Evidence for effective interventions to reduce mental-health-related stigma and discrimination

Differences in psychosocial factors of mental health in an ethnically diverse Black adult population

We conducted a cross-sectional analysis in a convenient sample of Black adults in the United States (n = 269, ages 18-65) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). We examined mean differences in self-reported medical mistrust, use of mental health services, depression symptom severity, mental health knowledge and stigma behavior (or a desire for separation away from people living with a mental illness) according to ethnicity, citizenship status, age group, and gender. African Americans with moderate to severe depression symptoms had greater stigma behavior (mean = 12.2, SD = 3.2) than African Americans who screened in the minimal to mild depression range (mean = 13.1, SD = 3.5). Across the spectrum of depression, immigrants showed greater stigma than African Americans (p = 0.037). This is a pilot study that explores heterogeneity in the Black population in depression symptom severity and psychosocial factors related to mental health. Understanding these differences may contribute to how we approach needs and health system practices and policies at the individual, systemic, and structural level of mental health care.

Overcoming the phenomenological Perpetuum mobile in clinical cognitive neuroscience for the benefit of replicability in research and the societal view on mental disorders

Cognitive neuroscience comes in many facets, and a particularly large branch of research is conducted in individuals with mental health problems. This article outlines why it is important that cognitive neuroscientists re-shape their role in mental health research and re-define directions of research for the next decades. At present, cognitive neuroscience research in mental health is too firmly rooted in categorial diagnostic definitions of mental health conditions. It is discussed why this hampers a mechanistic understanding of brain functions underlying mental health problems and why this is a problem for replicability in research. A possible solution to these problems is presented. This solution affects the strategy of research questions to be asked, how current trends to increase replicability in research can or cannot be applied in the mental health field and how data are analyzed. Of note, these aspects are not only relevant for the scientific process, but affect the societal view on mental disorders and the position of affected individuals as members of society, as well as the debate on the inclusion of so-called WEIRD and non-WEIRD people in studies. Accordingly, societal and science political aspects of re-defining the role of cognitive neuroscientists in mental health research are elaborated that will be important to shape cognitive neuroscience in mental health for the next decades.

The process of stigma experience in the families of people living with bipolar disorder: a grounded theory study

BACKGROUND

One of the most challenging issues faced by families of people living with bipolar disorder is stigma. This study was conducted to explain the process of stigma experience in the families of people living with bipolar disorder using the grounded theory method.

METHODS

Data for this study were collected through semi-structured interviews with participants in Razi Psychiatric Hospital in Tehran, Iran, via purposive sampling and field notetaking. The dependability, conformability, and transferability measures were included to support the data accuracy and robustness, and MAXQDA 2020 software was used to facilitate data coding. The Strauss-Corbin method was used to analyse the data.

RESULTS

A total of 20 family members of people living with bipolar disorder, four people living with bipolar disorder, and three mental health professionals participated in this study. The analysis of participants' experiences led to identifying 64 subcategories, 21 categories, and six main concepts, including social deprivation, being labelled, cultural deficiency and lack of awareness, economic challenges, forced acceptance of the existing situation, and social isolation.

CONCLUSION

Families of people living with bipolar disorder experience social deprivation, social isolation, and social rejection, which have irreparable consequences for them. Overcoming stigma in these families should be a priority of policymakers and planners in the field of psychosocial health.

Assessing diversity and inclusivity is the next frontier in mental health recovery narrative research and practice (Preprint)

Demand for digital health interventions is increasing in many countries. The use of recorded mental health recovery narratives in digital health interventions is becoming more widespread in clinical practice. Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, including struggles and successes over time. Helpful impacts of recorded mental health recovery narratives include connectedness with the narrative and validation of experiences. Possible harms include feeling disconnected and excluded from others. Diverse narrative collections from many types of narrators and describing multiple ways to recover are important to maximize the opportunity for service users to benefit through connection and to minimize the likelihood of harm. Mental health clinicians need to know whether narrative collections are sufficiently diverse to recommend to service users. However, no method exists for assessing the diversity and inclusivity of existing or new narrative collections. We argue that assessing diversity and inclusivity is the next frontier in mental health recovery narrative research and practice. This is important, but methodologically and ethically complex. In this viewpoint, we propose and evaluate one diversity and two inclusivity assessment methods. The diversity assessment method involves use of the Simpson Diversity Index. The two inclusivity assessment methods are based on comparator demographic rates and arbitrary thresholds, respectively. These methods were applied to four narrative collections as a case study. Refinements are needed regarding a narrative assessment tool in terms of its practicality and cultural adaptation.

A New Podcast to Reduce Stigma Against People Living with Complex Mental Health Issues: A Co-Design Study (Preprint)

BACKGROUND

Mental illness stigma refers to damaging stereotypes and emotional responses around the experience of mental health issues. Media-based interventions have the potential to reduce the public's stigmatizing attitudes by improving mental health literacy, emotional appeal, and the intimacy of address. As audio-based media facilitating storytelling, podcasts show potential for reducing stigma; however, it is unclear what features could make a podcast effective or engaging.

OBJECTIVE

The Co-Design and Anti-Stigma Podcast Research (CASPR) study aimed to collaborate with key target audience members to inform the development of a new podcast. This podcast primarily aims to reduce listeners' stigmatizing attitudes toward people living with complex mental health issues.

METHODS

This study was adapted from Experience-Based Co-Design methodology. The first part, information gathering, involved a web-based mixed methods survey with 629 Australian podcast listeners to explore their interest and concerns around podcasts. Then, a series of focus groups were held with a purposive sample of 25 participants to explore the potential benefits and challenges of the podcast format. Focus group participants included people with lived experience of complex mental health issues, media and communications professionals, health care professionals, and people interested in workplace mental health. The second part, co-design, constituted 3 meetings of a co-design committee with 10 participants drawn from the focus groups to design the podcast using brainstorming and decision-making activities.

RESULTS

Most survey respondents (537/629, 85.3%) indicated a willingness to listen to a podcast about experiences of mental illness stigma; participants indicated preference for semistructured episodes and a mixture of light and serious content. Focus group participants identified potential challenges with appealing to listeners, making the content emotionally resonant and engaging, and translation to listeners' attitude change. The co-design committee collaborated to achieve consensus on the focus of individual episodes: domains where stigma and discrimination are common, such as workplaces and health care settings; the structure of individual episodes: storyboards that centralize guests with lived experience, featuring explicit discussions around stigma and discrimination; and overarching content principles, including a sincere, empathetic, and hopeful tone; using plain language; having clear calls to action; and providing listener resources.

CONCLUSIONS

The co-design process informed a podcast design that features lived experience narratives with an explicit focus on stigma and discrimination, highlighting the realities of stigma while acknowledging progress in the space and how listeners can contribute toward social change. This study allowed for an in-depth discussion around the strengths and limitations of such a podcast according to different target audience members. The co-design committee designed key elements of a podcast that has the potential to minimize the limitations of the format while embracing the benefits of podcast-based storytelling. Once produced, the podcast will be evaluated for its impact on attitude change.

“You can kind of just feel the power behind what someone's saying”: a participatory-realist evaluation of peer support for young people coping with complex mental health and substance use challenges

Background

Youth peer support, as a practice that aligns youth engagement and participatory approaches, has become increasingly popular in the context of youth mental health services. However, there is a need for more evidence that describes how and why youth peer support practice might be effective. This study was designed to examine a peer support service for youth experiencing complex challenges with mental health, physical health and/or substance use to better understand key features and underlying mechanisms that lead to improved client outcomes.

Methods

We applied a hybrid realist-participatory approach to explore key issues and underlying theoretical assumptions within a youth peer support approach for young people (age 14–26) experiencing complex mental health and substance use challenges. We used semi-structured interviews and focus groups with staff, including peers (N = 8), clinical service providers and administrative staff (N = 15), to develop the theories and a client survey to validate them. Our qualitative thematic analysis applied a retroductive approach that involved both inductive and deductive processes. For the client survey (N = 77), we calculated descriptive statistics to examine participant profiles and usage patterns. Pearson correlations were examined to determine relationships among concepts outlined in the program theories, including context, mechanism and outcome variables.

Results

Our analyses resulted in one over-arching context, one over-arching outcome and four program theories. Program theories were focused on mechanisms related to 1) positive identity development through identification with peers, 2) enhanced social connections, 3) observational learning and 4) enhanced autonomy and empowerment.

Conclusions

This study serves as a unique example of a participatory-realist hybrid approach. Findings highlight possible key components of youth peer practice and shed light on the functional mechanisms that underlie successful peer practice. These key components can be examined in other settings to develop more comprehensive theories of change with respect to youth peer support and can eventually be used to develop guidelines and standards to strengthen practice. This research contributes to an expanding body of literature on youth peer support in mental health and connects peer practice with several social theories. This research begins to lay a foundation for enhanced youth peer support program design and improved outcomes for young people experiencing complex mental health and substance use challenges.

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

AIMS

Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs).

METHODS

MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to 'stigma and discrimination', 'intervention', 'indirect social contact', 'mental health' and 'low- and middle-income countries'. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results.

RESULTS

Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations.

CONCLUSIONS

ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.

Impact of an auditory hallucination simulation coupled with a speaker diagnosed with schizophrenia on mental illness stigma in pharmacy students

INTRODUCTION

Hallucination simulations improve student empathy but increase desired social distance from individuals with schizophrenia, while direct contact reduces social distance. This study describes the implementation of combining an auditory hallucination simulation with a speaker diagnosed with schizophrenia and its impact on mental illness stigma.

METHODS

Pharmacy students in their last year of didactic instruction (N = 346) attended a presentation by a speaker diagnosed with schizophrenia then participated in a hallucination simulation. Mental illness stigma was measured before and after the intervention using the Opening Minds Survey for Health Care Professionals (OMS-HC). Related-samples Wilcoxon-signed rank tests were used to evaluate changes in OMS-HC scores. An inductive qualitative analysis was conducted on student perceptions of patients with psychosis.

RESULTS

OMS-HC total scores were reduced by an average of 2.0 ± 5.6 (P = .005) for the first-year pilot and 2.3 ± 7.0 (P < .001) for the subsequent year. OMS-HC attitudes (P = .005) and disclosure/help-seeking (P < .005) subscales decreased both years. There was no significant change in the social distance subscale (P = .205) the first year and a significant decrease (P = .015) the second year. The themes identified from the open-ended comments were increased awareness, sympathy, empathy, inspiration/admiration, discomfort, and change to patient care.

CONCLUSIONS

The combination of a speaker with schizophrenia and auditory hallucination simulation effectively reduced mental illness stigma. The combination is likely effective for reducing stigmatizing attitudes and willingness to disclose mental illness with variable reduction in desired social distance.

The effect of a contact‐based intervention on attitudes and intended behaviors of nursing students toward people with mental illness: A quasi‐experimental study

Background and Aim

Although nursing students are professionally and ethically trained and educated to respect patients with a variety of medical and mental problems, they continue to exhibit negative attitudes and behaviors toward mental disease and patients with mental illness. The accumulated evidence indicates that contact‐based intervention (CBI) is helpful in enhancing nursing students' attitudes and behaviors toward patients with mental illness. Although evidence found to support the CBI, culture and settings might play a significant role to decide its effectiveness. This would call for testing further the effectiveness of CBI across cultures and healthcare settings. The purpose of this study was to assess the effect of a CBI on the attitudes and intended behaviors of nursing students in Jordan toward people with mental illness.

Methods

A quasi‐experimental, pre–post, design was used. Data were collected from 81 nursing students from two nursing schools implementing the CBI using self‐reported questionnaires to measure students' attitudes and intended behaviors toward people with mental illness. Data were collected during the first semester of the academic year 2019/2020. The paired‐samples and independent‐samples t tests were used to test the study's hypotheses.

Results

At baseline, the results indicated that there were no statistically significant differences between the experimental and control groups in terms of their attitudes and intended behaviors toward people with mental illness. At posttest, statistically significant improvements in the attitudes and intended behaviors of nursing students found in the experimental group and between control and experimental groups toward people with mental illness compared with baseline pretest measures (p < 0.001).

Conclusion

The CBI did improve the attitudes and intended behaviors of Jordanian nursing students toward people with mental illness. Significant implications for nurses were discussed.

Destigmatizing perceptions about Black adolescent depression: randomized controlled trial of brief social contact-based video interventions

OBJECTIVE

To test the utility of brief social contact-based video interventions of a Black adolescent girl to reduce stigmatized attitudes and increase help-seeking intentions around adolescent depression.

METHODS

We conducted a randomized controlled trial (RCT) with 14- to18-year-old healthy volunteers drawn from the general US population. We enrolled participants through a crowdsourcing platform (n = 1,093) and randomly assigned participants to one of three video conditions (117 s each): depressed (DEP); depressed, adjusted to aspects unique to being a Black adolescent girl (including experienced or internalized racism; ADJ); and control (CONT). The primary outcome was the Depression Stigma Scale (DSS); secondary outcomes were the General Health-Seeking Questionnaire (GHSQ), and thermometers for Black and white race perception "warmth".

RESULTS

Following the intervention, the DSS changed from baseline across the three conditions (p < .001). ADJ outperformed both DEP (p = .031) and CONT (p < .001). A race-by-intervention interaction (p < .001) revealed different response profiles between Black (ADJ = DEP = CONT; p = .726) and non-Black participants (ADJ > DEP > CONT; p < .001). DEP and ADJ both resulted in higher treatment-seeking intentions for both the emotional problems and the suicidal thought subscales of the GHSQ. We found a race-by-intervention interaction (p = .01) for the Black thermometer, which revealed a significant 2° increase in warmth among white (p < .001), but not Black, viewers (p = .06).

CONCLUSIONS

On a short-term basis, brief social contact-based videos proved effective among adolescents in reducing depression-related stigma, increasing help-seeking intentions, and providing an "empathic foothold" in the lives of racially stigmatized groups. Even as the enduring effects of these interventions remain to be determined, the deployment on social media of short videos opens new opportunities to reach a large number of at-risk youth."

Impact on public attitudes of a mental health audio tour of the National Gallery in London

AIM

The arts have the potential to increase public awareness about mental health and reduce stigma. However, arts-based projects to raise awareness have been small-scale. In this study, a mental health-awareness audio tour of The National Gallery in London was co-produced and narrated by young adults with relevant lived experience. The study investigated the acceptability of the tour to the public and evaluated its impact on public attitudes about mental health.

METHODS

Participants were Gallery visitors over four consecutive days. The tour led visitors on 10 stops through the Gallery. Each stop focused on artworks and Gallery spaces, challenged common myths about mental health, and invited visitors to consider their personal views. Participants completed measures of mood and attitudes about mental health pre- and post-tour and provided narrative feedback.

RESULTS

Pre-tour, participants (N = 213) reported high levels of happiness, compassion towards people with mental health conditions, comfort talking about mental health, and positive attitudes about mental health. Post-tour, participants (N = 111) reported significant increases in happiness, comfort, and positive attitudes. In feedback, participants (N = 85) reported that strengths of the tour were the music, inclusion of lived experience, art and mental health links, and reported that the tour was informative, innovative, and improved mental health awareness.

CONCLUSIONS

The tour increased positive attitudes, despite positive baseline attitudes, indicating the feasibility of arts-based interventions in major venues to reduce stigma. Sampling limitations and participant retention suggest that arts-based projects to raise awareness should target more diverse audiences and consider data collection strategies in large venues.

Attitudes of Catholic Priests Regarding the Participation of People with Schizophrenia and Depression in Religious Practices: Relationships with Prejudices and Community Size

This study investigated whether priests' attitudes regarding individuals with schizophrenia and depression participating in religious practices varied in relation to priests' adherence to prejudices about these mental disorders (MD). A sample of 559 Italian priests completed a questionnaire on their views of either schizophrenia or depression. Data were analyzed using a multiple-group structural equation in which the diagnostic group was a moderator and the size of the municipalities in which the churches were located was a covariate. The study revealed that: priests' attitudes towards churchgoers with MDs are related to views of these individuals as dangerous, easy to recognize and poorly aware of their MDs; community size has a direct effect on priests' attitudes and an indirect effect through perceived dangerousness; the above-mentioned relationships do not differ by type of disorder. Sensitizing priests on stigma may be helpful to facilitate the participation of believers with MDs to religious practices.

Community perspectives on the implementation of a group psychological intervention for adolescents with depression: A qualitative study in rural Nepal

Group-based psychological interventions could help to close the treatment gap for depression in low-resource settings, but implementation barriers exist. In Nepal we sought community members' perspectives on how to implement group interpersonal therapy for adolescents. We conducted qualitative interviews with 25 adolescents with depression (aged 13-18) and seven health and non-governmental organization workers, and four focus groups with non-depressed adolescents, four with parents/guardians, and two with teachers (126 participants total). Data were analyzed using the Framework Method. Participants recommended same-sex groups. School was the preferred location because it is accessible for adolescents and acceptable to parents. Adolescents wanted facilitators from their own community with good communication skills. They did not want parents or teachers to participate in groups but emphasized the need to inform parents and obtain their permission. Community members supported group psychological intervention. School-based psychological interventions facilitated by local people could be an acceptable option in rural Nepal.

Decentralisation and community stakeholders’ engagement for better mental health services development in the conflict-affected regions of Ukraine

Purpose

The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The main interest focuses on community stakeholders’ perception of their problems and solutions that communities can create to achieve better mental health coverage.

Design/methodology/approach

A series of roundtables (RTs) (4 RTs, 62 participants overall), accompanied by interactive brainstorming techniques, were conducted with communities’ representatives/stakeholders from the East of Ukraine (Lugansk region, a government-controlled area) during the year 2021. Participants (health, mental health, social care workers and administration representatives) were provided with the opportunity to discuss mental health services’ development challenges and create affordable solutions for their communities. Results of discussions were submitted to qualitative analysis and offered for review by participants.

Findings

Decentralisation in Ukraine led to allocating funds alongside responsibilities for developing the services to communities. Most of the communities appear not to be ready to acknowledge the role of mental health services, entirely relying on the existing weak psychiatric hospital-based system. Awareness-raising interactive capacity-building activities for the community leaders and decision-makers effectively promote community-based mental health services development. Five clusters of challenges were identified: leadership, coordination and collaboration problems; infrastructure, physical accessibility and financial problems; mental health and primary health-care workforce shortage and lack of competencies; low awareness of mental health and available services and high stigma; war, crises and pandemic-related problems. Communities stakeholders foresaw seven domains of action: increasing the role of communities and service users in the initiatives of governmental bodies; establishing in the communities local coordination/working groups dedicated to mental health service development; developing the community-based spaces (hubs) for integrated services provision; embedding the mental health services in the existing services (social, administrative and health care); mental health advocacy and lobbying led by local leaders and service users; increasing capacity of communities in financial management, fundraising; developing services by combining efforts and budgets of neighbouring communities.

Research limitations/implications

The study has potential limitations. Participants of the roundtables were mostly appointed by local authorities, so some of them didn`t have a motivation for mental health services development. Service users were involved only from the facilitators` side, not from the side of communities; therefore, it was impossible to include their view of problems and solutions. Obtained data were limited to the opinion of local professionals, administration workers and other local stakeholders. The human rights aspect was not clearly articulated in the tasks of the roundtables.

Originality/value

To the best of the authors’ knowledge, the paper is original in terms of its topic (connecting decentralisation and local stakeholders’ engagement for understanding the challenges of mental health services development) and research strategy (engagement of Ukrainian communities, qualitative analysis of the discussion results and applying the best practices and international recommendations to the local context).

Causes of Stress among Healthcare Professionals and Successful Hospital Management Approaches to Mitigate It during the COVID-19 Pandemic: A Cross-Sectional Study

The outbreak of the COVID-19 pandemic posed an immediate challenge to the management of hospitals in Germany and elsewhere. The risk of stress for front-line healthcare professionals forced occupational health and safety units to adopt a variety of protective measures, not all of which have been thoroughly validated. The main objective of the present analysis is to assess what the most important sources of stress were and which of the protective measures applied to counteract stress among healthcare staff had the greatest impact. A better understanding of these factors will improve hospital management and worker safety in a future health crisis situation and may also prove to be beneficial in non-crisis situations. For this purpose, in 2020, an exploratory, cross-sectional and quantitative study using a questionnaire created for this purpose was carried out on a total of 198 professionals-133 nurses and 65 physicians-at the Klinikum Mittelbaden Balg hospital in Baden-Baden, Germany, during the first wave of the pandemic. Statistical analyses showed that nurses suffer more stress than physicians and that stress is higher among professionals in critical care and emergency units than in units that are less exposed to infected patients. It was also found that measures such as salary incentives, encouragement of work in well-integrated teams, and perceived support from hospital management mitigate stress. These findings highlight the importance of support measures from management and superiors. Knowing the actual effectiveness of the measures applied by management and the factors mentioned above could help to protect healthcare professionals in the event of another pandemic or similar situations and may still be of value in dealing with the continuing COVID-19 pandemic.

Efficacy of contact intervention videos on college students' intentions toward mental health help-seeking

ObjectiveUntreated mental health (MH) concerns have significant implications for college students. This study examined the efficacy of a video contact intervention targeting students' intentions to seek counseling. Participants: One-hundred and sixty-three college students (M^age = 21.05, SD = 2.20) from a Mid-Atlantic university participated. The sample was predominantly female (74%). Method: Students were randomly assigned to view a student-targeted contact video (ie, clips from college students who share their mental health experiences), a MH comparison contact video, or a non-MH comparison video. Intentions to seek counseling and psychological distress were measured pretest and post-test. Results: Intentions to seek counseling significantly increased from pretest to post-test in the student-targeted contact video condition (F[1, 156] = 22.75, p < .001, partial η² = .13), but not in the comparison conditions. Further, this effect was only observed among participants who reported preexisting psychological distress (F[1, 153] = 28.00, p < .001, partial η² = .16). Conclusions: This study provides initial support for the utility of a student-targeted contact intervention video for increasing help-seeking intentions among those reporting current psychological distress.

Nursing students' beliefs about mental health, interest in work, and job tendencies

PURPOSE

To explore nursing students' mental health educational level, mental illness beliefs, and interest in working in mental health.

DESIGN AND METHODS

Descriptive research conducted with 173 nursing students which convenience sampled. The questionnaire was composed of mental illness beliefs, interest in working in mental health, and tendency to work in nursing areas.

FINDINGS

Main finding demonstarted perception of dangerous from mental illness related to low interest in working in mental health regarding all nursing students.

PRACTICE IMPLICATIONS

There is a necessity to discuss mental health beliefs within theoretical and practical learning as it may eventually can contribute to the quality of care and improve the image of mental healthcare.

The development of positive attitudes toward mental health among university nursing students: Countering the role of social desirability

PURPOSE

This study analyses the evolution of attitudes of nursing students towards mental health, paying particular attention to the influence of social desirability.

DESIGN AND METHODS

Prospective longitudinal repeated-measures study in a sample of nursing students who completed the Community Attitudes toward Mental Illness scale and The Social Desirability Scale.

FINDINGS

After their training, and after adjusting for social desirability, students of female gender recognized attitudes that foster humanistic values than their male counterparts. However, attitudes of restrictiveness and authoritarianism continued to be manifested significantly when the students themselves had mental health problems (MHPs), had had previous training, or were older.

PRACTICE IMPLICATIONS

University courses should continue to foster attitudes of acceptance and destigmatization of people with MHPs, through responses that value authenticity.

Effects of a Cognitive Schema Account on the Stigma of Schizophrenia: A Study in a French University Student Sample

Among people with psychiatric disorders, those with schizophrenia are subject to high levels of stigmatization. Research is necessary to identify new strategies that may help reduce the stigma of schizophrenia. Educational strategies using cognitive accounts, particularly early maladaptive schemas (EMSs), have shown promising results in the context of depression, but they have not been evaluated in the context of schizophrenia. The present study compared the effect on the stigma of three different educational strategies, based on cognitive distortions, biogenetics, and EMSs. A total of 378 students were randomly assigned to 1 of 4 groups. Three experimental groups were presented with a vignette that introduced 1 of 3 different etiological accounts of schizophrenia (cognitive distortions, EMSs, or biogenetics). The fourth group was presented with a text unrelated to schizophrenia. The participants completed questionnaires that measured their attitudes, empathic concern, and social distance toward people with schizophrenia, before and after reading the text. The intervention using the EMS etiology account for schizophrenia was the only one that led to a significant decrease in stigma. The latter effect was driven mainly by an increase in the level of empathic concern toward people with schizophrenia. Given that similar results have been observed for depression and that the role of EMSs in many psychiatric disorders has been demonstrated, studying the effects of EMS explanations for other stigmatized disorders may be promising for reducing the stigma of psychiatric disorders.

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.

Sağlık Öğrencileri İçin Ruh Sağlığı Okuryazarlık Ölçeğinin Türkçeye Uyarlanması: Geçerlik ve Güvenirlik Çalışması

Amaç: Bu çalışmada, Sağlık Öğrencileri için Ruh Sağlığı Okuryazarlık Ölçeğinin (RSOÖ-SÖ) Türkçe uyarlaması için geçerlilik ve güvenilirlik yapılması amaçlanmıştır. Method: Çalışma örneklemi 18-27 yaş arasında İstanbul Tıp Fakültesinde öğrenim gören 275 kişiden oluşmaktadır. RSOÖ-SÖ ölçeği, Ruhsal Hastalıklara Yönelik İnanç Ölçeği (RHYİÖ) ve Pozitif Mental Sağlık Ölçeğini (PMSÖ) veri toplamada kullanılmıştır. Dil uyarlaması için çeviri, geri çeviri, uzman görüşleri ve pilot uygulama yapılmıştır. Geçerlik için kapsam geçerlilik indeksi, doğrulayıcı faktör analizi ve güvenilirliği test etmek için Cronbach alfa analizi, test-tekrar test yöntemi kullanılmıştır. Bulgular: Ölçeğin kapsam geçerlilik indeksi 0.99 ve doğrulayıcı faktör analizine göre madde yükleri 0.38-0.94 olduğu bulunmuştur. Cronbach alfa katsayısı tüm ölçek için 0.79, beş alt boyutu için ise 0.60-0.89 arasında olduğu belirlenmiştir. Eşdeğer ölçüt geçerliliğinde RHYİÖ ile negatif yönlü zayıf korelasyon (r=-0.391, p

The effects of social isolation stress and discrimination on mental health

Social isolation and discrimination are growing public health concerns associated with poor physical and mental health. They are risk factors for increased morbidity and mortality and reduced quality of life. Despite their detrimental effects on health, there is a lack of knowledge regarding translation across the domains of experimental research, clinical studies, and real-life applications. Here, we review and synthesize evidence from basic research in animals and humans to clinical translation and interventions. Animal models indicate that social separation stress, particularly in early life, activates the hypothalamic-pituitary-adrenal axis and interacts with monoaminergic, glutamatergic, and GABAergic neurotransmitter systems, inducing long-lasting reductions in serotonin turnover and alterations in dopamine receptor sensitivity. These findings are of particular importance for human social isolation stress, as effects of social isolation stress on the same neurotransmitter systems have been implicated in addictive, psychotic, and affective disorders. Children may be particularly vulnerable due to lasting effects of social isolation and discrimination stress on the developing brain. The effects of social isolation and loneliness are pronounced in the context of social exclusion due to discrimination and racism, during widespread infectious disease related containment strategies such as quarantine, and in older persons due to sociodemographic changes. This highlights the importance of new strategies for social inclusion and outreach, including gender, culture, and socially sensitive telemedicine and digital interventions for mental health care.

"It's all about asking from those who have walked the path": Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa

BACKGROUND

South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers-individuals with lived experience of SUD-may be a promising solution for addressing SUD stigma, while also improving engagement in HIV care. We evaluated the perceived acceptability of integrating a peer role into community-based HIV care teams as a strategy to address SUD stigma at multiple levels and improve patient engagement in HIV care.

METHODS

Patients and stakeholders (N = 40) were recruited from publicly-funded HIV and SUD organizations in Cape Town, South Africa. We conducted a quantitative assessment of stigma among stakeholders using an adapted Social Distance Scale (SDS) and patient perceptions of working with a peer, as well as semi-structured interviews focused on experiences of SUD stigma, acceptability of a peer model integrated into community-based HIV care, and potential peer roles.

RESULTS

On the SDS, 75% of stakeholders had high stigma towards a patient with SUD, yet 90% had low stigma when in recovery for at least 2 years. All patients endorsed feeling comfortable talking to someone in recovery and wanting them on their HIV care team. Three main themes emerged from the qualitative data: (1) patient-reported experiences of enacted SUD and HIV stigmas were common and impacted HIV care engagement; (2) both patients and stakeholders considered a peer model highly acceptable for integration into HIV care to support engagement and address SUD stigma; and (3) patients and stakeholders identified both individual-level and systems-level roles for peers, how peers could work alongside other providers to improve patient care, and key characteristics that peers would need to be successful in these roles.

CONCLUSIONS

Findings from this formative work point to the promise of a peer model for reducing SUD stigma among patients and HCWs within community-based HIV care teams in SA.

Destigmatising mental health treatment and increasing openness to seeking treatment: randomised controlled trial of brief video interventions

BACKGROUND

Despite an elevated risk of psychopathology stemming from COVID-19-related stress, many essential workers stigmatise and avoid psychiatric care. This randomised controlled trial was designed to compare five versions of a social-contact-based brief video intervention for essential workers, differing by protagonist gender and race/ethnicity.

AIMS

We examined intervention efficacy on treatment-related stigma ('stigma') and openness to seeking treatment ('openness'), especially among workers who had not received prior mental healthcare. We assessed effectiveness and whether viewer/protagonist demographic concordance heightened effectiveness.

METHOD

Essential workers (N = 2734) randomly viewed a control video or brief video of an actor portraying an essential worker describing hardships, COVID-related anxiety and depression, and psychotherapy benefits. Five video versions (Black/Latinx/White and male/female) followed an identical 3 min script. Half the intervention group participants rewatched their video 14 days later. Stigma and openness were assessed at baseline, post-intervention, and at 14- and 30-day follow-ups. Trial registration: NCT04964570.

RESULTS

All video intervention groups reported immediately decreased stigma (P < 0.0001; Cohen's d = 0.10) and increased openness (P < 0.0001; d = 0.23). The initial increase in openness was largely maintained in the repeated-video group at day 14 (P < 0.0001; d = 0.18), particularly among viewers without history of psychiatric treatment (P < 0.0001; d = 0.32). Increases were not sustained at follow-up. Female participants viewing a female protagonist and Black participants viewing a Black protagonist demonstrated greater openness than other demographic pairings.

CONCLUSIONS

Brief video-based interventions improved immediate stigma and openness. Greater effects among female and Black individuals viewing demographically matched protagonists emphasise the value of tailored interventions, especially for socially oppressed groups. This easily disseminated intervention may proactively increase care-seeking, encouraging treatment among workers in need. Future studies should examine intervention mechanisms and whether linking referrals to psychiatric services generates treatment-seeking.

Utilisation and costs of mental health-related service use among adolescents

Background

The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs.

Methods

Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively.

Results

Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, [OR = 2.49, 95%CI = 1.44–4.30, p = 0.001], remittent [OR = 2.16, 95%CI = 1.27–3.69, p = 0.005] or persistent [OR = 3.01, 95%CI = 1.69–5.36, p<0.001]), higher impact of symptoms on adolescent’s life (OR = 1.32, 95%CI = 1.19–1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05–1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (β = 0.25, 95%CI = 0.12–0.39, p<0.001), lower parental stigma (β = 0.12, 95%CI = 0.02–0.23, p = 0.020) and white ethnicity (β = 0.55, 95%CI = 0.04–1.07, p = 0.036).

Conclusion

The impact of mental health problems on adolescents’ daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs.

Gambling Disorder and Stigma: Opportunities for Treatment and Prevention

Purpose of Review

Gambling disorder is among the most stigmatized mental health problems. More research is needed to understand the mechanisms that underlie this stigma and the effects of stigma-reduction interventions. This paper reviews extant literature on the stigma of gambling disorder and highlights evidence from this research and the broader mental illness stigma literature to help advance research on the prevention and reduction of gambling-related stigma.

Recent Finding

The public stigma of gambling disorder includes stereotypes of affected individuals as “greedy” and “irresponsible,” beliefs that affected individuals are to blame for their problems, and desire to avoid social contact with affected individuals. Stigmatizing attitudes held by the public are often internalized by individuals with gambling disorder, which leads to problem concealment, reduced treatment-seeking, and decreased self-esteem. Women with gambling disorder, as well as those with more severe gambling problems and who perceive greater stigma by the public, are most vulnerable to self-stigma. There is evidence that certain beliefs may underlie the stigmatization of gambling disorder, including beliefs about its causes. Contact- and education-based interventions show efficacy for the reduction of mental illness-related stigma more broadly; additional research is needed to determine the efficacy of various stigma reduction strategies for gambling disorder specifically.

Summary

Gambling disorder is highly stigmatized relative to other mental health problems, in part because it is viewed as more likely to be caused by controllable factors. Interventions that emphasize the biopsychosocial etiology of gambling disorder may help to prevent and reduce the blame and stigmatization of affected individuals. Structural stigma within domains such as legislation, healthcare, and the gambling industry, interventions to reduce self-stigma, stigma among mental health professionals, and the influence of culture on stigma and its reduction are critical issues for future research.

Attitudes of mental healthcare professionals and media professionals towards each other in reducing social stigma due to mental illness in Bangladesh

Mental illness is a neglected issue all over the world. The development of negligence towards mental illness could be due to the stigmatized attitudes. Also, social stigma due to mental illness is prevalent in many south Asian countries. In Bangladesh, the condition is even worse than regional data in Asia. The general people consider media as a primary source of information about mental health. However, mental health professionals (MHP) have direct contact with psychiatric patients and their family members. Therefore, both MHP and media professionals (MP) have a role in reducing social stigma due to mental illness. The present study aimed to identify attitudes of MHP and MP towards each other in reducing social stigma due to mental illness. We conducted a cross-sectional online survey among 174 participants (80 MHP and 94 MP). We used two sets of self-reporting questionnaires to assess the attitudes of MHP and MP towards one another. Also, we collected and analyzed sociodemographic profiles of study participants. We observed significant differences in terms of their profession-related statements between MHP and MP. Also, we have seen significant gaps between MHP and MP in terms of their complete agreement on attitude-related aspects. However, most respondents agreed that stigma due to mental illness is a vital problem in Bangladesh. Moreover, maximum participants accepted that the current public images about psychiatry and media role in reducing social stigma need to be improved. We observed gap between MHP and MP in their roles and beliefs in reducing social stigma due to mental illness in Bangladesh. Reciprocal training and awareness programs would help them in reducing social stigma due to mental illness. The findings of the present study would help to sort out the possible areas for interventions. However, the present study has few limitations; therefore, we recommend further studies with more homogeneous and large samples to make better conclusion.

Finding the right words: Articulating the value of mental health promotion. A focus group study

The Lapinlahti Hospital initiative in Helsinki has transformed a disused psychiatric hospital into an open site for mental health promotion. The current study uses qualitative methods to explore how the initiative may promote population mental health. The phenomenological study comprised of data from 7 focus group including 28 participants. Resulting data were thematically analysed to articulate how the initiative supports mental wellbeing in different ways. Mental health benefits were categorized into three themes; mental health value, civil values and common values which were comprised of nine subthemes; paradigm shift, social inclusion, personal meaning, regeneration, ambience, stigma, sustainability, democracy and environment. Mental health promotion emphasises the impact of daily environments in which people live their lives. Results from this study support the use of broad based actions which promote different components of mental wellbeing simultaneously. Psychiatric hospitals may offer historically meaningful sites for such actions.

Impact of celebrity disclosure on mental health-related stigma

Mental health stigma and discrimination are global problems, and their reduction is recognised as an important public health priority. Involving celebrities in stigma reduction is increasingly common. This Editorial considers the impact of celebrity disclosure on mental health-related stigma; that is, whether and how a famous person openly speaking about their experience of mental health conditions can reduce stigma. Potential explanations for how celebrity mental health disclosures can influence mental health-related knowledge, attitudes and behaviours are outlined, followed by an overview of evidence on how celebrity disclosure operates to reduce stigma. Considering the available evidence, we provide a number of conclusions and recommendations for how celebrities can effectively be involved in anti-stigma efforts, and what considerations this requires. It is fair to say that celebrity disclosures can support stigma-reduction efforts through increasing the public's awareness of mental health, modelling behaviour and generating openness on speaking about mental health problems, and on seeking help when needed. However, whether celebrity disclosure achieves changes in mental health stigma-related knowledge, attitudes and behaviours depends on the extent to which there is a match between the attributes of the famous person, the content shared in their disclosure narrative and the intended audience of the message. Further research is needed on all these questions to better understand how to successfully utilise the potentially huge power of celebrity disclosure in large-scale anti-stigma efforts.

Charting an Alternative Course for Mental Health-Related Anti-Stigma Social and Behaviour Change Programmes

Mental health-related anti-stigma strategies are premised on the assumption that stigma is sustained by the public's deficiencies in abstract professional knowledge. In this paper, we critically assess this proposition and suggest new directions for research. Our analysis draws on three data sets: news reports (N = 529); focus groups (N = 20); interviews (N = 19). In each social context, we explored representations of mental health and illness in relation to students' shared living arrangements, a key group indicated for mental health-related anti-stigma efforts. We analysed the data using term-frequency inverse-document frequency (TF-IDF) models. Possible meanings indicated by TF-IDF modelling were interpreted using deep qualitative readings of verbatim quotations, as is standard in corpus-based research approaches to health and illness. These results evidence the flawed basis of dominant mental health-related anti-stigma campaigns. In contrast to deficiency models, we found that the public made sense of mental health and illness using dynamic and static epistemologies and often referenced professionalised understandings. Furthermore, rather than holding knowledge in the abstract, we also found public understanding to be functional to the social context. In addition, rather than being agnostic about mental health-related knowledge, we found public understandings are motivated by group-based identity-related concerns. We will argue that we need to develop alternative anti-stigma strategies rooted in the public's multiple contextualised sense-making strategies and highlight the potential of engaging with ecological approaches to stigma.

Stakeholders' perceptions of barriers and facilitators for dental and mental health referrals of HIV/AIDS clinic patients

INTRODUCTION

Persons living with HIV/AIDS (PLWHA) are understudied and underserved with respect to both dental and mental health services. The coexistence of psychiatric and dental problems in PLWHA leads to more complex diagnostic assessments and treatments compared to the general population. The aim of the present study was to identify relevant themes from the perspectives of important stakeholders regarding the barriers to and facilitators of patient referral to these services.

METHOD

Semi-structured Key Informant Interviews (KIIs) were conducted with nine program directors and other key staff from New York State HIV clinics to examine barriers to and facilitators of successful dental and mental health referrals and factors that affect patient motivation.

RESULTS

Primary themes crystalized around dental and mental health referral, subject knowledge and perspective, patient barriers, and strategies to overcome barriers. Identified barriers included mental health and HIV status stigma, social determinants of health, fear, disconnectedness, and inconsistent access for dental care. Facilitators identified included case management, integrated one-stop-shop care, and interprofessional awareness and collaboration. Potential patient motivators included process improvement strategies such as transportation support, case management, incentives, and building trust.

CONCLUSION

Specific strategies to facilitate patient motivation such as care coordination and interprofessional collaboration is useful for improving dental and mental health referrals.

Mechanisms of action for stigma reduction among primary care providers following social contact with service users and aspirational figures in Nepal: an explanatory qualitative design

BACKGROUND

There are increasing initiatives to reduce mental illness stigma among primary care providers (PCPs) being trained in mental health services. However, there is a gap in understanding how stigma reduction initiatives for PCPs produce changes in attitudes and clinical practices. We conducted a pilot randomized controlled trial of a stigma reduction intervention in Nepal: REducing Stigma among HealthcAre Providers (RESHAPE). In a previous analysis of this pilot, we described differences in stigmatizing attitudes and clinical behaviors between PCPs receiving a standard mental health training (mental health Gap Action Program, mhGAP) vs. those receiving an mhGAP plus RESHAPE training. The goal of this analysis is to use qualitative interview data to explain the quantitative differences in stigma outcomes identified between the trial arms.

METHODS

PCPs were randomized to either standard mental health training using mhGAP led by mental health specialists or the experimental condition (RESHAPE) in which service users living with mental illness shared photographic recovery narratives and participated in facilitated social contact. Qualitative interviews were conducted with PCPs five months post-training (n = 8, standard mhGAP training; n = 20, RESHAPE). Stigmatizing attitudes and clinical practices before and after training were qualitatively explored to identify mechanisms of change.

RESULTS

PCPs in both training arms described changes in knowledge, skills, and confidence in providing mental healthcare. PCPs in both arms described a positive feedback loop, in which discussing mental health with patients encouraged more patients to seek treatment and open up about their illness, which demonstrated for PCPs that mental illness can be treated and boosted their clinical confidence. Importantly, PCPs in the RESHAPE arm were more likely to describe a willingness to treat mental health patients and attributed this in part to social contact with service users during the training.

CONCLUSIONS

Our qualitative research identified testable mechanisms of action for stigma reduction and improving clinical behavior: specifically, recovery stories from service users and social engagement led to greater willingness to engage with patients about mental illness, triggering a feedback loop of more positive experiences with patients who benefit from mental healthcare, which further reinforces willingness to deliver mental healthcare. Trial registration ClinicalTrials.gov identifier, NCT02793271.

Stigma towards people with mental illness in the Nordic countries - a scoping review

INTRODUCTION

Stigma affects people with mental illness globally, however, it is proposed that stigma is less prevalent in wealthier countries and that people hold more positive attitudes in Northern and Western Europe. Even so, accounts from surveys in Denmark and Sweden reveal that stigma is very much prevalent.

AIM

This scoping review aims to shed light on the body of literature regarding mental-health-related stigma in the Nordic Countries and identify knowledge gaps.

METHODS

We searched four electronic databases in December 2017 and again in June 2020. All types of empirical studies (qualitative, quantitative, and mix-methods) examining the stigma of people with mental illness were included.

RESULTS

In total, 61 studies were included. Overall, findings from the Nordic countries resemble global findings. Studies are primarily descriptive, and mostly survey studies of attitudes toward people with mental illness in the general population. Few studies focus on discrimination, and those who do, measure intended behavior in hypothetical situations rather than actual acts of discrimination in real-life situations. Studies were mostly conducted on a community or organizational level; no studies were identified on a system level. Experienced stigma and discrimination by patients, but also relatives, were a focus in one-third of the studies. Very few studies of interventions to reduce stigma and discrimination were identified.

CONCLUSION

More studies into stigma on a system or institutional level are needed. Ways to measure acts of discrimination should be invented. Furthermore, interventions to reduce stigma and discrimination should be developed, targeting all levels of society.

Knowledge and attitude regarding organ donation among medical students in Hong Kong: a cross-sectional study

Objectives

The rate of organ donation in Hong Kong is among the lowest in developed regions. Since medical students will play an important role in counselling patients for organ donation and identifying potential donors in the future, their knowledge, attitudes and action for organ donation are important. This study aims to understand knowledge, attitudes and actions with regard to organ donation among medical students and investigate the factors determining the knowledge and attitudes.

Design

A cross-sectional study.

Setting and participants

Medical students in Hong Kong were invited to complete a questionnaire. 377 medical students participated in the study.

Methods

The questionnaire assessed their attitudes, knowledge, action of organ donation, belief and perception on organ donation, and other factors. Linear regression analyses and logistic regression were performed to analyse the effect of the variables on knowledge, attitudes and action for organ donation.

Results

Almost all medical students (99.5%) held a positive attitude towards organ donation, but only 28.1% have signed up as organ donors. Determinants of knowledge of organ donation included belief in preservation of intact body after death (β = –0.14, 95% CI = –0.24 to –0.04) and perceived confidence and competence of organ donation discussion (β = –0.12, 95% CI = –0.22 to –0.02). Predictors of organ donor registration status included knowledge of organ donation (OR=1.03, 95% CI=1.00 to 1.06), perceived convenience of organ donation registration (OR=3.75, 95% CI=1.62 to 8.71), commitment to organ donation (OR=3.81, 95% CI=2.01 to 7.21) and exposure to organ donation (OR=4.28, 95% CI=2.37 to 7.74).

Conclusions

Knowledge is positively associated with organ donation action. The above determinants of organ donation could be emphasised in medical education.

An intervention to reduce stigma and improve management of depression, risk of suicide/self-harm and other significant emotional or medically unexplained complaints among adolescents living in urban slums: protocol for the ARTEMIS project

BACKGROUND

There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20% of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology-based electronic decision support system will help reduce stigma, depression, and suicide risk and improve mental health for high-risk adolescents living in urban slums in India.

METHODS

The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived-a high-risk cohort with an elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores.

DISCUSSION

The key elements that ARTEMIS will focus on are increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self-harm and should have relevance not only for India but also for other low- and middle-income countries.

TRIAL STATUS

Protocol version - V7, 20 Dec 2021 Recruitment start date: tentatively after 15th July 2022 Recruitment end date: tentatively 14th July 2023 (1 year after the trial start date) TRIAL REGISTRATION: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries ( https://www.who.int/clinical-trials-registry-platform/network/primary-registries ) Reference No. CTRI/2022/02/040307 . Registered on 18 February 2022. The tentative start date of participant recruitment for the trial will begin after 15th July 2022.

Healthcare use in commercially insured youth with mental health disorders

BACKGROUND

The objective of this study is to describe age-related patterns of outpatient healthcare utilization in youth and young adults with mental health disorders.

METHOD

We used the IBM^® MarketScan^® Commercial Database to identify 359,413 youth and young adults (12-27 years) with a mental health disorder continuously enrolled in private health insurance in 2018. Exploratory analysis was used to describe patterns of outpatient healthcare use (e.g., primary, reproductive, mental health care) and therapeutic management (e.g., medication prescriptions, psychotherapy) by age. Period prevalence and median number of visits are reported. Additional analysis explored utilization patterns by mental health disorder.

RESULTS

The prevalence of outpatient mental health care and primary care decreased with age, with a larger drop in primary care utilization. While 74.0-78.4% of those aged 12-17 years used both outpatient mental health care and primary care, 53.1-59.7% of those aged 18-27 years did. Most 18-19-year-olds had a visit with an internal medicine or family medicine specialist, a minority had a pediatrician visit. The prevalence of medication management increased with age, while the prevalence of psychotherapy decreased.

CONCLUSIONS

Taken together, this descriptive study illustrates age-related differences in outpatient healthcare utilization among those with mental health disorders. Additionally, those with the most severe mental health disorders seem to be least connected to outpatient care. This knowledge can inform efforts to improve utilization of healthcare across the transition to adulthood.

The influence of patient gender in healthcare professional decision-making: an interaction analysis of simulation debriefings

Previous research suggests that gender bias is pervasive in health care and has deleterious effects on treatment outcomes for patients. When developing and improving training on gender bias, we need to further our understanding of how such topics arise and are sustained in conversations between healthcare professionals (HCPs). The aim of this study is to analyze the influence of patient gender in HCP decision-making by analyzing how they surface, discuss and manage topics around gender.

An ethnomethodological qualitative study using discursive psychology and conversation analysis was implemented to examine 10 simulation debriefs in a specialized mental healthcare simulation centre in London. Video footage was obtained from mental health simulation training courses on bias in clinical decision-making, involving HCPs from mixed healthcare professions. Following transcription of selected segments, the debriefs were analyzed and repeated patterns of interaction were captured in distinct themes.

Four main themes were identified from the data, indicating some of the ways in which conversations about gender are managed: collaboration (to encourage discussion), surprise (when unexpected topics arose), laughter (to diffuse tense situations) and silence (demonstrating careful thinking). Patients with mental health conditions were perceived differently in terms of treatment decisions due to existing gender biases.

The persistence of gender bias that may result in discrimination in health care with negative consequences attests to the need for greater awareness and training development at various levels to include an intersectional approach.

Reducing dementia-related stigma and discrimination among community health workers in Brazil: protocol for a randomised controlled feasibility trial

INTRODUCTION

Stigma and discrimination among healthcare workers can hinder diagnosis and the provision of appropriate care in dementia. This study is aimed at developing, delivering and evaluating the feasibility of a group antistigma intervention to improve knowledge, attitudes and behaviours in relation to people living with dementia among community health workers (CHWs).

METHODS AND ANALYSIS

This will be a randomised controlled feasibility trial conducted with 150 CHWs from 14 primary care units (PCUs) in São Paulo, Brazil. PCUs will be randomly allocated (1:1) in two parallel groups-experimental group or control group. Participants from PCUs allocated to the experimental group will receive a 3-day group intervention involving audio-visual and printed materials as well as elements of social contact. The control group will keep their usual routine. Knowledge, attitude and intended behaviour stigma-based outcomes will be assessed at baseline and at follow-up (30 days after intervention) to both groups, with additional questions on feasibility for the experimental group at follow-up. Around 10-15 participants will take part in follow-up semistructured interviews to further explore feasibility. Quantitative analyses will follow an 'intention to treat' approach. Qualitative data will be analysed using content analysis.

ETHICS AND DISSEMINATION

This study was approved by the National Commission for Ethics in Research in Brazil (n. 5.510.113). Every participant will sign a consent form. Results will be disseminated through academic journals and events related to dementia. The intervention materials will be made available online.

Spanish adaptation and validation of the Peer Mental Health Stigmatization Scale (PMHSS-24)

INTRODUCTION

There is currently a growing interest in interventions aimed at the reduction of stigma towards people with emotional difficulties in adolescents. Unfortunately, the number of scales available in Spanish to assess stigma at these ages is limited. This paper aims to adapt and validate the scale of stigmatizing attitudes towards mental health among peers (Peer Mental Health Stigmatization Scale PMHSS-24).

MATERIAL AND METHODS

A total of 443 adolescents (46.6% female and 53.7% male) between 13 and 17 years of age participated (M_age = 14.64; SD = 0.83) in the 3rd and 4th grades of Obligatory Secondary Education. The internal consistency of the test was calculated, an exploratory factorial analysis (EFA) was performed with half of the sample and a confirmatory one (CFA) with the other half, and the invariance of measurement of the scale through sex was found.

RESULTS

The EFA showed a two-factor structure for the negative scale (53% of the variance explained) and another 2 for the positive scale (62% of the variance explained). The CFA corroborated the factor structure with appropriate goodness-of-fit indicators (CFI > 0.95; NNFI > 0.95, SRMR < 0.08, RMSEA < 0.08). Factor loads ranged from 0.49 to 0.89, with α factor correlation between r = 0.53 and 0.45. Both subscales exhibited optimal alpha values (negative 0.94 and positive 0.81). The scale was invariant between the sexes.

CONCLUSIONS

The data suggest that PMHSS-24 may be a useful scale for the initial screening of the stereotypes exhibited by adolescents toward people with mental illness.

Mexican Psychiatric Trainees' Attitudes Towards People with Mental Illness: A Qualitative Study

Despite their training, psychiatrists have been found to have negative attitudes towards people with mental illness, including the patients they treat. Similarly, studies focused on service users have identified psychiatrists as a source of stigma. Even though negative attitudes in psychiatrists have been identified in different countries and settings, in Mexico the attitudes of these professionals have never been assessed. Because of this, we invited psychiatric trainees from a hospital in Mexico to participate in individual interviews to describe their opinions regarding mental health-related stigma, to evaluate their attitudes towards people with mental illness and to identify factors that could be influencing their attitudes. Interviews were audio recorded, transcribed and analysed using thematic analysis. A total of 29 trainees participated in the study. The results suggested that trainees recognised psychiatrists can have negative attitudes towards people with mental illness, such as poor empathy, judgement and labelling, and mainly towards patients considered difficult and with borderline personality disorder. Participants recognised these attitudes can influence their relationship with patients, and considered it is necessary to develop interventions to improve their own attitudes and reduce mental health stigma. From this study we concluded Mexican psychiatrists are not free from stigma towards people with mental illness. However, Mexican psychiatric trainees are interested in improving their attitudes and reactions towards their patients.

Effect of a contact-based education intervention on reducing stigma among community health and care staff in Beijing, China: Pilot randomized controlled study

The aim was to assess the feasibility of an intervention to reduce stigma among primary care and community healthcare staff in Beijing, China through a contact-based education intervention. Participants were randomly assigned to: (i) "education only" group, a lecture-based education; or (ii) "education and contact" group, lectures plus contact with people with lived experience of mental illness. Each participant completed an assessment of mental health stigma related: knowledge (mental health knowledge schedule, MAKS); attitudes (mental illness: clinicians' attitudes scale, MICA-4); and behavior (reported and intended behavior scale, RIBS) before and after the intervention, with follow up at 1 month and 3 months after the intervention. A total of 121 healthcare staff were recruited. Both "education only" group and "education and contact" group showed improved knowledge after the intervention, MAKS scores increased by 1.77 ± 3.15 VS 2.46 ± 2.49 (both p < 0.001), respectively. There was no between-group difference in MAKS score. The "education and contact" group showed a significantly greater improvement for MICA and RIBS score than the "education only" group: the MICA score decreased by 4.43 ± 9.42 VS 8.41 ± 7.48 (p = 0.027), and the RIBS score increased by 2.28 ± 3.89 VS 4.57 ± 3.53 (p = 0.003), in the "education only" and the "education and contact" groups respectively, but the between group differences disappeared at 1 month and 3 months follow-up points. The positive effects on stigma levels (knowledge, attitudes and behaviours) in both groups were sustained at 3 months. The intervention to reduce stigma among the primary and community healthcare staff through a contact-based education intervention was feasible in Beijing.

An Exploration of Young Adults With Opioid use Disorder and How Their Perceptions of Family Members' Beliefs Affects Medication Treatment

Young adults with opioid use disorder (OUD) have low engagement and retention in medication treatment. Families are uniquely situated to play an important role in treatment decisions. This qualitative study explored how young adults with OUD perceive their families’ beliefs about OUD and medication treatment, and how those beliefs impacted young adults’ beliefs about their own treatment decisions.

Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions

BACKGROUND

People with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions.

METHODS

This evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions.

RESULTS

A total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction- one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care.

CONCLUSION

There is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia.

Establishing political priority for global mental health: a qualitative policy analysis

Mental disorders represent the leading cause of disability worldwide, yet they remain a low global health priority. This paper uses a case study methodology and different data sources (35 interviews and documents) to analyse factors that have shaped the generation of political priority for global mental health over the past three decades (1990–2020) and their changes over time. The Shiffman and Smith framework on determinants of political priority for global health issues is used to organize data into themes: actor power, ideas, political context and issue characteristics. Global mental health has gained political attention, especially over the past decade, yet support remains limited. Findings reveal that actor power is undermined by a fragmented policy community, the absence of one guiding institution or coordination mechanism and little civil society mobilization. Public portrayal of the issue is divided, hampered by the absence of a common understanding by the community and by stigma. Some policy windows have been missed and a strong global governance structure is lacking. Credible indicators and evidence on simple cost-effective solutions, especially in low- and middle-income countries, are scarce. However, opportunities are arising, including an increasing number of leaders and grassroots organizations, multiple arguments for action and integrated solutions resonating with broader audiences, widening political support at the national level, an emerging global governance structure and an expanding evidence base on the scale of the problem and available solutions. The results point to three technical and four political challenges that advocates need to address to increase political support over the next decade.