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Beckers T, Jaeqx-van Tienen L, Willems R, Koopmans M, Corstens D. Personal-recovery-oriented community mental healthcare: qualitative evaluation of a developmental project. BMJ Open 2020; 10:e035709. [PMID: 32503871 PMCID: PMC7279651 DOI: 10.1136/bmjopen-2019-035709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Mental healthcare is commonly aimed at reducing symptoms in individual service users. When only symptomatic recovery is addressed, not all service users experience sufficient recovery, and when care is aimed only at individuals (instead of the neighbourhood), not all people in need of mental healthcare are reached. This study evaluated a project that aimed to improve mental healthcare in a neighbourhood, by improving healthcare providers' outreach to the residents living in the neighbourhood, by improving collaboration among healthcare providers and focussing on the residents' personal recovery. This project was carried out by several public health services. It aimed to change the goal of mental healthcare provided in the neighbourhood from symptom reduction to personal recovery. DESIGN The study included qualitative focus groups and inductive content analysis. SETTING Primary and secondary mental healthcare that healthcare workers from different healthcare services provided. PARTICIPANTS The evaluation was conducted through three focus group interviews with services users, their friends and relatives, neighbourhood residents, neighbourhood representatives and the healthcare services that were involved (n = 24). RESULTS Evaluation indicated that the most valued part of the project was the utilisation of peer workers at the initiation of mental healthcare. Improved communication among healthcare providers that the project fostered was also highly regarded. The aim of the project to align it with existing initiatives in the neighbourhood was also considered important, although it was difficult to achieve. CONCLUSIONS The project did not find a panacea for recovery-oriented community mental healthcare. A variety of its components did, however, contribute to the mental health of the community residents.
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Affiliation(s)
- Thijs Beckers
- Research Group Social Psychiatry and Mental Health Nursing, Hogeschool Arnhem Nijmegen University of Applied Science, Schinveld, The Netherlands
- MET ggz, Roermond, Limburg, The Netherlands
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Subramaniam M, Shahwan S, Abdin E, Goh CMJ, Ong WJ, Tan GTH, Baig N, Samari E, Kwok KW, Chong SA. Advancing Research to Eliminate Mental Illness Stigma: The Design and Evaluation of a Single-Arm Intervention Among University Students in Singapore. Front Psychol 2020; 11:1151. [PMID: 32581957 PMCID: PMC7283943 DOI: 10.3389/fpsyg.2020.01151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background Anti-stigma interventions for school and college students have been studied in several countries, but to the best of our knowledge, this has not been addressed in Singapore. The current study was designed to address this lacuna and aimed to evaluate the effectiveness of an anti-stigma intervention focusing on depression among university students in Singapore. Methods A one-off intervention comprising education and personal contact with a person with lived experience of depression was carried out in nine consecutive sessions over 6 months (October 2018 to April 2019) among 390 university students. Knowledge of depression and extent of stigma toward mental illness were assessed pre- and post-intervention as well as at 3-month follow-up. Results The intervention was effective in improving depression knowledge (d = 1.09; p < 0.001), as well as reducing social distancing (d = 0.54; p < 0.001) and personal stigma (dangerous/undesirable: d = 0.60; p < 0.001 and weak not sick: d = 0.10; p < 0.033) pre- to post-intervention as well as pre- intervention to 3-month follow-up (p < 0.005). Limitations While 3-month follow-up data indicates favorable medium-term impact on knowledge and stigma; the study lacks long-term follow-up to examine the impact of anti-stigma interventions across time. The data were collected through self-report measures; however, social desirability bias is possible despite the assurances of confidentiality. Conclusion Given the impact of the intervention, there is a need to consider the feasibility, challenges, and enablers of implementation of such interventions into the curriculum of university students to ensure a broader and sustained outreach and stigma reduction.
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Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Wei Jie Ong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Nawira Baig
- Nursing Department, Institute of Mental Health, Singapore, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Kian Woon Kwok
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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103
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Impacto de uma intervenção no estigma em saúde mental e ansiedade intergrupal. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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104
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O'Ferrall-González C, Almenara-Barrios J, García-Carretero MÁ, Salazar-Couso A, Almenara-Abellán JL, Lagares-Franco C. Factors associated with the evolution of attitudes towards mental illness in a cohort of nursing students. J Psychiatr Ment Health Nurs 2020; 27:237-245. [PMID: 31663221 DOI: 10.1111/jpm.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/28/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People with mental health difficulties have poorer physical health than the general population. The stigmatizing attitude of health professionals impacts the quality of care for these people. There is a broad background on the effectiveness of activities based on theoretical training, clinical practices or social contact to improve nursing students' attitudes towards people with mental health difficulties. There is an important need to assess whether the benefits identified in the short term are maintained in the longer term. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The positive evolution of attitudes towards mental illness does not last over time. Some students' attitude towards people with a mental health difficulty worsened in the final stage of their training after completing clinical practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is necessary for tutors incorporate an understanding of stigma throughout the degree training and to discuss with the students the emotional aspects experienced during the performance of clinical practices. The design of any anti-stigma intervention must include the factor of "time". ABSTRACT: Introduction The stigma of health professionals is a contributing factor to morbi-mortality among people with mental health difficulties. There is a lack of research on long-term outcomes in nursing students. Objective To identify factors associated with the evolution of stigmatizing attitudes towards mental illness in a cohort of students trained in mental health. Method A prospective observational study of the impact of training in mental health care. Age, gender, stigma, level of previous familiarity with mental illness, self-education by Internet, academic performance and the place where practicums are conducted were evaluated on three occasions over 15 months. Results Academic performance, online consultation and the size or origin of the theoretical group were indicators of better attitudes. The positive evolution of attitudes does not last over time. Discussion Instability over time could be explained by students' experience in the practicum, although the time itself has been identified as a determining factor. Practical implications Further studies should be promoted in academia to assess the content of mental health training and its influence on the evolution of the stigmatizing attitude. It is also necessary to address stigma in small groups, where students with better academic results lead anti-stigma activities.
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Affiliation(s)
- Cristina O'Ferrall-González
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain.,Research Group PAIDI CTS-391, University of Cádiz, Cádiz, Spain
| | - José Almenara-Barrios
- Department of Biomedicine, Biotecnology and Public Health, University of Cádiz, Cádiz, Spain
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Kennedy AJ, Brumby SA, Versace VL, Brumby-Rendell T. The ripple effect: a digital intervention to reduce suicide stigma among farming men. BMC Public Health 2020; 20:813. [PMID: 32471501 PMCID: PMC7260777 DOI: 10.1186/s12889-020-08954-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Compared with the general population, Australian farmers-particularly men-have been identified as at greater risk of suicide. A complex range of factors are thought to contribute to this risk, including the experience of Stigma. stigma also impacts those who have attempted suicide, their carers, and those bereaved by suicide-manifesting as shame, guilt, social isolation, concealment of death, reduced help seeking and ongoing risk of suicide. This paper evaluates the effectiveness of an intervention, tailored for the farming context, designed to reduce stigma among farming men with a lived experience of suicide. METHODS The digital intervention used an adult learning model providing opportunity to share insights, reflect, learn and apply new knowledge among people with shared farming interests, suicide experience and cultural context. A range of content-tailored to the gender, farming type and suicide experience of participants-included video stories, postcard messages, education and personal goal setting. Pre- and post- assessment of suicide stigma and literacy was complemented by qualitative data collection during the intervention and participant feedback surveys. RESULTS The intervention was successful in reaching members of the target group from across Australia's rural communities-with diverse geographic locations and farming industries represented. One hundred and sixty-nine participants from the target group (farming males aged 30-64 years) were recruited. While the Stigma of Suicide Scale failed to identify a reduction in self- or perceived-stigma, qualitative data and participant feedback identified behavioural indicators of stigma reduction. Four subthemes-'growth', 'new realisations', 'hope' and 'encouragement'-highlighted attitudinal and behaviour change indicative of reduced stigma associated with mental health and suicide. Participants' baseline suicide literacy (Literacy of Suicide Scale) was high when compared with previous community samples and total literacy scores did not demonstrate significant improvement over time, although literacy about the link between suicide and alcoholism did significantly improve. CONCLUSIONS These results highlight opportunities in groups with high suicide literacy for targeted stigma reduction and suicide prevention efforts for both the target group and other populations within Australia and internationally. Results also highlight the need to reassess how stigma change is understood and evaluated across a wider range of population groups. TRIAL REGISTRATION This research project was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12616000289415) on 7th March, 2016.
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Affiliation(s)
- Alison J. Kennedy
- Deakin University/National Centre for Farmer Health, 75 Pigdons Road, Waurn Ponds, VIC 3216 Australia
| | - Susan A. Brumby
- Deakin University/National Centre for Farmer Health, 75 Pigdons Road, Waurn Ponds, VIC 3216 Australia
- Deakin Rural Health, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC 3216 Australia
| | - Vincent Lawrence Versace
- National Centre for Farmer Health, Western District Health Service, PO Box 283, Hamilton, VIC 3300 Australia
| | - Tristan Brumby-Rendell
- Deakin Rural Health, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC 3216 Australia
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106
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Economou M, Peppou LE, Kontoangelos K, Palli A, Tsaliagkou I, Legaki EM, Gournellis R, Papageorgiou C. Mental Health Professionals' Attitudes to Severe Mental Illness and Its Correlates in Psychiatric Hospitals of Attica: The Role of Workers' Empathy. Community Ment Health J 2020; 56:614-625. [PMID: 31863225 DOI: 10.1007/s10597-019-00521-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
To describe mental health workers' attitudes to severe mental illness and to explore its socio-demographic and professional correlates, including the influence of empathy. A total of 127 mental health staff working on the psychiatric hospitals of Attica participated in the study. Stigma was assessed with the Attitudes to Severe Mental Illness scale (ASMI) and the Greek Social Distance scale; whilst Empathy with the Interpersonal Reactivity Index. Participants' unfavourable attitudes to severe mental illness were limited to pessimism about recovery, difficulty in viewing people with mental illness as similar to other people and desire to keep distance in intimate encounters. Professional group and personal experience with mental illness were found to predict stigma. Only perspective taking was associated with both stigma measures; while Fantasy was positively correlated with social distance. Anti-stigma interventions in mental healthcare should prioritize nurses and psychiatrists and aim at enhancing perspective taking.
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Affiliation(s)
- Marina Economou
- First Department of Psychiatry, Medical School, Aigintion Hospital, National and Kapodistrian University of Athens, Athens, Greece.
- Community Mental Health Centre, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis" (U.M.H.R.I.), 2 Soranou toy Efesiou St, 11527, Athens, Greece.
| | - Lily Evangelia Peppou
- Community Mental Health Centre, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis" (U.M.H.R.I.), 2 Soranou toy Efesiou St, 11527, Athens, Greece
| | - Konstantinos Kontoangelos
- First Department of Psychiatry, Medical School, Aigintion Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Community Mental Health Centre, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis" (U.M.H.R.I.), 2 Soranou toy Efesiou St, 11527, Athens, Greece
| | - Alexandra Palli
- Community Mental Health Centre, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis" (U.M.H.R.I.), 2 Soranou toy Efesiou St, 11527, Athens, Greece
| | - Irene Tsaliagkou
- Community Mental Health Centre, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis" (U.M.H.R.I.), 2 Soranou toy Efesiou St, 11527, Athens, Greece
| | - Emilia-Maria Legaki
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Rossetos Gournellis
- Second Department of Psychiatry, Medical School, Aigintion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Papageorgiou
- First Department of Psychiatry, Medical School, Aigintion Hospital, National and Kapodistrian University of Athens, Athens, Greece
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107
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Craven MR, Quinton S, Taft TH. Inflammatory Bowel Disease Patient Experiences with Psychotherapy in the Community. J Clin Psychol Med Settings 2020; 26:183-193. [PMID: 30136200 DOI: 10.1007/s10880-018-9576-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study aimed to characterize patient expectations for integrating mental health into IBD treatment, describe experiences with psychotherapy, and evaluate therapy access and quality. Adults with IBD were recruited online and via a gastroenterology practice. Participants, 162 adults with IBD, completed online questionnaires. The sample was primarily middle-aged, White, and female. Sixty percent had Crohn's Disease. Disease severity was mild to moderate; 38% reported utilizing therapy for IBD-specific issues. The greatest endorsed barrier to psychotherapy was its cost. Psychotherapy was perceived as leading to modest gains in quality of life, emotional well-being, and stress reduction. Participants reported a disparity between their desire for mental health discussions and their actual interactions with providers. The majority of participants (81%) stated there are insufficient knowledgeable therapists. A significant number of patients with IBD endorsed the desire for mental health integration into care. Disparities exist in reported provider-patient communication on these topics. There appears to be a dearth of IBD-knowledgeable therapists in the community.
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Affiliation(s)
- Meredith R Craven
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Sarah Quinton
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tiffany H Taft
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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108
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Stigmatising attitudes towards people who inject drugs, and people living with blood borne viruses or sexually transmissible infections in a representative sample of the Australian population. PLoS One 2020; 15:e0232218. [PMID: 32339212 PMCID: PMC7185717 DOI: 10.1371/journal.pone.0232218] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/09/2020] [Indexed: 11/19/2022] Open
Abstract
Stigma has significant detrimental health outcomes for those affected. This study examined socio-demographic characteristics that were associated with stigmatising attitudes among the general population towards people who inject drugs, and people living with blood borne viruses or sexually transmissible infections. Questions were included in the Australian Survey of Social Attitudes (total sample = 1,001). Attitudes towards each of the target populations were measured by 5-item stigma scales. Bivariate analyses and multiple regression analyses were conducted to identify socio-demographic characteristics associated with stigmatising attitudes. Knowing a person affected by a stigmatised attribute was associated with reduced stigmatising attitudes, while voting for a conservative political party was associated with increased stigmatising attitudes. Age, gender, education, income, and marital status were each related to some stigmatising attitudes. Results also highlight differences between attitudes towards a stigmatised behaviour (i.e., injecting drug use) and stigmatised conditions (i.e., blood borne viruses and sexually transmissible infections). Identifying socio-demographic characteristics that are associated with stigmatising attitudes may have global implications for informing stigma reduction interventions, in order to promote positive health outcomes for affected communities.
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109
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Smythe T, Adelson JD, Polack S. Systematic review of interventions for reducing stigma experienced by children with disabilities and their families in low‐ and middle‐income countries: state of the evidence. Trop Med Int Health 2020; 25:508-524. [DOI: 10.1111/tmi.13388] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Tracey Smythe
- London School of Hygiene & Tropical Medicine London UK
| | - Jaimie D Adelson
- Institute for Health Metrics and Evaluation University of Washington Seattle WA USA
| | - Sarah Polack
- London School of Hygiene & Tropical Medicine London UK
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110
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Salinger R. Empirically Based Practices to Address Disability Stigma in the Classroom. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2020. [DOI: 10.1080/15377903.2020.1749203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Rachel Salinger
- School of Education, University of Delaware College of Education and Human Development, Newark, Delaware, USA
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111
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Murney MA, Sapag JC, Bobbili SJ, Khenti A. Stigma and discrimination related to mental health and substance use issues in primary health care in Toronto, Canada: a qualitative study. Int J Qual Stud Health Well-being 2020; 15:1744926. [PMID: 32228393 PMCID: PMC7170302 DOI: 10.1080/17482631.2020.1744926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE Community Health Centres (CHCs) are an essential component of primary health care (PHC) in Canada. This article examines health providers' understandings and experiences regarding stigma towards mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario. METHODS Using a phenomenological approach, we conducted twenty-three interviews with senior staff members and peer workers, and three focus groups with front-line health providers. Ahybrid approach to thematic analysis was employed, entailing a combination of emergent and a priori coding. RESULTS The findings indicate that PHC settings are sites where multiple forms of stigma create health service barriers. Stigma and discrimination associated with MHSU also cohere around intersecting experiences of gender, race, class, age and other issues including the degree and visibility of distress. Clients may find social norms to be alienating, including behavioural expectations in Canadian PHC settings. CONCLUSIONS Given the turmoil in clients' lives, systematic efforts to mitigate stigma were inhibited by myriad proximate factors that demanded urgent response. Health providers were enthusiastic about implementing anti-stigma/recovery-based approaches that could be integrated into current CHC services. Their recommendations for interventions centred around communication and education, such as training, CHC-wide meetings, and anti-stigma campaigns in surrounding communities.
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Affiliation(s)
- Maureen A Murney
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Toronto, Canada.,Department of Community Health Sciences, Centre for Global Public Health, Max Rady College of Medicine, University of Manitoba, Canada
| | - Jaime C Sapag
- WHO / PAHO Collaborating Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Canada.,Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Public Health and the Department of Family Medicine, Pontificia Universidad Católica De Chile, Santiago, Chile
| | - Sireesha J Bobbili
- WHO / PAHO Collaborating Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Canada
| | - Akwatu Khenti
- WHO / PAHO Collaborating Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Canada.,Social & Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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112
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Pescosolido BA, Perry BL, Krendl AC. Empowering the Next Generation to End Stigma by Starting the Conversation: Bring Change to Mind and the College Toolbox Project. J Am Acad Child Adolesc Psychiatry 2020; 59:519-530. [PMID: 31381992 DOI: 10.1016/j.jaac.2019.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 05/23/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine outcomes in a 4-year college pilot program built on stigma change research. U Bring Change to Mind (UBC2M) was developed and launched at Indiana University (IU) in 2014 as an institutionally supported, student-led organization to make campuses "safe and stigma-free zones." The accompanying College Toolbox Project (CTP) assessed change in student prejudice and discriminatory predispositions as well as perceptions and behaviors at follow-up. METHOD All entering Class of 2019 students were invited to complete a Web-based survey (N = 3,287; response rate = 44.6%). In their third year, students were sent a follow-up survey. Stigma indicators for 1,132 students completing both waves were analyzed using descriptive statistics and multivariate regressions. Models controlled for social desirability, prior contact, socio-demographics, and self-reported mental illness. Participation was examined for potential biases. RESULTS Statistically significant positive changes in attitudes and behavioral predispositions emerged. Although fewer students with prior contact endorsed stigma items initially, they reported significant reduction at follow-up. UBC2M active engagement was associated with lowering prejudice. Both passive and active engagement predicted change in discriminatory predispositions as well as current inclusive behaviors and positive perceptions of campus mental health culture. CONCLUSION A long-term, community-based, student empowerment approach with institutional supports is a promising avenue to reduce stigma on college campuses, to develop the next generation of mental health leaders, and to potentially reduce societal levels of stigma in the long run. CTP provides evidence that both contact and contextual visibility matter, and that UBC2M offers a nationally networked organizational strategy to reduce stigma.
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Affiliation(s)
- Bernice A Pescosolido
- Indiana University, Bloomington; Indiana Consortium for Mental Health Services Research, Bloomington.
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113
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What Differentiates Children with ADHD Symptoms Who Do and Do Not Receive a Formal Diagnosis? Results from a Prospective Longitudinal Cohort Study. Child Psychiatry Hum Dev 2020; 51:138-150. [PMID: 31385105 DOI: 10.1007/s10578-019-00917-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
ADHD diagnoses are increasing worldwide, in patterns involving both overdiagnosis of some groups and underdiagnosis of others. The current study uses data from a national longitudinal study of Irish children (N = 8568) to examine the sociodemographic, clinical and psychological variables that differentiate children with high hyperactivity/inattention symptoms, who had and had not received a diagnosis of ADHD. Analysis identified no significant differences in the demographic characteristics or socio-emotional wellbeing of 9-year-olds with hyperactivity/inattention who had and who had not received a diagnosis of ADHD. However, by age 13, those who had held a diagnosis at 9 years showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept. Further research is required to clarify the developmental pathways responsible for these effects.
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114
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Ugarte Bustamante LH, Cerqueira RO, De Marzio F, Leite KP, Cadurin TDP, Leclerc E, Vistorte AOR, Evans-Lacko S, Brietzke E. Barriers to care and psychopathology among Bolivian migrants living in São Paulo, Brazil. Transcult Psychiatry 2020; 57:71-80. [PMID: 31248358 DOI: 10.1177/1363461519853639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to investigate barriers to appropriate mental health care in a sample of Bolivian migrants living in São Paulo and to examine the association between barriers of care and the presence of symptoms of non-psychotic psychiatric disorders in this population. Considering that treatment usually reduces symptoms, it could be hypothesized that individuals reporting more barriers to care also will report more symptoms. The sample comprised 104 individuals born in Bolivia, with Bolivian nationality and living in São Paulo for at least 30 days prior to enrolling in the study, between 18 and 80 years of age and able to read and write in Spanish or Portuguese. The symptoms of mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20) and barriers to appropriate mental health care were evaluated using the Barriers to Assessing Care Evaluation (BACE). A multiple linear regression analysis was performed to determine the predictive effect of the BACE total score (independent variable) in the SRQ-20 score (dependent variable), including in the model, and the variables that were significantly correlated with the BACE total score or SRQ-20. Our results indicate that more than a half of the sample of Bolivian migrants living in Sao Paulo, Brazil, especially females, presented significant non-psychotic psychopathology. Individuals reporting more barriers to care, especially instrumental and attitudinal barriers, also have a higher risk of psychiatric symptoms, independently of sex, age and family income. Our results suggest that actions to increase availability of mental health services, especially culturally sensitive services, could reduce barriers to care and improve mental health among migrants.
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115
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Whitley R, Sitter KC, Adamson G, Carmichael V. Can participatory video reduce mental illness stigma? Results from a Canadian action-research study of feasibility and impact. BMC Psychiatry 2020; 20:16. [PMID: 31918689 PMCID: PMC6953159 DOI: 10.1186/s12888-020-2429-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that stigma against people with mental illness remains high. This demands innovative approaches to reduce stigma. One innovative stigma reduction method is participatory video (PV), whereby marginalized people come together to script, film and produce bottom-up educational videos about shared issues. These videos are then shown to target groups. This paper has two objectives (i) to examine the feasibility of using participatory video with people with severe mental illness (SMI); and (ii) to assess viewer impressions of the resultant videos and subsequent subjective impact. METHODS We conducted a participatory action research study with three workgroups of people with severe mental illness situated in different Canadian cities, who set out to create and disseminate locally-grounded mental-health themed videos. This involved process and outcome evaluation to assess feasibility and impact. Specifically, we (i) observed fidelity to a co-designed action-plan in all three workgroups; (ii) distributed brief purpose-built questionnaires to viewers at organized screenings to assess preliminary impact; and (iii) conducted focus groups with viewers to elicit further impressions of the videos and subsequent subjective impact. RESULTS The three workgroups achieved high-fidelity to the action-plan. They successfully produced a total of 26 videos, over double the targeted number, during an 18-month period. Likewise, the workgroups organized 49 screenings at a range of venues attended by 1542 people, again exceeding the action-plan targets. Results from the viewer questionnaires (N = 1104, response rate 72%) indicated that viewers reported that their understandings had improved after watching the videos. Four themes emerged from six viewer focus groups (N = 30), with participants frequently noting that videos were (i) educational and informative; (ii) real and relatable; (iii) attention-grabbing; and (iv) change-inducing. CONCLUSIONS To our knowledge, this study is the first large-scale multi-site project examining the feasibility and impact of a participatory video program for people with severe mental illness. The results indicate that participatory video is a feasible method in this population and gives preliminary evidence that resultant videos can reduce viewer stigma. Thus, participatory video should be considered a promising practice in the ongoing effort to reduce mental illness stigma.
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Affiliation(s)
- Rob Whitley
- Department of Psychiatry, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Kathleen C. Sitter
- 0000 0004 1936 7697grid.22072.35University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Gavin Adamson
- 0000 0004 1936 9422grid.68312.3eSchool of Journalism, Ryerson University, 350 Victoria St, Toronto, ON M5B 2K3 Canada
| | - Victoria Carmichael
- 0000 0004 1936 8649grid.14709.3bDepartment of Psychiatry, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Blvd, Montreal, QC H4H 1R3 Canada
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Tomar N, Thornicroft G. Principle of gradient rationality: Revisiting stigma and conceptualizing its guiding mechanism. Soc Sci Med 2020; 245:112716. [PMID: 31835195 DOI: 10.1016/j.socscimed.2019.112716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/19/2019] [Accepted: 12/02/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Historically, much of the stigma research has relied on a language of attributes, using survey methodology for assessment, and the consumers' perspectives on stigma are also inadequate, hindering an in-depth understanding of social processes related to stigma. Thus, this study aims to understand the social processes guiding experiences of stigma among adults with serious mental illness. METHODS Ethnographic methodology was employed to collect data for this study. Methods included interviews and participant observation. Participants included adults with serious mental illness (n = 18) and mental healthcare providers (n = 16), along with policy stakeholders/experts (n = 7). Data analysis was conducted via open and focused coding along with analytic interpretation. RESULTS A social process guiding experiences of stigma, termed as the principle of gradient rationality (PoGR), is proposed. Three components to the principle are: 1) categorization via stigma or status symbols, 2) movement within hierarchy via exchange of social capital, and 3) institutionalization of stigma via interactional stigma. Briefly, the principle suggests that, during an interaction, individuals can be placed in a hierarchy of three roles/categories ("unreasonable," "high-functioning," or "normal") based on their measure of non-normative behavior. The lower one's position in the hierarchy, the more likely one is to experience stigma. Findings can help develop stigma measures that are sensitive to the variability of individuals experiencing mental illness and to the variability of stigma experiences on a personal/contextual level. Research in other settings is required to further study the applicability of this principle across contexts.
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Affiliation(s)
- Nikhil Tomar
- Department of Occupational Therapy at the University of New Hampshire, Hewitt Hall, 4 Library Way, The University of New Hampshire, Durham, NH, 03824, USA.
| | - Graham Thornicroft
- Community Psychiatry in the Institute of Psychiatry, Psychology and Neuroscience at the King's College London, United Kingdom
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117
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Time to Change's social marketing campaign for a new target population: results from 2017 to 2019. BMC Psychiatry 2019; 19:417. [PMID: 31881957 PMCID: PMC6933720 DOI: 10.1186/s12888-019-2415-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Since 2009 Time to Change has included among its strategies a social marketing campaign to tackle the stigma surrounding mental health problems. At the start of its third phase (2016-2021) the target group of the campaign was kept as people aged between mid-twenties and mid-forties but changed to middle-low income groups and the content was focused on men. METHODS Participants (n = 3700) were recruited through an online market research panel, before and after each burst of the campaign. They completed an online questionnaire evaluating knowledge (Mental Health Knowledge Schedule, MAKS); attitudes (Community Attitudes toward Mental Illness, CAMI); and desire for social distance (Intended Behaviour subscale of the Reported and Intended Behaviour Scale, RIBS). Socio-demographic data and awareness of the campaign were also collected. RESULTS For each of the 3 bursts, significant pre-post awareness differences were found (OR = 2.83, CI = 1.90-4.20, p < 0.001; OR = 1.72, CI = 1.22-2.42, p = 0.002; OR = 1.41, CI = 1.01-1.97, p = 0.043), and awareness at the end of the third burst was 33%. Demographic factors associated with awareness for one or more bursts included having children, familiarity with mental illness, male sex, being Black, Asian or other ethnic minorities and living in London or the East Midlands regions. An improvement across bursts in the "living with" subscale item of the RIBS, and in the "recover" and "advice to a friend" MAKS items were found. Familiarity with mental illness had the strongest association with all outcome measures, while the awareness of the campaign was also related with higher scores in MAKS and RIBS. CONCLUSIONS These interim results suggest that the campaign is reaching and having an impact on its new target audience to a similar extent as did the TTC phase 1 campaign. While over the course of TTC we have found no evidence that demographic differences in stigma have widened, and indeed those by age group and region of England have narrowed, those for socioeconomic status, ethnicity and sex have so far remained unchanged. By targeting a lower socioeconomic group and creating relatively greater awareness among men and in Black and ethnic minority groups, the campaign is showing the potential to address these persistent differences in stigma.
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118
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Tomar N, Brinkley-Rubinstein L, Ghezzi MA, Van Deinse TB, Burgin S, Cuddeback GS. Internalized stigma and its correlates among justice-involved individuals with mental illness. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2019. [DOI: 10.1080/00207411.2019.1703358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nikhil Tomar
- Department of Occupational Therapy, University of New Hampshire, Durham, New Hampshire, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marilyn Ann Ghezzi
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonya Bloomer Van Deinse
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stacey Burgin
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gary Steven Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Anttila K, Anttila M, Välimäki M. A web-based adolescent depression support system: feedback and implications for the future. Inform Health Soc Care 2019; 45:111-129. [PMID: 31684788 DOI: 10.1080/17538157.2019.1656206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim is to describe feedback from the adolescents on their use of a web-based depression support system. Web-based support systems can serve as an alternative to conventional treatment or to complement the current services. Mixed methods were used to approach the topic from multiple perspectives. Feedback was collected from adolescents with symptoms of depression or anxiety. Adolescents (n = 46) responded to a questionnaire after participating on the support system, and 24 adolescents did not provide feedback. The data were analyzed with quantitative descriptive statistics and qualitative thematic analysis. Out of 45 adolescents, 93% agreed that the web-based support system was targeted at them, and 89% felt it was reliable and safe. It was perceived as a good channel for reflecting thoughts. However, some adolescents felt it was difficult to use or that using it did not help them. Ideas for development were also offered. Depis.Net provided the adolescents with a reliable way to ease their condition at home. Using feedback from the adolescents on the support system makes it possible to identify those who are able to use this kind of system in daily practice.
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Affiliation(s)
- Katriina Anttila
- Department of Nursing Science, University of Turku, Turku, Finland.,Child Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Development Unit, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Development Unit, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong, People's Republic of China
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120
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Mutiso VN, Pike KM, Musyimi CN, Rebello TJ, Tele A, Gitonga I, Thornicroft G, Ndetei DM. Changing patterns of mental health knowledge in rural Kenya after intervention using the WHO mhGAP-Intervention Guide. Psychol Med 2019; 49:2227-2236. [PMID: 30345938 DOI: 10.1017/s0033291718003112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Despite the high prevalence of mental disorders, mental health literacy has been comparatively neglected. People's symptom-management strategies will be influenced by their mental health literacy. This study sought to determine the feasibility of using the World Health Organization mhGAP-Intervention Guide (IG) as an educational tool for one-on-one contact in a clinical setting to increase literacy on the specified mental disorders. METHODS This study was conducted in 20 health facilities in Makueni County, southeast Kenya which has one of the poorest economies in Kenya. It has no psychiatrist or clinical psychologist. We recruited 3267 participants from a community that had already been exposed to community mental health services. We used Mental Health Knowledge Schedule to measure the changing patterns of mental health knowledge after a period of 3 months, following a training intervention using the WHO mhGAP-IG. RESULTS Overall, there was a significant increase in mental health related knowledge [mean range 22.4-23.5 for both post-test and pre-test scores (p < 0.001)]. This increase varied with various socio-demographic characteristics such as sex, marital status, level of education, employment status and wealth index. CONCLUSIONS mhGAP-IG is a feasible tool to increase mental health literacy in low-resource settings where there are no mental health specialists. Our study lends evidence that the WHO Mental Health Action Plan 2013-2020 and reduction of the treatment gap may be accelerated by the use of mhGAP-IG through improving knowledge about mental illness and potentially subsequent help seeking for early diagnosis and treatment.
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Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA
| | - C N Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - G Thornicroft
- Institute of Psychiatry, King's College London, London, UK
| | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Rasmussen JD, Kakuhikire B, Baguma C, Ashaba S, Cooper-Vince CE, Perkins JM, Bangsberg DR, Tsai AC. Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda. PLoS Med 2019; 16:e1002908. [PMID: 31539373 PMCID: PMC6754129 DOI: 10.1371/journal.pmed.1002908] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness. METHODS AND FINDINGS Study participants were randomly assigned to receive a vignette describing a typical woman (control condition) or one of nine variants describing a different symptom presentation (suggestive of schizophrenia, bipolar, or major depression) and treatment course (no treatment, treatment with remission, or treatment with remission followed by subsequent relapse). Participants then answered questions about personal beliefs and perceived norms in three domains of stigma: willingness to have the woman marry into their family, belief that she is receiving divine punishment, and belief that she brings shame on her family. We used multivariable Poisson and ordered logit regression models to estimate the causal effect of vignette treatment assignment on each stigma-related outcome. Of the participants randomized, 1,355 were successfully interviewed (76%) from November 2016 to June 2018. Roughly half of respondents were women (56%), half had completed primary school (57%), and two-thirds were married or cohabiting (64%). The mean age was 42 years. Across all types of mental illness and treatment scenarios, relative to the control vignette (22%-30%), substantially more study participants believed the woman in the vignette was receiving divine punishment (31%-54%) or believed she brought shame on her family (51%-73%), and most were unwilling to have her marry into their families (80%-88%). In multivariable Poisson regression models, vignette portrayals of untreated mental illness, relative to the control condition, increased the risk that study participants endorsed stigmatizing personal beliefs about mental illness and about persons with mental illness, irrespective of mental illness type (adjusted risk ratios [ARRs] varied from 1.7-3.1, all p < 0.001). Portrayals of effectively treated mental illness or treatment followed by subsequent relapse also increased the risk of responses indicating stigmatizing personal beliefs relative to control (ARRs varied from 1.5-3.0, all p < 0.001). The magnitudes of the estimates suggested that portrayals of initially effective treatment (whether followed by relapse or not) had little moderating influence on stigmatizing responses relative to vignettes portraying untreated mental illness. Responses to questions about perceived norms followed similar patterns. The primary limitations of this study are that the vignettes may have omitted context that could have influenced stigma and that generalizability beyond rural Uganda may be limited. CONCLUSIONS In a population-based, randomized survey experiment conducted in rural southwestern Uganda, portrayals of effectively treated mental illness did not appear to reduce endorsement of stigmatizing beliefs about mental illness or about persons with mental illness. These findings run counter to evidence from the United States. Further research is necessary to understand the relationship between mental illness treatment and stigmatizing attitudes in Uganda and other countries worldwide. TRIAL REGISTRATION The experimental procedures for this study were registered with ClinicalTrials.gov as "Measuring Beliefs and Norms About Persons With Mental Illness" (NCT03656770).
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Affiliation(s)
- Justin D. Rasmussen
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Duke University, Durham, North Carolina, United States of America
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health Sciences University–Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Alexander C. Tsai
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
- Harvard Medical School, Boston, Massachusetts, United States of America
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122
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Topp J, Andrees V, Weinberger NA, Schäfer I, Sommer R, Mrowietz U, Luck-Sikorski C, Augustin M. Strategies to reduce stigma related to visible chronic skin diseases: a systematic review. J Eur Acad Dermatol Venereol 2019; 33:2029-2038. [PMID: 31177601 DOI: 10.1111/jdv.15734] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/27/2019] [Indexed: 12/14/2022]
Abstract
Many patients with a visible chronic skin disease experience discrimination and stigmatization. This results in psychosocial impairments in addition to the burden of disease and emphasizes the urgency to implement effective stigma-reduction strategies. To synthesize what is known globally about effective interventions to reduce stigma associated with visible chronic skin diseases, a systematic review was conducted. Four electronic databases were searched until May 2018. Studies evaluating interventions to reduce stigmatization in patients with visible chronic skin diseases and applying at least one stigma-related outcome measure were included. Data were extracted on study design, country, study population, outcome measures and main findings. Results were subsequently synthesized in a narrative review. Critical Appraisal Skills Programme tools were used to assess study quality. Nineteen studies were included in the review. Study design was very heterogeneous and study quality rather poor. Thirteen studies addresses patients with leprosy in low- and middle-income countries, and one study each targeted patients with onychomycosis, leg ulcer, facial disfigurement, atopic dermatitis, vitiligo and alopecia. Evaluated interventions were mainly multi-faceted incorporating more than one type of intervention. While 10 studies focused on the reduction in self-stigma and 4 on the reduction in public stigma, another 5 studies aimed at reducing both. The present review revealed a lack of high-quality studies on effective approaches to reduce stigmatization of patients with visible chronic skin diseases. Development and evaluation of intervention formats to adequately address stigma is essential to promote patients' health and well-being.
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Affiliation(s)
- J Topp
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - V Andrees
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - I Schäfer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - R Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - U Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - M Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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123
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Maunder RD, White FA. Intergroup contact and mental health stigma: A comparative effectiveness meta-analysis. Clin Psychol Rev 2019; 72:101749. [PMID: 31254936 DOI: 10.1016/j.cpr.2019.101749] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Mental health stigma is a substantial problem all over the world. Although many interventions to reduce stigma exist, there is considerable methodological variability, making it difficult for decision-makers to determine what strategies are the most effective and what characteristics make them so. To this end, we conducted a meta-analysis on intergroup contact strategies and examined several potential moderators. We searched 5 databases for published and unpublished studies and retrieved 101 studies from 24 countries that could be included in the analyses. Ninety studies assessed outcomes immediately after the intervention (n = 15,826), 33 in the short-term (n = 3,697), and 7 in the medium-term (n = 842). The effect of contact was significant and small-to-medium in size at all three timepoints, d = -0.384, -0.334, and -0.526, respectively. Intervention effectiveness did not differ between contact with or without an educational component, different contact mediums, or the mental illness of the outgroup member. However, the effect of contact was stronger in non-Western countries and in university students and health professionals compared to community members. These results may inform policy-makers of the most effective and suitable stigma-reduction initiatives to invest in and can guide researchers towards important avenues for future research.
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Affiliation(s)
| | - Fiona A White
- School of Psychology, University of Sydney, NSW, Australia
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124
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Edge D, Lemetyinen H. Psychology across cultures: Challenges and opportunities. Psychol Psychother 2019; 92:261-276. [PMID: 31001925 DOI: 10.1111/papt.12229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Indexed: 12/27/2022]
Abstract
Large variations of inequalities in rates of mental health disorders and access to mental health care exist within and between countries. Globally, disparities range from countries where there is little provision to those where, despite the availability of evidence-based mental health care, service access and outcomes are mediated by social factors such as socio-economic status, race/ethnicity, and culture. This is salient because increasingly diverse populations are inevitably created with globalization. We posit that in multicultural contexts, effective therapeutic engagement requires therapists who are competent and confident to work with diversity and difference, utilizing insights into their own as well as their clients' internal and external worlds. Although there are many reasons why psychotherapies can be insensitive and harmful, for example, the inherent power imbalance in therapeutic relationships, a lack of awareness of cultural and ethnic variation and needs are among them. Acquisition of 'cultural competence' and increasing availability of culturally-adapted interventions should, in theory, enable practitioners to work with a range of individuals with whom they might have little in common. However, whilst cultural adaptation appears promising, there are concerns regarding its viability as a strategy for tackling disparities in access to psychological care. Evidence for cultural competency is patchy at best. We show how and why delivering effective psychotherapy in the twenty-first century requires a paradigm shift from current approaches to truly integrated models, developed in collaboration with recipients of care. Coproducing interventions, training, and means of evaluating them with clients necessitates taking into consideration social contexts, alternative conceptualizations of mental health and disorders and difficulties, and what constitutes appropriate helpful interventions for psychological distress. PRACTITIONER POINTS: Upskilling therapists to work with diversity and difference is essential for effective delivery of psychological treatments. Increasing the availability of culturally-adapted interventions together with therapists who are sufficiently competent and confident to deliver them should enable practitioners to work with a range of individuals with whom they might have little in common. Coproducing culturally appropriate means of responding to mental health difficulties, staff training and development, and service evaluation methods with clients necessitates taking into consideration social contexts, alternative explanatory models of mental health and 'illness', and what constitutes helpful interventions for psychological distress.
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Affiliation(s)
- Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, UK.,Research & Innovation, Greater Manchester Mental Health NHS Trust, UK
| | - Henna Lemetyinen
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, UK
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Wada M, Suto MJ, Lee M, Sanders D, Sun C, Le TN, Goldman-Hasbun J, Chauhan S. University students’ perspectives on mental illness stigma. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mph.2019.200159] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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126
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Milner A, Aitken Z, Law PCF, LaMontagne AD, Mann C, Cooper T, Witt K. The relationship between an electronic mental health stigma campaign and suicidal thoughts and behaviours: a two-arm randomized controlled trial in the Australian construction industry. Health Promot Int 2019; 35:478-485. [DOI: 10.1093/heapro/daz034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Males employed in the construction industry are at greater risk of suicide than other employed males. It is plausible that a high level of stigma against mental health problems explains the elevated rates of suicide among this group. This study sought to test the effectiveness of an electronic mental health stigma intervention on suicide ideation, communication about suicide and attempts. Participants were randomly assigned to receive either a series of brief contact interventions over a 6-week period or a wait list control. Suicidal ideation, communication about suicide and suicide attempts were assessed using the Suicidal Behaviors Questionnaire-Revised at post-intervention. We used linear regression to assess effectiveness at post-intervention, adjusting for relevant covariates using both conventional methods and a propensity score approach. Results indicate that the intervention had no significant impact on suicidal thoughts, communication or suicide attempts. There was some indication that individuals in the intervention group reported a slight increase in attempts and communication about suicide. These observations underscore an urgent need for more research to understand the complex and nuanced relationship between stigma and suicide in non-clinical populations.
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Affiliation(s)
- A Milner
- Melbourne School of Population and Global Health, Centre for Health Equity, University of Melbourne, Australia
| | - Z Aitken
- Melbourne School of Population and Global Health, Centre for Health Equity, University of Melbourne, Australia
| | - P C F Law
- Melbourne School of Population and Global Health, Centre for Health Equity, University of Melbourne, Australia
| | - A D LaMontagne
- School of Health and Social Development, Centre for Population Health Research, Deakin University, Australia
| | - C Mann
- Incolink – Victoria, 1 Pelham Street, Carlton, VIC 3053, Australia
| | - T Cooper
- Incolink – Victoria, 1 Pelham Street, Carlton, VIC 3053, Australia
| | - K Witt
- Turning Point, Eastern Health Clinical School, Monash University, Australia
- Orygen, the National Centre of Excellence in Youth Mental Health, Australia
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Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: a systematic review. Epidemiol Psychiatr Sci 2019; 29:e28. [PMID: 30929650 PMCID: PMC6848770 DOI: 10.1017/s2045796019000167] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS This systematic review compiled evidence on interventions to reduce mental health-related stigma among medical and nursing students in low- and middle-income countries (LMICs). Primary outcomes were stigmatising attitudes and discriminatory behaviours. METHODS Data collection included two strategies. First, previous systematic reviews were searched for studies that met the inclusion criteria of the current review. Second, a new search was done, covering the time since the previous reviews, i.e. January 2013 to May 2017. Five search concepts were combined in order to capture relevant literature: stigma, mental health, intervention, professional students in medicine and nursing, and LMICs. A qualitative analysis of all included full texts was done with the software MAXQDA. Full texts were analysed with regard to the content of interventions, didactic methods, mental disorders, cultural adaptation, type of outcome measure and primary outcomes. Furthermore, a methodological quality assessment was undertaken. RESULTS A total of nine studies from six countries (Brazil, China, Malaysia, Nigeria, Somaliland and Turkey) were included. All studies reported significant results in at least one outcome measure. However, from the available literature, it is difficult to draw conclusions on the most effective interventions. No meta-analysis could be calculated due to the large heterogeneity of intervention content, evaluation design and outcome measures. Studies with contact interventions (either face-to-face or video) demonstrated attitudinal change. There was a clear lack of studies focusing on discriminatory behaviours. Accordingly, training of specific communication and clinical skills was lacking in most studies, with the exception of one study that showed a positive effect of training interview skills on attitudes. Methods for cultural adaptation of interventions were rarely documented. The methodological quality of most studies was relatively low, with the exception of two studies. CONCLUSIONS There is an increase in studies on anti-stigma interventions among professional students in LMICs. Some of these studies used contact interventions and showed positive effects. A stronger focus on clinical and communication skills and behaviour-related outcomes is needed in future studies.
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Deb T, Lempp H, Bakolis I, Vince T, Waugh W, Henderson C. Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness - study protocol for an international multisite non-randomised controlled study. BMC MEDICAL EDUCATION 2019; 19:41. [PMID: 30704531 PMCID: PMC6357462 DOI: 10.1186/s12909-019-1472-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/24/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND Stigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students' ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding. METHODS/DESIGN READ training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students' knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention. DISCUSSION This is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patients' experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed.
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Affiliation(s)
- Tanya Deb
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Heidi Lempp
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Tushar Vince
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - William Waugh
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Claire Henderson
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
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Cleary M, Visentin DC, West S, Hills AP, Kornhaber R. When the Problem Is 'Global' but the Response Is Not: Inequities in Mental Health Services in Low-and Middle-Income Countries. Issues Ment Health Nurs 2019; 40:83-85. [PMID: 30605355 DOI: 10.1080/01612840.2018.1534477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michelle Cleary
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , NSW , Australia
| | - Denis C Visentin
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , NSW , Australia
| | - Sancia West
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , NSW , Australia
| | - Andrew P Hills
- b College of Health and Medicine , University of Tasmania , Launceston , Tasmania , Australia
| | - Rachel Kornhaber
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , NSW , Australia
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Yamaguchi S, Ojio Y, Ando S, Bernick P, Ohta K, Watanabe KI, Thornicroft G, Shiozawa T, Koike S. Long-term effects of filmed social contact or internet-based self-study on mental health-related stigma: a 2-year follow-up of a randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol 2019; 54:33-42. [PMID: 30315333 DOI: 10.1007/s00127-018-1609-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/08/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE There is a critical need to clarify the long-term effects of anti-stigma interventions. The study aimed to assess the long-term effects of repeated filmed social contact or internet-based self-study on mental health-related stigma through a randomised controlled trial with 2-year follow-up. METHODS We randomly allocated 259 university or college students to a filmed social contact group, an internet-based self-study group, or a control group. The filmed social contact and internet-based self-study groups each received a 30-min initial intervention followed by emailed interventions every 2 months over a 12-month period. The Japanese version of the Reported and Intended Behaviour Scale (RIBS-J) and the Mental Illness and Disorder Understanding Scale (MIDUS) were used to assess behaviour, behavioural intentions (attitudes), and knowledge regarding mental health. RESULTS Of the 259 original participants, 187 completed the 24-month follow-up assessment. Mean scores for the RIBS-J future domain and MIDUS peaked at 1 month after initial intervention. Compared with baseline, at 24-month follow-up, we found a significant difference in RIBS-J future domain scores between the filmed social contact and control groups at 24-month follow-up (B = 0.95, 95% CI = 0.01,1.90, p = 0.049), while MIDUS scores in the filmed social contact group (B = - 4.59, 95%CI = - 6.85, - 2.33, p < 0.001) and the internet-based self-study group (B = - 4.51, 95%CI = - 6.86, - 2.15, p < 0.001) significantly decreased compared with the control group. CONCLUSION While outcome scores peaked at 1 month after initial intervention, results suggest that filmed social contact might have a long-term effect on behavioural intentions, and both filmed social contact and internet-based self-study may contribute to improved knowledge of mental health.
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Affiliation(s)
- Sosei Yamaguchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Yasutaka Ojio
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Shuntaro Ando
- Department of Psychiatry, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Peter Bernick
- Student Accessibility Office, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki, 852-8521, Japan
| | - Kazusa Ohta
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
| | - Kei-Ichiro Watanabe
- Office for Mental Health Support, Division for Counseling and Support, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Takuma Shiozawa
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan.,Institute for Diversity and Adaptation of Human Mind (UTIDAHM), The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan.,The International Research Center for Neurointelligence (WPI-IRCN), Institutes for Advanced Study (UTIAS), The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.,UTokyo Center for Integrative Science of Human Behavior (CiSHuB), 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
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Anderson C, Robinson EJ, Krooupa AM, Henderson C. Changes in newspaper coverage of mental illness from 2008 to 2016 in England. Epidemiol Psychiatr Sci 2018; 29:e9. [PMID: 30511612 PMCID: PMC8061298 DOI: 10.1017/s2045796018000720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/30/2018] [Accepted: 11/04/2018] [Indexed: 11/08/2022] Open
Abstract
AIMS Since 2008 England's anti-stigma programme Time to Change has lobbied media outlets about stigmatising coverage and worked with them to promote accurate and non-stigmatising coverage. While this may have an impact on coverage and hence attitudes, it is also possible that coverage can change in response to improving attitudes, through the creation of a market demand for less stigmatising coverage. This study evaluates English newspaper coverage of mental health topics between 2008 and 2016. METHOD Articles covering mental health in 27 newspapers were retrieved using keyword searches on two randomly chosen days each month in 2008-2016, excluding 2012 and 2015 due to restricted resources. Content analysis used a structured coding framework. Univariate logistic regression models were used to estimate the odds of each hypothesised element occurring in 2016 compared with 2008 and Wald tests to assess the overall statistical significance of the year variable as the predictor. RESULTS The sample retrieved almost doubled between 2008 (n = 882) and 2016 (n = 1738). We found a significant increase in the proportion of anti-stigmatising articles (odds ratio (OR) 2.26 (95% confidence interval (CI) 1.86-2.74)) and a significant decrease in stigmatising articles (OR 0.62 (95% CI 0.51-0.75)). Reports on all diagnoses except for schizophrenia were more often anti-stigmatising than stigmatising. CONCLUSIONS This is the first clear evidence of improvement in coverage since the start of Time to Change. However, coverage of schizophrenia may be less affected by this positive shift than that of other diagnoses. The increase in the level of coverage identified in 2016 requires further investigation, as it may also influence public conceptualisation of what constitutes mental illness, attitudes to mental illness in general and/or specific diagnoses. While most anti-stigma programmes are not diagnosis specific, we suggest their evaluation would benefit from a diagnosis specific approach to allow fuller interpretation of their effects. This could include media analysis driven by hypotheses based on diagnoses to ascertain whether variations by diagnosis over time occur both in the nature and in the proportion of coverage.
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Affiliation(s)
- C. Anderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E. J. Robinson
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A.-M. Krooupa
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - C. Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Tay JL, Tay YF, Klainin-Yobas P. Effectiveness of information and communication technologies interventions to increase mental health literacy: A systematic review. Early Interv Psychiatry 2018; 12:1024-1037. [PMID: 29897166 DOI: 10.1111/eip.12695] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/03/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
AIM Most mental health conditions affect adolescent and young adults. The onset of many mental disorders occurs in the young age. This is a critical period to implement interventions to enhance mental health literacy (MHL) and to prevent the occurrence of mental health problems. This systematic review examined the effectiveness of information and communication technologies interventions on MHL (recognition of conditions, stigma and help-seeking). METHODS The authors searched for both published and unpublished studies. RESULTS Nineteen studies were included with 9 randomized controlled trials and 10 quasi-experimental studies. Informational interventions were useful to enhance MHL of less-known disorders such as anxiety disorder and anorexia, but not depression. Interventions that were effective in enhancing depression MHL comprised active component such as videos or quizzes. Interventions that successfully elevated MHL also reduced stigma. Elevated MHL levels did not improve help-seeking, and reduction in stigma levels did not enhance help-seeking behaviours. CONCLUSIONS Future good quality, large-scale, multi-sites randomized controlled trials are necessary to evaluate MHL interventions.
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Affiliation(s)
- Jing Ling Tay
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Yi Fen Tay
- National University of Singapore, Singapore
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yoo Loo Lin School of Medicine, National University of Singapore, Singapore
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133
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Cratsley K. The Ethical and Empirical Status of Dimensional Diagnosis: Implications for Public Mental Health? NEUROETHICS-NETH 2018. [DOI: 10.1007/s12152-018-9390-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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134
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Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review. Epidemiol Psychiatr Sci 2018; 29:e3. [PMID: 30176952 PMCID: PMC6399081 DOI: 10.1017/s2045796018000458] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIMS This systematic review compiled evidence on interventions to reduce mental health-related stigma in primary health care (PHC) in low- and middle-income countries (LMICs). Studies targeting PHC staff (including non-professionals) were included. Primary outcomes were stigmatising attitudes and discriminatory behaviours. METHODS Data collection included two strategies. First, previous systematic reviews were searched for studies that met the inclusion criteria of the current review. Second, a new search was done, covering the time since the previous reviews, i.e. January 2013 to May 2017. Five search concepts were combined in order to capture relevant literature: stigma, mental health, intervention, PHC staff and LMICs. A qualitative analysis of all included full-texts was done with software MAXQDA. Full-texts were analysed with regards to the content of interventions, didactic methods, mental disorders, cultural adaptation, type of outcome measure and primary outcomes. Furthermore, a risk of bias assessment was undertaken. RESULTS A total of 18 studies were included. Risk of bias was rated as high in most included studies. Only six studies had tested their intervention against a control condition, two of which had used random allocation. Most frequently used interventions were lectures providing theoretical information. Many studies also used interactive methods (N = 9), discussed case studies (N = 8) or used role plays (N = 5). Three studies reported that they had used clinical practice and supervision. Results of these studies were mixed. No or little effects were found for brief training interventions (e.g. 1 h to 1 day). Longer training interventions with more sophisticated didactic methods produced statistically significant changes in validated stigma questionnaires. These results have to be interpreted with caution due to risk of bias. Methods for cultural adaptation of interventions were rarely documented. CONCLUSIONS More rigorous trials are needed in LMICs to test interventions that target discriminatory behaviours in relationship with patients. Cultural adaptation of stigma interventions and structural/institutional factors should be more explicitly addressed in such trials.
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135
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Hastings RP, Gillespie D, Flynn S, McNamara R, Taylor Z, Knight R, Randell E, Richards L, Moody G, Mitchell A, Przybylak P, Williams B, Hunt PH. Who's challenging who training for staff empathy towards adults with challenging behaviour: cluster randomised controlled trial. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:798-813. [PMID: 30033655 DOI: 10.1111/jir.12536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND One in five adults with intellectual disabilities (ID) known to services display challenging behaviours (CBs), and these individuals are at risk for restrictive practices and poor care. Staff attitudes may contribute to the development and/or maintenance of CBs. We investigated the effectiveness of co-produced Who's Challenging Who? training delivered by people with ID to staff. METHOD This study involved a cluster randomised controlled trial (RCT) of Who's Challenging Who? training with follow-up at six and 20 weeks post-randomisation. PARTICIPANTS two staff from each of 118 residential care settings for adults with ID at least one of whom displayed aggressive CB. PRIMARY OUTCOME Self-reported Staff Empathy for people with Challenging Behaviour Questionnaire. ANALYSIS intention to treat of all randomised settings. ISCRTN registration: ISRCTN53763600. RESULTS 118 residential settings (including 236 staff) were randomised to either receive training (59 settings) or to receive training after a delay (59 settings). The primary analysis included data from 121 staff in 76 settings (51% of staff, 64% of settings). The adjusted mean difference on the transformed (cubed) Staff Empathy for people with Challenging Behaviour Questionnaire score at the primary end point was 1073.2 (95% CI: -938.1 to 3084.5, P = 0.296) in favour of the intervention group (effect size Cohen's d = .19). CONCLUSIONS This is the first large-scale RCT of a co-produced training course delivered by people with ID. Findings indicated a small positive (but statistically non-significant) effect on increased staff empathy at 20 weeks, and small to moderate effects for staff reported secondary outcomes in favour of the intervention group.
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Affiliation(s)
- R P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - D Gillespie
- Centre for Trials Research, Cardiff University, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - R McNamara
- Centre for Trials Research, Cardiff University, UK
| | - Z Taylor
- Royal Mencap Society, London, UK
| | - R Knight
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - E Randell
- Centre for Trials Research, Cardiff University, UK
| | - L Richards
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - G Moody
- Centre for Trials Research, Cardiff University, UK
| | - A Mitchell
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - P Przybylak
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - B Williams
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
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Palmer EC, Douglass AR, Smith T, Fuentes DG. Evaluation of perceptions and knowledge of mental illness in the United States through crowdsourcing. Ment Health Clin 2018; 8:227-234. [PMID: 30206506 PMCID: PMC6125116 DOI: 10.9740/mhc.2018.09.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction Crowdsourcing is a method of data collection with possible benefits in assessing perceptions of mental illness in a large US population. Methods The objective was to describe perceptions and trends of stigma surrounding mental illness in the United States using crowdsourcing. An online survey was conducted evaluating adults in the United States recruited via the online resource Amazon Mechanical Turk. Questions evaluated demographics and perceptions of mental illness. Survey data were adjusted for demographic variables and compared via logistic regression. Results Respondents (n = 1422) were predominately 18 to 30 years of age (n = 743; 52.3%) and white (n = 1101; 77.4%). Over half reported an individual close to them had mental illness (n = 932; 65.5%), and more than one quarter (n = 397; 27.9%) reported having a current or previous mental illness. Non-whites were less likely to agree that: medications are effective (odds ratio [OR] 0.63); they would be comfortable around a coworker with mental illness (OR 0.66); and mental illness is inheritable (OR 0.74). They are also more likely to agree that mental illness is preventable (OR 1.49). Individuals reporting mental illness were more likely to agree that medications (OR 1.34; 95% confidence interval 1.03 to 1.74) and talk therapy (OR 1.46; 95% confidence interval 1.12 to 1.90) are effective. Those reporting some or no college were more likely to agree that the United States has good access to mental health treatment. Discussion Crowdsourcing may be an effective way to obtain information regarding demographics, stigma, and mental illness. Personal experiences with mental illness, ethnicity, and educational level appear to continue to impact perceptions of mental illness.
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Affiliation(s)
- Emma C Palmer
- (Corresponding author) Assistant Professor, Clinical and Administrative Sciences, Sullivan University College of Pharmacy, Louisville, Kentucky,
| | - Amber R Douglass
- Clinical Pharmacy Specialist - Mental Health, Tennessee Valley Healthcare System, Murfreesboro, Tennessee
| | - Thomas Smith
- Assistant Professor of Pharmacy Practice, Manchester University College of Pharmacy, Fort Wayne, Indiana
| | - David G Fuentes
- Professor and Department Chair, California Health Sciences University, Clovis, California
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Tora A, Mengiste A, Davey G, Semrau M. Community Involvement in the Care of Persons Affected by Podoconiosis-A Lesson for Other Skin NTDs. Trop Med Infect Dis 2018; 3:E87. [PMID: 30274483 PMCID: PMC6161108 DOI: 10.3390/tropicalmed3030087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022] Open
Abstract
Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma; mental disorders and distress are also common. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis. We first draw on research conducted in Ethiopia for this, which has included community-based provision of care and treatment, education, and awareness-raising, and socioeconomic rehabilitation to reduce stigma. Since people affected by podoconiosis and other skin NTDs often suffer the double burden of mental-health illness, which is similarly stigmatized, we then point to examples from the mental-health field in low-resource community settings to suggest avenues for stigma reduction and increased patient engagement that may be relevant across a range of skin NTDs, though further research is needed on this.
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Affiliation(s)
- Abebayehu Tora
- Department of Sociology, Wolaita Sodo University, Sodo, Ethiopia.
| | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia.
| | - Gail Davey
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton BN1 9PX, UK.
| | - Maya Semrau
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton BN1 9PX, UK.
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Morgan AJ, Reavley NJ, Ross A, Too LS, Jorm AF. Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis. J Psychiatr Res 2018; 103:120-133. [PMID: 29843003 DOI: 10.1016/j.jpsychires.2018.05.017] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/10/2018] [Accepted: 05/22/2018] [Indexed: 12/01/2022]
Abstract
This review evaluates the evidence on what interventions are effective in reducing public stigma towards people with severe mental illness, defined as schizophrenia, psychosis or bipolar disorder. We included 62 randomised controlled trials of contact interventions, educational interventions, mixed contact and education, family psychoeducation programs, and hallucination simulations. Contact interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.39, 95% CI: 0.22 to 0.55) and desire for social distance (d = 0.59, 95% CI: 0.37 to 0.80) post-intervention, but these were reduced after adjusting for publication bias (d = 0.24 and d = 0.40, respectively). Effects did not vary by type or length of contact. Effects at follow-up were smaller and not significant. Education interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.30, 95% CI: 0.14 to 0.47) and desire for social distance (d = 0.27, 95% CI: 0.08 to 0.46) post-intervention. Small improvements in social distance persisted up to 6 months later (d = 0.27, 95% CI: 0.05 to 0.49), but not attitudes (d = 0.03, 95% CI: -0.12 to 0.18). The combination of contact and education showed similar effects to those that presented either intervention alone, and head-to-head comparisons did not show a clear advantage for either kind of intervention. Family psychoeducation programs showed reductions in stigma post-intervention (d = 0.41, 95% CI: 0.11 to 0.70). The effectiveness of hallucination simulations was mixed. In conclusion, contact interventions and educational interventions have small-to-medium immediate effects upon stigma, but further research is required to investigate how to sustain benefits in the longer-term, and to understand the active ingredients of interventions to maximise their effectiveness.
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Affiliation(s)
- Amy J Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Anna Ross
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Lay San Too
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Casañas R, Arfuch VM, Castellví P, Gil JJ, Torres M, Pujol A, Castells G, Teixidó M, San-Emeterio MT, Sampietro HM, Caussa A, Alonso J, Lalucat-Jo L. "EspaiJove.net"- a school-based intervention programme to promote mental health and eradicate stigma in the adolescent population: study protocol for a cluster randomised controlled trial. BMC Public Health 2018; 18:939. [PMID: 30064404 PMCID: PMC6069564 DOI: 10.1186/s12889-018-5855-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One half of adults who develop any mental disorder do so during adolescence. Previous literature showed that Mental Health Literacy (MHL) interventions impact mental health knowledge, reduce the associated stigma, and promote help-seeking among the adolescent population. However, evidence for the effectiveness and cost-effectiveness of these programmes remains inconclusive. The aim of this paper is to present a study protocol that evaluates the effectiveness of the " EspaiJove.net " programme. " EspaiJove.net " consists of a universal MHL intervention designed to promote mental health knowledge, increase help-seeking, reduce the stigma associated with mental illness, and prevent mental disorders in Spanish school settings. METHODS A school-based clustered randomised controlled trial (cRCT) design with 12 months of follow-up. SUBJECTS At least 408 secondary school students who attend the 3rd year of E.S.O (Compulsory secondary education for 13- to 14-year- olds) will be recruited from 8 schools within Barcelona city, Catalonia (Spain). INTERVENTION A dose-response intervention will be delivered with 4 arms: 1) Sensitivity Programme (SP) in Mental Health (1 h); 2) Mental Health Literacy (MHL) Programme (6 h); 3) MHL plus first-person Stigma Reduction (MHL + SR) (7 h); 4) Control group: waiting list. Primary outcomes: 1) MHL: EspaiJove.net MHL Test (EMHLT); 2) Stigma: Reported and Intended Behaviour Scale (RIBS) and Community Attitudes toward the Mentally Ill (CAMI). Others outcomes: 1) Acceptability of intervention; 2) Mental health symptoms and emotional well-being (SDQ); 3) States of Change Scale (SCS); 4) Bullying and Cyberbullying; 5) Quality of life (EQ-5D); 6) Help seeking and use of treatment; 7) Health benefits. DISCUSSION Results would be informative for efforts to prevent mental disorders and promote mental wellbeing in secondary school students. TRIAL REGISTRATION NCT03215654 (date registration July 12, 2017).
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Affiliation(s)
- Rocío Casañas
- Research Department, Associació Centre Higiene Mental Les Corts, Grup CHM Salut Mental, C/ Numància, 103-105, Bajos, 08029, Barcelona, Spain. .,Escola Superior Infermeria del Mar (ESIM), Universitat Pompeu Fabra (UPF), C/ Numància, 103-105, Bajos, 08029, Barcelona, Spain.
| | - Victoria-Mailen Arfuch
- Departament of Clinical and Health Psychology, School of Psychology, Universitat Autònoma de Barcelona (UAB), Building B Campus de Bellaterra, 08193 Bellaterra (Cerdanyola del Vallès Barcelona), Barcelona, Spain
| | - Pere Castellví
- Department of Psychology, Division of Clinical Psychology, Universidad de Jaen, Campus Las Lagunillas, s/n, 23071, Jaén, Spain
| | - Juan-José Gil
- Child and Juvenile Mental Health Centre of Les Corts, Associació Centre Higiene Mental Les Corts, Grup CHM Salut Mental, C/Montnegre 21, 3a planta, 08029, Barcelona, Spain
| | - Maria Torres
- Child and Juvenile Mental Health Centre of Sarria-Sant Gervasi, Associació Centre Higiene Mental Les Corts, Grup CHM Salut Mental, C/ Via Augusta 364-372, 4a planta, 08017, Barcelona, Spain
| | - Angela Pujol
- Fundació Privada Centre Higiene Mental Les Corts, Grup CHM Salut Mental, C/ Numancia, 103-105, Bajos, 08029, Barcelona, Spain
| | - Gemma Castells
- Child and Juvenile Mental Health Centre of Sarria-Sant Gervasi, Associació Centre Higiene Mental Les Corts, Grup CHM Salut Mental, C/ Via Augusta 364-372, 4a planta, 08017, Barcelona, Spain
| | - Mercè Teixidó
- Child and Juvenile Mental Health Centre of Sarria-Sant Gervasi, Associació Centre Higiene Mental Les Corts, Grup CHM Salut Mental, C/ Via Augusta 364-372, 4a planta, 08017, Barcelona, Spain
| | - Maria Teresa San-Emeterio
- Child and Juvenile Mental Health Centre of Les Corts, Associació Centre Higiene Mental Les Corts, Grup CHM Salut Mental, C/Montnegre 21, 3a planta, 08029, Barcelona, Spain
| | | | - Aleix Caussa
- Spora Sinergies Consultoria social, C/ Floridablanca, 146, 08011, Barcelona, Spain
| | - Jordi Alonso
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), C/ Dr. Aiguader, 88, 08003, Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP) and Dept. Health and Experimental Sciences (DCEXS), Pompeu Fabra University (UPF), C/ Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Lluís Lalucat-Jo
- Research Department, Associació Centre Higiene Mental Les Corts, Grup CHM Salut Mental, C/ Numància, 103-105, Bajos, 08029, Barcelona, Spain
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Jackson-Best F, Edwards N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 2018; 18:919. [PMID: 30049270 PMCID: PMC6062983 DOI: 10.1186/s12889-018-5861-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/17/2018] [Indexed: 01/12/2023] Open
Abstract
Background Stigma across HIV/AIDS, mental illness, and physical disability can be co-occurring and may interact with other forms of stigma related to social identities like race, gender, and sexuality. Stigma is especially problematic for people living with these conditions because it can create barriers to accessing necessary social and structural supports, which can intensify their experiences with stigma. This review aims to contribute to the knowledge on stigma by advancing a cross-analysis of HIV/AIDS, mental illness, and physical disability stigma, and exploring whether and how intersectionality frameworks have been used in the systematic reviews of stigma. Methods A search of the literature was conducted to identify systematic reviews which investigated stigma for HIV/AIDS, mental illness and/or physical disability. The electronic databases MEDLINE, CINAHL, EMBASE, COCHRANE, and PsycINFO were searched for reviews published between 2005 and 2017. Data were extracted from eligible reviews on: type of systematic review and number of primary studies included in the review, study design study population(s), type(s) of stigma addressed, and destigmatizing interventions used. A keyword search was also done using the terms “intersectionality”, “intersectional”, and “intersection”; related definitions and descriptions were extracted. Matrices were used to compare the characteristics of reviews and their application of intersectional approaches across the three health conditions. Results Ninety-eight reviews met the inclusion criteria. The majority (99%) of reviews examined only one of the health conditions. Just three reviews focused on physical disability. Most reviews (94%) reported a predominance of behavioural rather than structural interventions targeting stigma in the primary studies. Only 17% of reviews used the concept and/or approach of intersectionality; all but one of these reviews examined HIV/AIDS. Conclusions The lack of systematic reviews comparing stigma across mental illness, HIV/AIDS, and physical disability indicates the need for more cross-comparative analyses among these conditions. The integration of intersectional approaches would deepen interrogations of co-occurring social identities and stigma.
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Affiliation(s)
| | - Nancy Edwards
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Room 205, Ottawa, ON, K1N 7M9, Canada
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141
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Petkari E, Masedo Gutiérrez AI, Xavier M, Moreno Küstner B. The influence of clerkship on students' stigma towards mental illness: a meta-analysis. MEDICAL EDUCATION 2018; 52:694-704. [PMID: 29498433 DOI: 10.1111/medu.13548] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/02/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT In university programmes preparing students to work with patients with mental illness, clerkship is proposed as a component that may contribute to the battle against stigma, through bringing students into contact with the patients' reality. Yet, the precise contribution of clerkship remains unclear, perhaps because of the variety of university programmes, clerkship characteristics or types of stigma explored. This is the first systematic meta-analysis of available evidence determining the precise effect size of the influence of clerkship on stigma and the potential moderators. METHODS We carried out a systematic literature review in Eric, PsycINFO, Pubmed, Scopus, UMI and Proquest dissertations, aiming to identify all the studies exploring health care students' stigma of mental illness (measured as overall stigma or as attitudes, affect and behavioural intentions) before and after a clerkship from 2000 to 2017. Twenty-two studies were included in the meta-analysis, providing data from 22 independent samples. The total sample consisted of 3161 students. The effects of programme (medicine, nursing, occupational therapy, and their combination), study design (paired-unpaired samples), publication year, sex, age and clerkship context, and inclusion of theoretical training and duration, were examined as potential moderators. RESULTS Our analyses yielded a highly significant medium effect size for overall stigma (Hedge's g = 0.35; p < 0.001; 95% confidence interval [CI], 0.20, 0.42), attitudes (Hedge's g = 0.308; p = 0.003; 95% CI, 0.10, 0.51) and behavioural intentions (Hedge's g = 0.247; p < 0.001; 95% CI, 0.17, 0.33), indicating a considerable change, whereas there was no significant change in the students' affect. Moderator analyses provided evidence for the distinct nature of each stigma outcome, as they were influenced by different clerkship and student characteristics such as clerkship context, theoretical training, age and sex. CONCLUSIONS The robust effect of clerkship on students' stigma of mental illness established by the present meta-analysis highlights its role as a crucial curriculum component for experiential learning and as a necessary agent for the battle against stigma.
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Affiliation(s)
- Eleni Petkari
- Department of Behavioural and Social Sciences, European University Cyprus, Nicosia, Cyprus
- International Maristan Network, http://www.redmaristan.org
| | - Ana I Masedo Gutiérrez
- International Maristan Network, http://www.redmaristan.org
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Malaga, Malaga, Spain
| | - Miguel Xavier
- International Maristan Network, http://www.redmaristan.org
- Department of Mental Health, CEDOC, NOVA Medical School, University of Lisbon, Lisbon, Portugal
| | - Berta Moreno Küstner
- International Maristan Network, http://www.redmaristan.org
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Malaga, Malaga, Spain
- Biomedicine Institute of Malaga-IBIMA, Malaga, Spain
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142
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Kasahara-Kiritani M, Matoba T, Kikuzawa S, Sakano J, Sugiyama K, Yamaki C, Mochizuki M, Yamazaki Y. Public perceptions toward mental illness in Japan. Asian J Psychiatr 2018; 35:55-60. [PMID: 29787953 PMCID: PMC6019626 DOI: 10.1016/j.ajp.2018.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/01/2018] [Accepted: 05/13/2018] [Indexed: 10/16/2022]
Abstract
AIM The purpose was to characterize public perceptions in Japan of mental illness and how they related to stigma-related attitudes for the same. METHODS Data were obtained using a vignette survey conducted as a part of the Stigma in Global Context - Mental Health Study and contained a nationally representative sample (n = 994). The survey was conducted using a multi-mode approach (face-to-face interviews, the drop-off-and-pick-up, postal collection) from September to December 2006, with a multi-stage probability sample of Japanese residents aged 18-64 years. Respondents were randomly assigned one of four vignette conditions that described psychiatric disorders meeting the diagnostic criteria for schizophrenia and major depressive disorder (one vignette for each gender exhibiting each diagnosis). We compared respondents' stigma-related attitudes and perceptions toward mental illness between vignettes. RESULTS Over 80% of Japanese participants believed that depressive disorder or schizophrenia could be cured via treatment. However, Japanese people still had relatively strong vigilance and denial of competency toward schizophrenia. CONCLUSIONS Participants expressed the belief that mental illnesses are curable, but stigma toward people with schizophrenia was still relatively strong.
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Affiliation(s)
- Mami Kasahara-Kiritani
- Department of Ethics Support, Kyoto University Hospital, Kyoto, Japan; Department of Family Nursing, The University of Tokyo, Tokyo, Japan.
| | - Tomoko Matoba
- Department of Human Care and Support, Faculty of Human Life Design, Toyo University, Saitama, Japan
| | - Saeko Kikuzawa
- Department of Sociology, Faculty of Social Sciences, Hosei University, Tokyo, Japan
| | - Junko Sakano
- Department of Welfare System and Health Science, Okayama Prefectural University, Okayama, Japan
| | - Katsumi Sugiyama
- Department of Social Welfare, Aomori University of Health and Welfare, Aomori, Japan
| | - Chikako Yamaki
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
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143
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Butler JM, Becker WC, Humphreys K. Big Data and the Opioid Crisis: Balancing Patient Privacy with Public Health. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:440-453. [PMID: 30146994 DOI: 10.1177/1073110518782952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parts I through III of this paper will examine several, increasingly comprehensive forms of aggregation, ranging from insurance reimbursement "lock-in" programs to PDMPs to completely unified electronic medical records (EMRs). Each part will advocate for the adoption of these aggregation systems and provide suggestions for effective implementation in the fight against opioid misuse. All PDMPs are not made equal, however, and Part II will, therefore, focus on several elements - mandating prescriber usage, streamlining the user interface, ensuring timely data uploads, creating a national data repository, mitigating privacy concerns, and training doctors on how to respond to perceived doctor-shopping - that can make these systems more effective. In each part, we will also discuss the privacy concerns of aggregating data, ranging from minimal to significant, and highlight the unique role of stigma in motivating these concerns. In Part IV, we will conclude by suggesting remedial steps to offset this loss of privacy and to combat the stigma around SUDs and mental health disorders in general.
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Affiliation(s)
- John Matthew Butler
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
| | - William C Becker
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
| | - Keith Humphreys
- John Matthew Butler is a student at the Yale Law School. William C. Becker, M.D., is an Assistant Professor of Medicine at Yale School of Medicine. Keith Humphreys, Ph.D., is the Esther Ting Memorial Professor in the Department of Psychiatry at Stanford University School of Medicine and a Senior Career Scientist at the VA Health Services Research Center in Palo Alto
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144
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Tzouvara V, Papadopoulos C, Randhawa G. Self-Stigma Experiences Among Older Adults with Mental Health Problems Residing in Long-Term Care Facilities: A Qualitative Study. Issues Ment Health Nurs 2018; 39:403-410. [PMID: 29286837 DOI: 10.1080/01612840.2017.1383540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Self-stigma is linked with a variety of deleterious consequences for the stigmatised individual. Much of the past research on self-stigma focuses on younger adults; however, little is known about the self-stigma experience among institutionalised older adults with mental health problems. This study aims to explore experiences of self-stigma among older adults with mental health problems in long-term care facilities. Ten semi-structured interviews were conducted. Insight into mental illness was identified as having a key influence upon the self-stigma experiences among this group. Participants shared common understandings, views, and behavioural reactions towards mental health problems. Lacking control, public stigma, sympathy, disinterest, avoidance, and fear were key themes among them. Re-conceptualising self-stigma theories and implementing interventions that aim at reducing stigmatising attitudes among this group are essential.
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Affiliation(s)
- Vasiliki Tzouvara
- a King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care , Department of Mental Health Nursing , London , UK
| | - Chris Papadopoulos
- b University of Bedfordshire, Institute for Health Research , Putteridge Bury Campus, Luton , UK
| | - Gurch Randhawa
- b University of Bedfordshire, Institute for Health Research , Putteridge Bury Campus, Luton , UK
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145
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Development, validation and cultural-adaptation of the knowledge about psychosis questionnaire for African-Caribbean people in the UK. Psychiatry Res 2018; 263:199-206. [PMID: 29573660 DOI: 10.1016/j.psychres.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 11/21/2022]
Abstract
The absence of assessment tools incorporating different cultural models of mental illness is a major barrier to recruiting ethnic minorities into clinical trials, reducing generalisability of findings and potentially increasing disparities in access to evidence-based care. This study aimed to develop and validate a new Knowledge about Psychosis (KAP) self-report measure and a culturally-adapted version for African-Caribbean people (CaKAP). Content and face validity were achieved through consultations with experts in psychosis and a focus group with service users, carers, and community members. Eighty-seven predominantly White British participants and 79 African-Caribbean participants completed the knowledge questionnaires (KAP and CaKAP) and measures of help-seeking and stigma. Overall, the measures showed good internal consistency and test re-test reliability. Construct validity was evidenced via significant positive associations between knowledge about psychosis and help-seeking and significant negative associations between knowledge and stigma. These measures could improve the delivery of psychosocial interventions and outcome measurement in research trials.
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146
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Sweet D, Byng R, Webber M, Enki DG, Porter I, Larsen J, Huxley P, Pinfold V. Personal well-being networks, social capital and severe mental illness: exploratory study. Br J Psychiatry 2018; 212:308-317. [PMID: 28982657 DOI: 10.1192/bjp.bp.117.203950] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Connectedness is a central dimension of personal recovery from severe mental illness (SMI). Research reports that people with SMI have lower social capital and poorer-quality social networks compared to the general population.AimsTo identify personal well-being network (PWN) types and explore additional insights from mapping connections to places and activities alongside social ties. METHOD We carried out 150 interviews with individuals with SMI and mapped social ties, places and activities and their impact on well-being. PWN types were developed using social network analysis and hierarchical k-means clustering of this data. RESULTS Three PWN types were identified: formal and sparse; family and stable; and diverse and active. Well-being and social capital varied within and among types. Place and activity data indicated important contextual differences within social connections that were not found by mapping social networks alone. CONCLUSIONS Place locations and meaningful activities are important aspects of people's social worlds. Mapped alongside social networks, PWNs have important implications for person-centred recovery approaches through providing a broader understanding of individual's lives and resources.Declaration of interestNone.
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Affiliation(s)
| | - Richard Byng
- Peninsula Schools of Medicine and Dentistry,Plymouth University,Plymouth
| | | | | | - Ian Porter
- Primary Care Research,Peninsula Schools of Medicine and Dentistry,Plymouth University,Plymouth
| | | | - Peter Huxley
- Centre for Mental Health and Society,School of Social Sciences,Bangor
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147
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Ashton LJ, Gordon SE, Reeves RA. Key Ingredients-Target Groups, Methods and Messages, and Evaluation-of Local-Level, Public Interventions to Counter Stigma and Discrimination: A Lived Experience Informed Selective Narrative Literature Review. Community Ment Health J 2018; 54:312-333. [PMID: 29185150 DOI: 10.1007/s10597-017-0189-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Abstract
A proliferation of recent literature provides substantial direction as to the key ingredients-target groups, messages and methods, and evaluation-of local-level, public interventions to counter stigma and discrimination. This paper provides a selective narrative review of that literature from the perspective or standpoint of anti-stigma experts with lived experience of mental distress, the key findings of which have been synthesised and presented in diagrammatic overviews (infographics). These are intended to guide providers in planning, delivering and evaluating lived experience-directed local-level, public interventions to counter stigma and discrimination in accord with current best practice.
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Affiliation(s)
- Laura J Ashton
- Mind and Body, PO Box 26396, Epsom, Auckland, 1344, New Zealand
| | - Sarah E Gordon
- University of Otago Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Racheal A Reeves
- Capital & Coast District Health Board, Private Bag 7902, Wellington South, New Zealand
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148
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A randomised controlled trial of repeated filmed social contact on reducing mental illness-related stigma in young adults. Epidemiol Psychiatr Sci 2018; 27:199-208. [PMID: 27989255 PMCID: PMC7032789 DOI: 10.1017/s2045796016001050] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Public stigma alters attitudes towards people with mental illness, and is a particular concern for young people since most mental health problems occur in adolescence and young adulthood. However, little is known about the long-term effects of repeated filmed social contact (FSC) on reducing mental health-related stigma among young adults in the general population, compared with self-instructional Internet search (INS) and control interventions. METHODS This study is a parallel-group randomised controlled trial over 12 months conducted in Tokyo, Japan. A total of 259 university students (male n = 150, mean age = 20.0 years, s.d. = 1.2) were recruited from 20 colleges and universities between November 2013 and July 2014, without being provided information about the mental health-related survey or trial. Participants were assigned to one of three groups before completion of the baseline survey (FSC/INS/control = 89/83/87). The FSC group received a computer-based 30-min social contact film with general mental health education and five follow-up web-based FSCs at 2-month intervals. The INS group undertook a 30-min search for mental health-related information with five follow-up web-based reminders for self-instructional searches at 2-month intervals. The control group played PC games and had no follow-up intervention. The main outcome measures were the future (intended behaviour) domain of the Reported and Intended Behaviour Scale at 12 months after the intervention. Analysis was conducted in September 2015. RESULTS At the 12-month follow-up, 218 participants completed the survey (84.1%, 75:70:73). The FSC group showed the greatest change at the 12-month follow-up (FSC: mean change 2.11 [95% CI 1.49, 2.73], INS: 1.04 [0.29, 1.80], control: 0.71 [0.09, 1.33]; FSC v. INS p = 0.037, FSC v. controls p = 0.004). No adverse events were reported during the follow-up period. CONCLUSIONS FSC was more successful in reducing stigma at 12 months after intervention than INS or control interventions. FSC could be used to reduce stigma in educational lectures and anti-stigma campaigns targeted at young people. STUDY REGISTRATION This study is registered at UMIN-CTR (No. UMIN000012239).
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149
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Schnyder N, Michel C, Panczak R, Ochsenbein S, Schimmelmann BG, Schultze-Lutter F. The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model. Eur Psychiatry 2018. [PMID: 29518618 DOI: 10.1016/j.eurpsy.2017.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The stigma of mental illness, especially personal attitudes towards psychiatric patients and mental health help-seeking, is an important barrier in healthcare utilisation. These attitudes are not independent of each other and are also influenced by other factors, such as mental health literacy, especially the public's causal explanations for mental problems. We aimed to disentangle the interrelations between the different aspects of stigma and causal explanations with respect to their association with healthcare utilisation. METHODS Stigma and causal explanations were assessed cross-sectional using established German questionnaires with two unlabelled vignettes (schizophrenia and depression) in a random-selection representative community sample (N = 1375, aged 16-40 years). They were interviewed through a prior telephone survey for current mental disorder (n = 192) and healthcare utilisation (n = 377). Structural equation modelling was conducted with healthcare utilisation as outcome and stigma and causal explanations as latent variables. The final model was additionally analysed based on the vignettes. RESULTS We identified two pathways. One positive associated with healthcare utilisation, with high psychosocial stress and low constitution/personality related causal explanations, via positive perception of help-seeking and more help-seeking intentions. One negative associated with healthcare utilisation, with high biogenetic and constitution/personality, and low psychosocial stress related explanations, via negative perception of psychiatric patients and a strong wish for social distance. Sensitivity analysis generally supported both pathways with some differences in the role of biogenetic causal explanation. CONCLUSION Our results indicate that campaigns promoting early healthcare utilisation should focus on different strategies to promote facilitation and reduce barriers to mental healthcare.
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Affiliation(s)
- N Schnyder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - R Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - S Ochsenbein
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - B G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - F Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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150
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Martínez-Hidalgo MN, Lorenzo-Sánchez E, López García JJ, Regadera JJ. Social contact as a strategy for self-stigma reduction in young adults and adolescents with mental health problems. Psychiatry Res 2018; 260:443-450. [PMID: 29272729 DOI: 10.1016/j.psychres.2017.12.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/19/2017] [Accepted: 12/08/2017] [Indexed: 11/17/2022]
Abstract
This study assessed the effectiveness of a social contact program between young adults and adolescents with and without mental health problems. It was evaluated if the development of a social contact program in a non-segregated space and respecting criteria of contact hypothesis reduced Self-Stigma and Public Stigma and, increased Self-Esteem. A pre-post intervention design was used with a sample of 47 subjects, 25 with different mental health diagnoses (Psychotic Disorder, Anxiety Disorder, Depression, Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder) and 22 without mental health problems, aged between 15 and 35 years. Five workshops of social contact and creativity were carried out during five months with a 2-h weekly meeting. The results analysis revealed a significant reduction in Self-Stigma for participants with mental health problems and may suggest a slight reduction in Public Stigma as well as a slight increase in the level of Self-Esteem of all participants. These findings suggest that programs of this nature reduce Self-Stigma and facilitate social inclusion in young adults and adolescents with and without mental health problems.
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Affiliation(s)
- Mª Nieves Martínez-Hidalgo
- Research and Development Department, Fundación Cattell Psicólogos, Trapería, 6, 1°B, 30001 Murcia, Spain.
| | - Elena Lorenzo-Sánchez
- Research and Development Department, Fundación Cattell Psicólogos, Trapería, 6, 1°B, 30001 Murcia, Spain
| | | | - Juan José Regadera
- Research and Development Department, Fundación Cattell Psicólogos, Trapería, 6, 1°B, 30001 Murcia, Spain
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