of cancer (treatment) possibly affecting their work ability. As little is known about the guidance of this group, the aim of this study was to explore the experiences and ideas of managers and professionals about the guidance of these workers in the case of late effects of cancer (treatment). Given the positive associations with work ability of the job resources autonomy, social support by colleagues and an open organisational culture found in several quantitative studies, these job resources were also discussed. Further ideas about the influences of other factors and points of attention in the guidance of this group of workers were explored.

METHODS

Semi-structured interviews were conducted with managers (n = 11) and professionals (n = 47). Data-collection was from November 2019 to June 2020. The data were coded and analysed using directed content analyses.

RESULTS

The late effects of cancer or cancer treatment discussed were physical problems, fatigue, cognitive problems, anxiety for cancer recurrence, and a different view of life. The self-employed have less options for guidance but may struggle with late effects affecting work ability in the same way as the salaried. Late effects may affect work ability and various approaches have been described. Autonomy, social support of colleagues and an open organisational culture were regarded as beneficial. It was indicated that interventions need to be tailor-made and created in dialogue with the worker.

CONCLUSIONS

Especially with respect to cognitive problems and fatigue, guidance sometimes turned out to be complicated. In general, the importance of psychological safety to be open about late effects that affect work ability was emphasized. Moreover, it is important to take the perspective of the worker as the starting point and explore the possibilities together with the worker. Autonomy is an important factor in general, and a factor that must always be monitored when adjustments in work are considered. There is a lot of experience, but there are still gaps in knowledge and opportunities for more knowledge sharing.

Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study

INTRODUCTION

Nutritional psychiatry is an emerging field of study that investigates the role of diet and nutrition in mental health. Studies conducted in the general population have linked depressive symptoms with poor dietary patterns. The aim of this study was to characterise the dietary intake and analyse the dietary pattern using the Dietary Approach to Stop Hypertension (DASH) in a sample of psychiatric patients in a multiethnic Asian nation.

METHODS

Participants were recruited from an outpatient clinic and an inpatient unit at the Institute of Mental Health in Singapore. Self-reported dietary habits of a sample of psychiatric patients (N=380) were analysed using DASH. To examine the variables associated with DASH scores, a linear regression was conducted with the full sample and sociodemographic variables.

RESULTS

Persons with depressive disorders had a mean DASH score of 21.3 (±4.2), while persons with psychotic disorders had a mean DASH score of 21.2 (±4.9). Respondents who were older (B=1.94, 95% confidence interval [CI] 0.91-2.96, P<0.001), female (B=1.09, 95% CI 0.07-2.11, P=0.04) and economically inactive (B=1.98, 95% CI 0.006-3.96, P=0.049) were more likely to report a higher diet quality compared with their respective counterparts, while smokers (B= -1.39, 95% CI -2.45 to -0.34, P=0.009) tended to report a lower diet quality compared with their non-smoking counterparts.

CONCLUSION

Dietary patterns of persons with mental disorders were characterised. A host of sociodemographic factors, and not diagnosis of mental disorders, influenced the dietary quality of people with depressive and psychotic disorders. Clinicians treating psychiatric patients need to be aware of the nuanced reasons behind poor dietary choices and provide targeted psychoeducation to specific subgroups within the patient population.

Knowledge and Attitude of Pharmacy Students toward People with Mental Illnesses and Help-Seeking: A Cross-Sectional Study from Saudi Arabia

People with mental illnesses (MIs) face several challenges in addition to their disease. People’s negative views of those with MIs impact patients’ decisions to seek professional help. The aims of this study were to assess pharmacy students’ attitudes toward people with MIs and seeking help for mental health, as well as their knowledge about the causes of MIs. A cross-sectional survey was conducted on pharmacy students at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Out of the 460 distributed questionnaires, 330 complete questionnaires were received, giving a response rate of 71.7%. Overall, the mean total score for attitude towards people with MIs was 60.16 ± 10.48 (maximum attainable score: 105). In this study, 51.12% believed that people with MIs are more likely to harm others than a person without MIs and 66.9% mentioned that they did not trust the work of a mentally ill person as part of their work team. However, only 35.45% believed that it is difficult for mentally ill individuals to follow social rules. In terms of attitudes toward help-seeking, the mean total score of was 12.83 ± 3.16 out of the maximum score of 25. In addition, the mean total score for knowledge about causes of mental illness was 2.92 ± 1.76 out of the maximum score of 8. The participants reported that MIs could be due to genetic inheritance (56%), substance abuse (54.5%), or brain disease (66.1%). The findings showed that there are some negative attitudes toward people with MIs and negative attitudes towards seeking help for mental health. In addition, some misconceptions about the causes of MIs are prevalent. Consequently, the incorporation of more topics concerning mental health in pharmacy curricula could help improve the awareness of and knowledge about mental health.

The influence of chronic diseases and multimorbidity on entering paid employment among unemployed persons - a longitudinal register-based study

Objectives This study aimed to investigate the influence of chronic diseases and multimorbidity on entering paid employment among unemployed persons. A secondary objective was to estimate the proportion of persons not entering paid employment that can be attributed to specific chronic diseases across different age groups. Methods Data linkage of longitudinal nationwide registries on employment status, medication use and socio-demographic characteristics was applied. Unemployed Dutch persons (N=619 968) were selected for a three-year prospective study. Cox proportional hazards analyses with hazard ratios (HR) were used to investigate the influence of six common chronic diseases on entering paid employment, stratified by age. The population attributable fraction (PAF) was calculated as the proportion of all persons who did not enter paid employment that can be attributed to a chronic disease. Results Persons with chronic diseases were less likely to enter paid employment among all age groups. The impact of a chronic disease on maintaining unemployment at population level was largest for common mental disorders (PAF 0.20), due to a high prevalence of common mental disorders (6%), and for psychotic disorders (PAF 0.19), due to a high likelihood of not entering paid employment (HR 0.21), among persons aged 45-55 years. Multimorbidity increased with age, and the impact of having multiple chronic diseases on remaining unemployed increased especially among persons aged ≥45 years. Conclusion Chronic diseases and multimorbidity are important factors that reduce employment chances among all age groups. Our results provide directions for policy measures to target specific age and disease groups of unemployed persons in order to improve employment opportunities.

How can wellbeing at work and sustainable employability of gifted workers be enhanced? A qualitative study from a capability approach perspective

Background

Being gifted with a very high IQ (> 98 percentile) can provide an advantage in the occupational context but can also come with its` own specific challenges. Where some studies found higher than average levels of wellbeing at work and successful careers amongst the gifted, other studies report boredom and less job satisfaction. This poses the question what gifted people value in work, and which factors are associated with the achievement of valued work related outcomes, wellbeing and sustainable employability. In this study these questions were explored using the value driven capability approach as a theoretical framework.

Method

A qualitative approach was chosen and 16 in-depth semi-structured interviews with gifted workers (IQ > 130) were conducted. The transcripts were analysed using a reflexive thematic analysis aimed at identifying the work related outcomes participants aspired to achieve and the contextual and personal factors that affected the actualisation of these outcomes.

Results

Participants placed great value on the opportunity to learn, to use their knowledge and skills, and tended to have high ethical standards. If realized, these values contributed to wellbeing whereas if not fulfilled, this often resulted in frustration and sadness. The most important personal factors associated with wellbeing at work and sustainable employability were the level of organizational awareness, self-knowledge, a willingness to compromise, and fear of stigmatisation. Contextually a facilitating leadership style of managers was important, allowing the worker autonomy and decision latitude. Socially, participants enjoyed others as sparring partners but often had an aversion to small talk which could lead to social avoidance and loneliness.

Conclusions

If gifted workers managed (to get) what they valued in work, this was associated with wellbeing and sustainable employment Coaching aimed at improving organizational awareness, specific social skills (e.g. small talk, adaptability) and understanding their own cognitive processes could be valuable. The application of an autonomy supporting facilitative leadership style by supervisors would be beneficial. Further research should try to confirm the findings using quantitative methods and needs to examine more closely the impact of stigmatisation and leadership styles.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10413-8.

Line managers' hiring intentions regarding people with mental health problems: a cross-sectional study on workplace stigma

OBJECTIVES

Stigma may negatively affect line managers' intention to hire people with mental health problems (MHP). This study aims to evaluate line managers' knowledge and attitudes concerning job applicants with MHP, and to assess which factors are associated with the intention (not) to hire an applicant with MHP.

METHODS

A sample of Dutch line managers (N=670) filled out a questionnaire on their knowledge, attitudes and experiences concerning applicants/employees with MHP. Descriptive analyses and multiple regression analyses were used.

RESULTS

The majority (64%) was reluctant to hire a job applicant with MHP, despite the fact that only 7% had negative and 52% had positive personal experiences with such employees. Thirty per cent were reluctant to hire an applicant if they knew the applicant had past MHP. Associated with higher reluctance to hire an applicant with MHP were the concerns that it will lead to long-term sickness absence (β (95% CI)=0.39 (0.23 to 0.55)), that the employee cannot handle the work (β (95% CI)=0.16 (0.00 to 0.33)) that one cannot count on the employee (β (95% CI)=0.41 (0.23 to 0.58)) and higher manager education level (β (95% CI)=0.25 (0.05 to 0.44)). Conversely, associated with positive hiring intentions was being in favour of diversity and/or inclusive enterprise (β(95% CI)=-0.64 (-0.87 to -0.41)).

CONCLUSIONS

As the majority of managers were reluctant to hire applicants with MHP, and even 30% were reluctant to hire applicants who had past MHP, these findings have major implications for social inclusion in the Netherlands, where about 75% of employees would disclose MHP at work.

Barriers and facilitators for treatment-seeking for mental health conditions and substance misuse: multi-perspective focus group study within the military

BACKGROUND

Globally, millions are exposed to stressors at work that increase their vulnerability to develop mental health conditions and substance misuse (such as soldiers, policemen, doctors). However, these types of professionals especially are expected to be strong and healthy, and this contrast may worsen their treatment gap. Although the treatment gap in the military has been studied before, perspectives of different stakeholders involved have largely been ignored, even though they play an important role.

AIMS

To study the barriers and facilitators for treatment-seeking in the military, from three different perspectives.

METHOD

In total, 46 people participated, divided into eight homogeneous focus groups, including three perspectives: soldiers with mental health conditions and substance misuse (n = 20), soldiers without mental health conditions and substance misuse (n = 10) and mental health professionals (n = 16). Sessions were audio-taped and transcribed verbatim. Content analysis was done by applying a general inductive approach using ATLAS.ti-8.4.4 software.

RESULTS

Five barriers for treatment-seeking were identified: fear of negative career consequences, fear of social rejection, confidentiality concerns, the 'strong worker' workplace culture and practical barriers. Three facilitators were identified: social support, accessibility and knowledge, and healthcare within the military. The views of the different stakeholder groups were highly congruent.

CONCLUSIONS

Barriers for treatment-seeking were mostly stigma related (fear of career consequences, fear of social rejection and the 'strong worker' workplace culture) and this was widely recognised by all groups. Social support from family, peers, supervisors and professionals were identified as important facilitators. A decrease in the treatment gap for mental health conditions and substance misuse is needed and these findings provide direction for future research and destigmatising interventions.

Work Ability, Burnout Complaints, and Work Engagement Among Employees With Chronic Diseases: Job Resources as Targets for Intervention?

PURPOSE

The aim of this study was to investigate the occupational well-being among employees with chronic diseases, and the buffering effect of four job resources, possibly offering targets to enhance occupational well-being.

METHOD

This cross-sectional study (N = 1951) was carried out among employees in educational and (semi-)governmental organizations in the Netherlands. The dimensions of the survey were chronic diseases (i.e., physical, mental, or both physical and mental), occupational well-being (i.e., work ability, burnout complaints, and work engagement), and job resources (i.e., autonomy, social support by colleagues, supportive leadership style, and open and communicative culture). First, it was analyzed if chronic diseases were associated with occupational well-being. Second, it was analyzed if each of the four job resources would predict better occupational well-being. Third, possible moderation effects between the chronic disease groups and each job resource on occupational well-being were examined. Regression analyses were used, controlling for age.

RESULTS

Each chronic disease group was associated with a lower work ability. However, higher burnout complaints and a lower work engagement were only predicted by the group with mental chronic diseases and by the group with both physical and mental chronic disease(s). Furthermore, all four job resources predicted lower burnout complaints and higher work engagement, while higher work ability was only predicted by autonomy and a supportive leadership style. Some moderation effects were observed. Autonomy buffered the negative relationship between the chronic disease groups with mental conditions (with or without physical conditions) and work ability, and the positive relationship between the group with both physical and mental chronic disease(s) and burnout complaints. Furthermore, a supportive leadership style is of less benefit for occupational well-being among the employees with mental chronic diseases (with or without physical chronic diseases) compared to the group employees without chronic diseases. No buffering was demonstrated for social support of colleagues and an open and communicative organizational culture.

CONCLUSION

Autonomy offers opportunities to reinforce occupational well-being among employees with mental chronic diseases. A supportive leadership style needs more investigation to clarify why this job resource is less beneficial for employees with mental chronic diseases than for the employees without chronic diseases.