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Hankir AK, Northall A, Zaman R. Stigma and mental health challenges in medical students. BMJ Case Rep 2014; 2014:bcr2014205226. [PMID: 25183806 PMCID: PMC4158203 DOI: 10.1136/bcr-2014-205226] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2014] [Indexed: 11/03/2022] Open
Abstract
Despite the perception that medical students and doctors should be 'invincible', mental health challenges are common in this population. Medical students and doctors have low levels of help seeking for their own psychiatric problems often only presenting to mental health services once a crisis arises. Fear of exposure to stigmatisation is a crucial factor contributing to symptom concealment and is a barrier to accessing mental health services. Autobiographical narratives of the 'Wounded Healer' are gaining popularity among medical students and doctors with mental health challenges both as an effective form of adjunctive therapy and as a means to campaign against stigma. Indeed, the results of a randomised controlled trial to assess the efficacy of Coming Out Proud with mental illness revealed immediate positive effects on stigma stress-related variables. We provide an autobiographical narrative from a medical student who has first-hand experience with mental health challenges.
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Affiliation(s)
| | - Amy Northall
- School of Medicine, University of Sheffield, Sheffield, USA
| | - Rashid Zaman
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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102
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[Stigma: Barrier to Access to Mental Health Services]. ACTA ACUST UNITED AC 2014; 43:162-7. [PMID: 26575130 DOI: 10.1016/j.rcp.2014.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/01/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The perceived stigma represents a sociocultural barrier to access mental health services and prevents individuals who meet criteria for a mental disorder the possibility of receiving comprehensive and integred care. OBJECTIVE To update institutional mechanisms by which stigma related to mental disorders, perceived and perpetrated, acts as a barrier to mental health access. RESULTS Stigma as a barrier to access to mental health services is due to a reduction in service requests, the allocation of limited resources to mental health, the systematic process of impoverishment of the people who suffer a mental disorder, increased risk of crime, and implications in contact with the legal system, and the invisibility of the vulnerability of these people. CONCLUSIONS Structured awareness and education programs are needed to promote awareness about mental disorders, promote community-based psychosocial rehabilitation, and reintegration into productive life process. In Colombia, the frequency and variables associated with the stigma of mental disorders needs to be studied. This knowledge will enable the implementation of measures to promote the social and labor inclusion of people who meet the criteria for mental disorders.
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Prüß S, Speerforck S, Bahlmann J, Freyberger HJ, Schomerus G. Werden Psychotherapeuten, Psychiater oder die Psychotherapie stigmatisiert? PSYCHOTHERAPEUT 2014. [DOI: 10.1007/s00278-014-1057-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ayazi T, Lien L, Eide A, Shadar EJS, Hauff E. Community attitudes and social distance towards the mentally ill in South Sudan: a survey from a post-conflict setting with no mental health services. Soc Psychiatry Psychiatr Epidemiol 2014; 49:771-80. [PMID: 24136000 DOI: 10.1007/s00127-013-0775-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE This study investigates attitudes and social distance towards the mentally ill in a post-conflict, low-income country. METHODS A cross-sectional community survey (n = 1,200) was conducted in South Sudan. Associations between various sociodemographic variables and attitudes toward/social distance from the mentally ill were investigated. RESULTS The regression analysis showed that lower levels of education were positively associated with social distance, and Christian or Muslim beliefs, compared with traditional beliefs, were negatively associated with social distance. Familiarity with mental illness or psychological distress was not significantly associated with social distance. Participants who endorsed community-oriented attitudes (rather than hospital/drug-oriented attitudes) about health care for the mentally ill were more likely show a decreased social distance. Participants who believed that the mentally ill were dangerous had higher scores on the social distance scale. CONCLUSIONS A high level of stigma towards the mentally ill exists in South Sudan, especially in the rural areas. Alongside efforts to build up mental health services in South Sudan, the existing stigma needs to be addressed. Information regarding the role of the community both in preventing mental illnesses and in service delivery should be prioritised.
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Affiliation(s)
- Touraj Ayazi
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1171, Blindern, 0318, Oslo, Norway,
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Affiliation(s)
- Girish Banwari
- Department of Psychiatry, Sheth Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. E-mail:
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Magliano L, Read J, Sagliocchi A, Patalano M, Oliviero N. Effect of diagnostic labeling and causal explanations on medical students' views about treatments for psychosis and the need to share information with service users. Psychiatry Res 2013; 210:402-7. [PMID: 23916362 DOI: 10.1016/j.psychres.2013.07.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 04/24/2013] [Accepted: 07/07/2013] [Indexed: 11/15/2022]
Abstract
This study examines whether medical students' views of treatments for 'schizophrenia' and of patients' rights to be informed about their condition and their medication were influenced by diagnostic labeling and causal explanations and whether they differed over medical training. Three hundred and eighty-one Italian students attending their first or fifth/sixth year of medical studies read a vignette portraying someone who met diagnostic criteria for 'schizophrenia' and completed a self-report questionnaire. The study found that labeling the case as 'schizophrenia' and naming heredity among its causes were associated with confidence in psychiatrists and psychiatric drugs. Naming psychological traumas among the causes was associated with confidence in psychologists and greater acknowledgment of users' right to be informed about drugs. Compared to first year students, those at their fifth/sixth-year of studies more strongly endorsed drugs, had less confidence in psychologists and family support, and were less keen to share information on drugs with patients. These findings highlight that students' beliefs vary during training and are significantly related to diagnostic labeling and belief in a biogenetic causal model. Psychiatric curricula for medical students should include greater integration of psychological and medical aspects in clinical management of 'schizophrenia'; more information on the psychosocial causes of mental health problems.
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, Second University of Naples, Viale Ellittico 31, 81100 Caserta, Italy.
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Papish A, Kassam A, Modgill G, Vaz G, Zanussi L, Patten S. Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial. BMC MEDICAL EDUCATION 2013; 13:141. [PMID: 24156397 PMCID: PMC3828029 DOI: 10.1186/1472-6920-13-141] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 09/11/2013] [Indexed: 05/14/2023]
Abstract
BACKGROUND The stigma of mental illness among medical students is a prevalent concern that has far reaching negative consequences. Attempts to combat this stigma through educational initiatives have had mixed results. This study examined the impact of a one-time contact-based educational intervention on the stigma of mental illness among medical students and compared this with a multimodal undergraduate psychiatry course at the University of Calgary, Canada that integrates contact-based educational strategies. Attitudes towards mental illness were compared with those towards type 2 diabetes mellitus (T2DM). METHOD A cluster-randomized trial design was used to evaluate the impact of contact-based educational interventions delivered at two points in time. The impact was assessed by collecting data at 4 time points using the Opening Minds Scale for Health Care Providers (OMS-HC) to assess changes in stigma. RESULTS Baseline surveys were completed by 62% (n=111) of students before the start of the course and post-intervention ratings were available from 90 of these. Stigma scores for both groups were significantly reduced upon course completion (p < 0.0001), but were not significantly changed following the one-time contact based educational intervention in the primary analysis. Student confidence in working with people with a mental illness and interest in a psychiatric career was increased at the end of the course. Stigma towards mental illness remained greater than for T2DM at all time points. CONCLUSIONS Psychiatric education can decrease the stigma of mental illness and increase student confidence. However, one-time, contact-based educational interventions require further evaluation in this context. The key components are postulated to be contact, knowledge and attention to process, where attending to the student's internal experience of working with people with mental illness is an integral factor in modulating perceptions of mental illness and a psychiatric career.
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Affiliation(s)
- Andriyka Papish
- Department of Psychiatry, College of Medicine - Regina Campus, University of Saskatchewan, 2110 Hamilton St, Regina, SK S4P 2E3, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Geeta Modgill
- Opening Minds Anti-Stigma Initiative, Mental Health Commission of Canada, 110 Quarry Park Blvd, Suite 320, Calgary, Alberta T2C 3G3, Canada
| | - Gina Vaz
- Department of Psychiatry, Faculty of Medicine, University of Calgary, 1403 - 29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Lauren Zanussi
- Department of Psychiatry, Faculty of Medicine, University of Calgary, 1403 - 29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Scott Patten
- Department of Community Health Sciences, University of Calgary, 3rd Floor TRW, 3280 Hospital Drive NW, Calgary T2N 4Z6, Canada
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Ahmedani BK, Kubiak SP, Kessler RC, de Graaf R, Alonso J, Bruffaerts R, Zarkov Z, Viana MC, Huang YQ, Hu C, Posada-Villa JA, Lepine JP, Angermeyer MC, de Girolamo G, Karam AN, Medina-Mora ME, Gureje O, Ferry F, Sagar R, Anthony JC. Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study. Psychol Med 2013; 43:2191-2202. [PMID: 23298443 PMCID: PMC4013530 DOI: 10.1017/s003329171200298x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study. METHOD In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions. RESULTS There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p<0.001), even with covariate adjustments for age and sex. CONCLUSIONS . The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.
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Affiliation(s)
- B K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA.
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110
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry; University of Naples SUN; Naples; Italy
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111
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Abstract
BACKGROUND Psychiatric stigma is pervasive injustice that complicates the course of illness and reduces quality of life for people with mental illnesses. This article reviews the research examining stigma towards bipolar disorder (BD) with a view to guiding the development of stigma reduction initiatives and ongoing research. METHODS PsychInfo, Medline, and Embase databases were searched for peer-reviewed studies addressing stigma in BD. RESULTS Stigma is a serious concern for individuals with BD and their families. Stigma occurs within affected individuals, families, social environments, work and school environments, and the healthcare industry. With stigma often come a loss of social support and occupational success, reduced functioning, higher symptom levels and lower quality of life. BD stigma is comparable to that of other severe mental illnesses, such as schizophrenia. Few interventions are available to specifically target stigma against BD. LIMITATIONS Most studies have used explicit, attitude-based measures of stigma without controlling for social desirability, which may not translate into real-world stigmatizing behaviors. Furthermore, many studies have not clearly delineated results in a manner consistent with the conceptual framework of stigmatization. CONCLUSIONS Stigma toward BD is ubiquitous and has insidious consequences for affected individuals and their families. Stigma reduction initiatives should target individuals living with BD, their families, workplaces, and the healthcare industry, taking into account the experiences and impacts of BD stigma to improve social support, course of illness, and quality of life.
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Fernandes RLF, Citero VA, Nogueira-Martins LA, Mari JJ. Psychiatry career in Brazil: regional disparities, differences and similarities in an international context. Int Rev Psychiatry 2013; 25:486-92. [PMID: 24032506 DOI: 10.3109/09540261.2013.831813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review explores the literature related to career choice of psychiatry in Brazil through selection of scientific articles published in the period from 1999 to 2013 in the MEDLINE and SciELO databases. There are currently 145 medical schools in Brazil, the highest concentration being in the more developed areas. In 2005, there were 6,003 psychiatrists working in Brazil, a rate of 3.3 psychiatrists per 100,000 inhabitants, with unequal distribution across the geographical regions of the country: a rate of 4.5 psychiatrists/100,000 inhabitants in the southern region, and less than one psychiatrist per 100,000 inhabitants in the northern region. The south and south-east regions comprise 56% of the national population and 76% of the residency posts in psychiatry. In 2013, 27% of the residency posts in psychiatry were not filled, particularly in the north and north-east areas, where the shortage of professionals is more pronounced. The number of specialized doctors is far below what is needed to cover the burden attributed to neuropsychiatric disorders in the country. The main hypotheses to explain this imbalance in Brazil are the relatively low exposure to the speciality during undergraduate course work, the stigma attached to mental disorders, and the poor organization of mental healthcare services.
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Praharaj SK, Behere RV, Deora S, Sharma PSVN. Psychiatric specialization as an option for medical students in the Indian context. Int Rev Psychiatry 2013; 25:419-24. [PMID: 24032496 DOI: 10.3109/09540261.2013.822347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is a shortage of psychiatrists in India and psychiatry as a subject of specialization is not a preferred option among medical undergraduates. There is inadequate exposure to psychiatry during the medical undergraduate training in India which might contribute towards it. There are attempts to overcome the negative attitudes towards psychiatry and mental illness among medical undergraduates by changes in the curriculum. In this paper we attempt to review studies on attitudes of undergraduate students towards psychiatry and compare the results with findings from our own survey done as a part of International Study of Student Career Choice in Psychiatry (ISoSCCiP) project.
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Affiliation(s)
- Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal University , Manipal, Karnataka , India
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Abstract
There is a serious shortage of psychiatrists and poor recruitment of new psychiatry trainees worldwide. Low and middle income countries suffer disproportionately on many accounts. A negative attitude towards psychiatry is thought to contribute to poor recruitment of psychiatry trainees. Previous reviews have focused on the attitudes of medical students in high income countries, but factors relevant to attitude and recruitment may be different in lower income countries. Here we review studies of medical students' attitudes towards psychiatry from low and lower-middle income countries, summarize key themes which negatively influence attitudes, and suggest strategies for overcoming them. Major themes include stigma, perceived status of psychiatry, lack of psychiatric trainers, local cultural beliefs, poor working conditions, and quality of patient care.
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Affiliation(s)
- Gareth Nortje
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch , South Africa
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Somasundaram O. Literary destigmatisation of mental illness: A study of the writings of Jayakanthan. Indian J Psychiatry 2013; 55:295-9. [PMID: 24082255 PMCID: PMC3777356 DOI: 10.4103/0019-5545.117154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
National and international associations of psychiatry are busy formulating and executing anti-stigma measures and activities. Literary works of creative artists could be utilised for this purpose. This article based on the writings of a popular Tamil writer Jayakanthan discusses some of his works in relation to this.
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Affiliation(s)
- O Somasundaram
- Institute of Mental Health, Kilpauk, Chennai, Tamil Nadu, India
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117
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Atilola O, Olayiwola F. Frames of mental illness in the Yoruba genre of Nigerian movies: implications for orthodox mental health care. Transcult Psychiatry 2013; 50:442-54. [PMID: 23670966 DOI: 10.1177/1363461512443998] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines the modes of framing mental illness in the Yoruba genre of Nigerian movies. All Yoruba films on display in a convenient sample of movie rental shops in Ibadan (Nigeria) were sampled for content. Of the 103 films studied, 27 (26.2%) contained scenes depicting mental illness. Psychotic symptoms were the most commonly depicted, while effective treatments were mostly depicted as taking place in unorthodox settings. The most commonly depicted aetiology of mental illness was sorcery and enchantment by witches and wizards, as well as other supernatural forces. Scenes of mental illness are common in Nigerian movies and these depictions-though reflecting the popular explanatory models of Yoruba-speaking Nigerians about mental illness- may impede utilization of mental health care services and ongoing efforts to reduce psychiatry stigma in this region. Efforts to reduce stigma and improve service utilization should engage the film industry.
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Affiliation(s)
- Olayinka Atilola
- Department of Psychiatry, University College Hospital Ibadan, Ibadan 234, Nigeria.
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Lam TP, Lam KF, Lam EWW, Ku YS. Attitudes of primary care physicians towards patients with mental illness in Hong Kong. Asia Pac Psychiatry 2013; 5:E19-28. [PMID: 23857792 DOI: 10.1111/j.1758-5872.2012.00208.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 05/01/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aims to describe the attitudes of primary care physicians towards mental health patients in Hong Kong, especially to examine the doctors' views on schizophrenia and depression, and the influence of their demographic variables. METHODS A questionnaire developed by the research team was sent to members of Hong Kong College of Family Physicians. Potential respondents were allocated on equal basis to one of the two sets of questionnaire, set 1 for clinical vignette of schizophrenia and set 2 for depression. RESULTS A response rate of 37% (500 of 1,360) was achieved. There were 255 and 245 returned questionnaires for set 1 and set 2, respectively. Comparing the two clinical vignettes, there were large differences in their willingness to have the patient on practice list for mental issues (40.0% for schizophrenia versus 71.5% for depression) and to deal with the patient's needs (37.0% versus 60.9%). Multiple ordinal logistic regression analysis showed that doctors with the following demographic factors tended to have more worries or stigma on mental health patients: "having longer years of practice," "being female," "working in hospital," "employed in public sector," and "not having a relative/friend with mental health problems." DISCUSSION Our study shows that two-thirds of primary care doctors are prepared to look after patients with depression, which is substantially higher than that for schizophrenia. In contrast with the Australian findings, the experienced doctors in Hong Kong have more negative attitudes towards mental health patients than the younger ones.
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Affiliation(s)
- Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
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Küey L. The characteristics, content, performance, and impact of the WPA website (www.wpanet.org). World Psychiatry 2013; 12:85-6. [PMID: 23509026 PMCID: PMC3619163 DOI: 10.1002/wps.20023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stuart H, Arboleda-Flórez J. A Public Health Perspective on the Stigmatization of Mental Illnesses. Public Health Rev 2012. [DOI: 10.1007/bf03391680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Omori A, Tateno A, Ideno T, Takahashi H, Kawashima Y, Takemura K, Okubo Y. Influence of contact with schizophrenia on implicit attitudes towards schizophrenia patients held by clinical residents. BMC Psychiatry 2012; 12:205. [PMID: 23173747 PMCID: PMC3539926 DOI: 10.1186/1471-244x-12-205] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 10/25/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with schizophrenia and their families have suffered greatly from stigmatizing effects. Although many efforts have been made to eradicate both prejudice and stigma, they still prevail even among medical professionals, and little is known about how contact with schizophrenia patients affects their attitudes towards schizophrenia. METHODS We assessed the impact of the renaming of the Japanese term for schizophrenia on clinical residents and also evaluated the influence of contact with schizophrenia patients on attitudes toward schizophrenia by comparing the attitudes toward schizophrenia before and after a one-month clinical training period in psychiatry. Fifty-one clinical residents participated. Their attitudes toward schizophrenia were assessed twice, before and one month after clinical training in psychiatry using the Implicit Association Test (IAT) as well as Link's devaluation-discrimination scale. RESULTS The old term for schizophrenia, "Seishin-Bunretsu-Byo", was more congruent with criminal than the new term for schizophrenia, "Togo-Shitcho-Sho", before clinical training. However, quite opposite to our expectation, after clinical training the new term had become even more congruent with criminal than the old term. There was no significant correlation between Link's scale and IAT effect. CONCLUSIONS Renaming the Japanese term for schizophrenia still reduced the negative images of schizophrenia among clinical residents. However, contact with schizophrenia patients unexpectedly changed clinical residents' attitudes towards schizophrenia negatively. Our results might contribute to an understanding of the formation of negative attitudes about schizophrenia and assist in developing appropriate clinical training in psychiatry that could reduce prejudice and stigma concerning schizophrenia.
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Affiliation(s)
- Ataru Omori
- Department of Neuropsychiatry, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Amane Tateno
- Department of Neuropsychiatry, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Takashi Ideno
- Department of Psychology, Waseda University, 1-24-1 Toyama, Shinjyuku-ku, Tokyo, 162-8644, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan,Precursory Research for Embryonic Science and Technology (PRESTO), Japan Science and Technology Agency, 4-1-8 Honcho, Kawaguchi, Saitama, 332-0012, Japan
| | - Yoshitaka Kawashima
- Department of Neuropsychiatry, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Kazuhisa Takemura
- Department of Psychology, Waseda University, 1-24-1 Toyama, Shinjyuku-ku, Tokyo, 162-8644, Japan
| | - Yoshiro Okubo
- Department of Neuropsychiatry, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
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122
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Affiliation(s)
- MARIO LUCIANO
- Department of Psychiatry, University of Naples
SUN, Naples, Italy
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123
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Atilola O, Olayiwola F. The Nigerian home video boom: should Nigerian psychiatrists be worried? Lessons from content review and views of community dwellers. Int J Soc Psychiatry 2012; 58:470-6. [PMID: 21813485 DOI: 10.1177/0020764011408544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Media depiction of sufferers of mental illness is a widely viewed source of stigmatization and studies have found stigmatizing depictions of mental illness in Nigerian films. With the recent boom in the Nigerian home video industry, there is a need to know how often Nigerians are exposed to films that contain scenes depicting mental illness and how much premium they place on such portrayals as reflecting reality. AIM To assess the popularity of Nigerian home videos among Nigerian community dwellers and the frequency of their exposure to scenes depicting mental illness. METHODS A semi-structured questionnaire was designed to obtain socio-demographic data and to find out how often respondents see scenes depicting 'madness' in home videos, as well as their views about the accuracy of such depictions from the orthodox psychiatry point of view. Current home videos available in video rental shops were selected for viewing and content review. RESULTS All 676 respondents had seen a Nigerian home video in the preceding 30 days: 528 (78%) reported scenes depicting 'mad persons'; 472 (70%) reported that the scenes they saw agreed with their own initial understanding of the cause and treatment of 'madness'. About 20% of the films depicted mental illness. The most commonly depicted cause was sorcery and enchantment by witches and wizards, while the most commonly depicted treatment was magical and spiritual healing by diviners and religious priests. CONCLUSIONS Nigerian home video is a popular electronic media in Nigeria and scenes depicting mental illness are not uncommon. The industry could be harnessed for promoting mental health literacy.
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Affiliation(s)
- Olayinka Atilola
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
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Abstract
OBJECTIVE To explore the meaning of taking antipsychotic medication in a population with schizophrenia. METHOD A literature review of publications on the meaning of medication was conducted using PsycINFO, Medline, and SOCINDEX databases (2001-2012) and search terms attitude or meaning plus antipsychotics or neuroleptics. Based on this search, 110 articles were found, 60 of which were judged relevant to the goal of this article. A recently published expert consensus guideline was also used to better understand current thinking about medication adherence issues in patients with severe mental illness. Quotations from patients attending a women's clinic for psychosis were used to expand on themes found in the literature. RESULTS Themes extracted from the reviewed literature fell into three main categories: a) control by and of medication, b) dependence on medication and on the prescriber, and c) stigma resulting from medication use. These themes contrast with the usual medical associations with medication (e.g., symptom relief or side effects). CONCLUSION Shared discussion of beliefs about medication between patient and care provider allows wider exploration of personal meanings that can help establish therapeutic relationships and integrate psychological therapy with psychopharmacology.
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Abstract
Healthcare in Germany is characterized by a dichotomy of a private and a public healthcare sector, which also pertains to mental healthcare. While the prevalence figures of mental disorders in Germany remained fairly constant over the last 15 years, utilization rates of healthcare services due to mental disorders increased by 70-80% including inpatient and outpatient services, sick leave cases and cases of early retirement due to mental disorders. Several challenges are currently evident for mental healthcare in Germany, ranging from interesting a sufficient number of medical students for this field of medicine, dealing with the yet unforeseeable consequences of a novel mental hospital remuneration system, better integration of services and remuneration providers, to elucidating the causes of the increasing utilization rates. Mental healthcare research will take centre stage in addressing these challenges.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany.
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126
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James BO, Omoaregba JO, Okogbenin EO. Stigmatising attitudes towards persons with mental illness: a survey of medical students and interns from southern Nigeria. Ment Illn 2012; 4:e8. [PMID: 25478110 PMCID: PMC4253366 DOI: 10.4081/mi.2012.e8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/13/2012] [Accepted: 03/21/2012] [Indexed: 11/25/2022] Open
Abstract
Stigmatising attitudes towards persons with mental illness are commonly reported among health professionals. Familiarity with mental illness has been reported to improve these attitudes. Very few studies have compared future medical doctors’ attitudes toward types of mental illness, substance use disorders and physical illness. A cross-sectional survey of 5th and 6th year medical students as well as recently graduated medical doctors was conducted in April 2011. The 12-item level of contact report and the Attitude towards Mental Illness Questionnaire were administered. Participants endorsed stigmatising attitudes towards mental illness; with attitudes more adverse for schizophrenia compared to depression. Stigmatising attitudes were similarly endorsed for substance use disorders. Paradoxically, attitudes towards HIV/AIDS were positive and similar to diabetes mellitus. Increasing familiarity with mental illness was weakly associated with better attitudes towards depression and schizophrenia. Stigmatising attitudes towards depression and schizophrenia are common among future doctors. Efforts to combat stigma are urgently needed and should be promoted among medical students and recent medical graduates.
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127
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Lorem GF, Hem MH. Attuned understanding and psychotic suffering: a qualitative study of health-care professionals' experiences in communicating and interacting with patients. Int J Ment Health Nurs 2012; 21:114-22. [PMID: 22017495 DOI: 10.1111/j.1447-0349.2011.00773.x] [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: 11/28/2022]
Abstract
This study was initiated to examine how experiences with mental illness are perceived by health-care workers, and how insight affects assessment of their perspective and involvement. Lack of insight gives rise to problems concerning communication: if we expect what the person says and does not to have any meaning, how then can we establish a relationship based on understanding? This study was based on in-depth interviews with 11 mental health-care workers. Participants were recruited from a variety of institutions and professional backgrounds. The following topics were discussed with the participants: lack of insight, awareness of illness, and coping strategies, as well as how these factors affected treatment, cooperation, and participation. The participants describe attuned understanding as an other-oriented process, involving sensitivity to many aspects of the person's situation. Understanding is sought and is established through emotional, human contact, and practical interaction, and ends with new articulated understanding. The results suggest that the process described here can be viewed as other-oriented understanding, and not merely sympathy. It is an interdependent process of imagining oneself in the other's place, and depends on awareness of the nature of this process and on sensitivity to the person's expressions.
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128
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Affiliation(s)
- NORMAN SARTORIUS
- Association for the Improvement of Mental Health
Programmes, Geneva, Switzerland
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129
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130
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Papers and documents available on the WPA website. World Psychiatry 2012; 11:63. [PMID: 22295016 PMCID: PMC3266756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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131
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Sousa SD, Marques A, Rosário C, Queirós C. Stigmatizing attitudes in relatives of people with schizophrenia: a study using the Attribution Questionnaire AQ-27. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2012; 34:186-97. [DOI: 10.1590/s2237-60892012000400004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 03/07/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND: Family members of people with mental disorders can contribute to stigmatization. Because of the lack of adequate information and resources, and the fatigue resulting from daily care, the family can reinforce social exclusion of the mentally ill and disbelieve recovery. Furthermore, family members may also suffer from self-stigma, experiencing a decrease in their own self-esteem and self-worth. OBJECTIVE: To evaluate the presence of stigmatizing attitudes towards patients diagnosed with schizophrenia in a group of relatives of patients with this disorder. METHODS: In this exploratory study, we surveyed 40 family members of patients with schizophrenia seen at the Community Psychiatry Unit of the Psychiatry Department at Centro Hospitalar de São João (CHSJ), in Porto, Portugal, using a preliminary version of the Attribution Questionnaire AQ-27 in Portuguese. RESULTS: The questionnaire dimensions with the highest mean scores were help, pity, and coercion, followed by segregation, anger, avoidance, dangerousness, responsibility, and fear. These results suggest that relatives do not see people with schizophrenia as responsible for their illness and that they show concern and willingness to help. They avoid but do not fear people with schizophrenia and neither consider them dangerous. CONCLUSION: The participants expressed positive, little stigmatizing attitudes towards people with schizophrenia, probably as a result of their familiarity with severe mental disorder, an adequate attribution process, and low levels of perceived dangerousness. However, the high scores of coercion, pity, and segregation may reflect concealed stigmas that may influence the self-determination of the mentally ill, suggesting the need for psychoeducational interventions aimed at family members.
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132
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Shrivastava A, Johnston M, Bureau Y. Stigma of Mental Illness-1: Clinical reflections. Mens Sana Monogr 2012; 10:70-84. [PMID: 22654383 PMCID: PMC3353607 DOI: 10.4103/0973-1229.90181] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/22/2011] [Accepted: 11/23/2011] [Indexed: 11/30/2022] Open
Abstract
Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss the causes and consequences of stigma related to mental illness.
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Affiliation(s)
- Amresh Shrivastava
- The University of Western Ontario. Regional Mental health Care, 467, Sunset Drive, St.Thomas, Ontario, N6H3V9, Canada
| | - Megan Johnston
- Dept. of Psychology, University of Toronto, 100 St. George St., Toronto, ON M5S 3G3, Canada
| | - Yves Bureau
- Lawson Health Research Institute, 268 Grosvenor Street, Room E5-136 London, Ontario, Canada N6A . 4V2, Assistant Professor (Psychology), The University of Western Ontario, Canada
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133
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Gaebel W, Zäske H, Cleveland HR, Zielasek J, Stuart H, Arboleda-Florez J, Akiyama T, Gureje O, Jorge MR, Kastrup M, Suzuki Y, Tasman A, Sartorius N. Measuring the stigma of psychiatry and psychiatrists: development of a questionnaire. Eur Arch Psychiatry Clin Neurosci 2011; 261 Suppl 2:S119-23. [PMID: 21947511 DOI: 10.1007/s00406-011-0252-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/14/2011] [Indexed: 11/26/2022]
Abstract
The stigma of mental illness is a severe burden for people suffering from mental illness both in private and public life, also affecting their relatives, their close social network, and the mental health care system in terms of disciplines, providers, and institutions. Interventions against the stigma of mental illness employ complementary strategies (e.g., protest, education, and contact) and address different target groups (e.g., school children and teachers, journalists, stakeholders). Within this framework, the World Psychiatric Association has adopted an Action Plan with the goal to improve the image of psychiatry and to reduce potential stigmatizing attitudes toward psychiatry and psychiatrists. To evaluate such interventions, a questionnaire has been developed that assesses opinions and attitudes toward psychiatrists and psychiatry in different samples of medical specialists (psychiatrists and general practitioners). The questionnaire comprises scales about perceived stigma in terms of the perception of societal stereotypes, self-stigma in terms of stereotype agreement, perceived stigma in terms of structural discriminations, discrimination experiences, stigma outcomes, and attitudes toward a second medical discipline. It is available in several languages (Arab, English, German, Japanese, Polish, and Spanish) and can easily be adapted for utilization in other medical specialties.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
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134
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135
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Affiliation(s)
- Mario Maj
- President, World Psychiatric Association
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136
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Measuring the stigma of psychiatry and psychiatrists: development of a questionnaire. Eur Arch Psychiatry Clin Neurosci 2011. [PMID: 21947511 DOI: 10.1007/s00406-011-025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The stigma of mental illness is a severe burden for people suffering from mental illness both in private and public life, also affecting their relatives, their close social network, and the mental health care system in terms of disciplines, providers, and institutions. Interventions against the stigma of mental illness employ complementary strategies (e.g., protest, education, and contact) and address different target groups (e.g., school children and teachers, journalists, stakeholders). Within this framework, the World Psychiatric Association has adopted an Action Plan with the goal to improve the image of psychiatry and to reduce potential stigmatizing attitudes toward psychiatry and psychiatrists. To evaluate such interventions, a questionnaire has been developed that assesses opinions and attitudes toward psychiatrists and psychiatry in different samples of medical specialists (psychiatrists and general practitioners). The questionnaire comprises scales about perceived stigma in terms of the perception of societal stereotypes, self-stigma in terms of stereotype agreement, perceived stigma in terms of structural discriminations, discrimination experiences, stigma outcomes, and attitudes toward a second medical discipline. It is available in several languages (Arab, English, German, Japanese, Polish, and Spanish) and can easily be adapted for utilization in other medical specialties.
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137
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Portrayal of psychiatrists in Hindi movies released in the first decade of the 21st century. Asian J Psychiatr 2011; 4:210-3. [PMID: 23051119 DOI: 10.1016/j.ajp.2011.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 06/27/2011] [Accepted: 07/04/2011] [Indexed: 11/22/2022]
Abstract
CONTEXT Of late, there has been an increase in the number of psychiatrists shown in Hindi movies. There is dearth of systematic research that focuses specifically upon the depiction of psychiatrists in Hindi cinema. AIM To explore the portrayal of psychiatrists in recent Hindi cinema. MATERIALS AND METHODS Twenty-six Hindi movies released between January 2001 and March 2010 portraying 33 'psychiatrist' characters in a main or a secondary (but significant) role, were reviewed and data related to the personal attributes and professional conduct of the movie psychiatrists was collected. RESULTS AND CONCLUSIONS The portrayal of psychiatrists in Hindi movies released in the first decade of the 21st century is unflattering. Hindi movies depicted psychiatrists as most likely to be male, middle-aged, and friendly in their attitude towards the patients. 42.4% of them were clinically incompetent, and only 30.3% could make an accurate diagnosis. 39.4% of them breached professional ethics. Eight (24. 2%) transgressed non-sexual boundaries, whereas five (15.2%) violated both sexual and non-sexual boundaries. The most common clinical/treatment setting was outpatient (53.8%), and pharmacotherapy was the most common treatment modality used. Treatment outcome was depicted positive in only 23.1% of the movies analyzed.
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Magliano L, Read J, Rega S, Oliviero N, Sagliocchi A, Patalano M, D'Ambrosio A. The influence of causal explanations and diagnostic labeling on medical students' views of schizophrenia. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:1155-1162. [PMID: 21785312 DOI: 10.1097/acm.0b013e318226708e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Negative attitudes toward mental illness among medical professionals can influence the quality of medical care they provide. The authors examined the impact of causal explanations and diagnostic labeling on medical students' views of schizophrenia. METHOD Medical students in their fifth and sixth years at the Second University of Naples (Italy) who attended lectures from April through June 2010 completed a self-report questionnaire regarding their beliefs about the mental disorder described (but not named) in a case vignette depicting a person who meets the International Classification of Diseases-10 criteria for schizophrenia. RESULTS Of the 232 students invited, 194 (84%) completed the questionnaire. Students most frequently cited heredity as the cause (81%), followed by stress (69%), psychological traumas (45%), and misuse of street drugs (44%). Most students (82%) labeled the case "schizophrenia"; a minority (24%) believed that persons with the case vignette disorder could be well again. Both labeling the case as "schizophrenia" and naming heredity as the cause were independently associated with pessimism about the possibility of recovery and with the perception that "others" keep their distance from persons with this diagnosis. Heredity was more frequently cited by respondents who labeled the case schizophrenia and was significantly associated with students' perception that people with this diagnosis are unpredictable. CONCLUSIONS These findings confirm that, in a sample of medical students, biogenetic causal explanations and diagnostic labeling have negative effects on beliefs about schizophrenia. They highlight the need to educate medical students about recovery from and stigma related to schizophrenia.
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Affiliation(s)
- Lorenza Magliano
- Department of Experimental Medicine, Second University of Naples, Italy.
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139
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The 15th World Congress of Psychiatry and recent WPA activities. World Psychiatry 2011; 10:159-60. [PMID: 21633696 PMCID: PMC3104893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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140
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PEJUSKOVIC BOJANA, LECIC-TOSEVSKI DUSICA, PRIEBE STEFAN. Burnout in psychiatrists, general practitioners and surgeons. World Psychiatry 2011; 10:78. [PMID: 21379358 PMCID: PMC3048514 DOI: 10.1002/j.2051-5545.2011.tb00015.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - DUSICA LECIC-TOSEVSKI
- Institute of Mental Health, Belgrade, Serbia ,School of Medicine, Belgrade University, Belgrade,
Serbia
| | - STEFAN PRIEBE
- Unit for Social and Community Psychiatry, Barts,
and the London School of Medicine and Dentistry, Queen Mary University of
London, UK
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141
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WPA papers and documents 2009-2010. World Psychiatry 2011; 10:79-80. [PMID: 21379360 PMCID: PMC3048504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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142
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The implementation of the WPA Action Plan 2008-2011. World Psychiatry 2010; 9:190-1. [PMID: 20975868 PMCID: PMC2948724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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