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Yatirajula SK, Kallakuri S, Paslawar S, Mukherjee A, Bhattacharya A, Chatterjee S, Sagar R, Kumar A, Lempp H, Raman U, Singh R, Essue B, Billot L, Peiris D, Norton R, Thornicroft G, Maulik PK. 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. Trials 2022; 23:612. [PMID: 35906663 PMCID: PMC9336093 DOI: 10.1186/s13063-022-06539-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar
- Dr.A.V. Baliga Memorial Trust, New Delhi, India
| | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Usha Raman
- University of Hyderabad, Hyderabad, India
| | | | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laurent Billot
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Robyn Norton
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
- Imperial College, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India.
- University of New South Wales, Sydney, Australia.
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202
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Healthcare use in commercially insured youth with mental health disorders. BMC Health Serv Res 2022; 22:952. [PMID: 35883138 PMCID: PMC9323879 DOI: 10.1186/s12913-022-08353-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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203
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Gauci AA, Attoe C, Woodhead C, Hatch SL, Kainth R. The influence of patient gender in healthcare professional decision-making: an interaction analysis of simulation debriefings. Simul Healthc 2022. [DOI: 10.54531/iivd1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Andrea Amato Gauci
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Chris Attoe
- ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Charlotte Woodhead
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephani L Hatch
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ranjev Kainth
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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204
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Oliveira D, Godoy C, da Mata FAF, Mateus E, Franzon ACA, Farina N, Evans-Lacko S, Ferri CP. Reducing dementia-related stigma and discrimination among community health workers in Brazil: protocol for a randomised controlled feasibility trial. BMJ Open 2022; 12:e060033. [PMID: 38687683 PMCID: PMC9301803 DOI: 10.1136/bmjopen-2021-060033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Déborah Oliveira
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Carolina Godoy
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Fabiana A F da Mata
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Elaine Mateus
- Brazilian Federation of Alzheimer's Associations (FEBRAZ), Paraná, Brazil
- Applied Linguistics, Department of Modern Languages, Universidade Estadual de Londrina (UEL), Paraná, Brazil
| | | | - Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Cleusa P Ferri
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
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de la Higuera-Romero J, Candelas-Muñoz A, Jiménez-González A, Castañeda-Jiménez C, Fuica-Pereg P, Zurita-Carrasco M, Martínez-Fernandez-Repeto E, Senín-Calderón C. Spanish adaptation and validation of the Peer Mental Health Stigmatization Scale (PMHSS-24). REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:176-184. [PMID: 36167643 DOI: 10.1016/j.rpsmen.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/15/2020] [Indexed: 06/16/2023]
Abstract
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 (Mage = 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.
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Affiliation(s)
| | - Andrea Candelas-Muñoz
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Andrea Jiménez-González
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario de Puerto Real, Cádiz, Spain
| | | | - Paula Fuica-Pereg
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - María Zurita-Carrasco
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario de Puerto Real, Cádiz, Spain
| | | | - Cristina Senín-Calderón
- Departamento de Psicología, Facultad de CC de la Educación, Universidad de Cádiz, Cádiz, Spain
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Lagunes-Cordoba E, Lagunes-Cordoba R, Fresan-Orellana A, Gonzalez-Olvera J, Jarrett M, Thornicroft G, Henderson C. Mexican Psychiatric Trainees' Attitudes Towards People with Mental Illness: A Qualitative Study. Community Ment Health J 2022; 58:982-991. [PMID: 34716830 PMCID: PMC9187538 DOI: 10.1007/s10597-021-00907-5] [Citation(s) in RCA: 1] [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] [Received: 02/26/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Emmeline Lagunes-Cordoba
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Roberto Lagunes-Cordoba
- Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Ana Fresan-Orellana
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Jorge Gonzalez-Olvera
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico.,Comisión Nacional Para la Prevención de Adicciones, Mexico City, Mexico
| | - Manuela Jarrett
- School of Health Sciences, City, University of London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Claire Henderson
- Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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207
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Zhang W, Henderson C, Magnusdottir E, Chen W, Ma N, Ma H, Thornicroft G. Effect of a contact-based education intervention on reducing stigma among community health and care staff in Beijing, China: Pilot randomized controlled study. Asian J Psychiatr 2022; 73:103096. [PMID: 35430494 DOI: 10.1016/j.ajp.2022.103096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/27/2022] [Accepted: 04/02/2022] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Wufang Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, China; NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), China
| | - Claire Henderson
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Erla Magnusdottir
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Weiran Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, China
| | - Ning Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, China; NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), China
| | - Hong Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, China; NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), China.
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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208
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Girma E, Ketema B, Mulatu T, Kohrt BA, Wahid SS, Heim E, Gronholm PC, Hanlon C, Thornicroft G. Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions. Int J Ment Health Syst 2022; 16:30. [PMID: 35739558 PMCID: PMC9219139 DOI: 10.1186/s13033-022-00540-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Eshetu Girma
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Bezawit Ketema
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfahun Mulatu
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA
| | - Syed Shabab Wahid
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA
- Department of International Health, Georgetown University, DC, Washington, USA
| | - Eva Heim
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Petra C Gronholm
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Paula CS, Ziebold C, Ribeiro WS, Pan PM, Mari JJ, Bressan R, Miguel EC, Rohde LA, Salum GA, Evans-Lacko S. THE INFLUENCE OF CAREGIVER ATTITUDES AND SOCIO-ECONOMIC GROUP ON FORMAL AND INFORMAL MENTAL HEALTH SERVICE USE AMONGST YOUTH. Eur Psychiatry 2022; 65:e34. [PMID: 35684952 PMCID: PMC9251818 DOI: 10.1192/j.eurpsy.2022.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cristiane Silvestre Paula
- Programa de Pós-Graduação em Distúrbios do Desenvolvimento e Centro Mackenzie de Pesquisa sobre a Infância e Adolescência-Universidade Presbiteriana Mackenzie (UPM), São Paulo-SP, Brazil
| | - Carolina Ziebold
- Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Wagner S Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science-LSE
| | - Pedro Mario Pan
- Laboratório de Neurociências Integrativas (LiNC), Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Jair Jesus Mari
- Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Rodrigo Bressan
- LiNC - Lab Integrative Neuroscience, Departamento de Psiquiatria - Universidade Federal de São Paulo (UNIFESP); Instituto Ame Sua Mente. São Paulo-SP, Brazil
| | | | - Luiz Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil
| | - Giovanni A Salum
- Section on Negative Affect and Social Processes - Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; National Institute of Developmental Psychiatry
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science-LSE
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210
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Effects of Recovery Measures on Internalized Stigma in Patients Diagnosed with Schizophrenia. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00847-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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211
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Parry S, Eve Z, Myers G. Exploring the Utility and Personal Relevance of Co-Produced Multiplicity Resources with Young People. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:427-439. [PMID: 35600531 PMCID: PMC9120276 DOI: 10.1007/s40653-021-00377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 06/15/2023]
Abstract
Multiplicity, the experience of more than one self in the body, is an under-researched area of young people's mental health. The aim of this study was to explore the perspectives of experts-by-experience within a community sample regarding two specific resources: a co-produced self-help guide about multiplicity for adolescents, and a set of guidelines for supporting someone who identifies as 'multiple'. 34 participants (Mage= 22.06, 2.26 SD; 15F, 1M, 18NBG) completed an online survey consisting of open-ended and Likert scale questions to assess the language, utility, transferability and therapeutic impact of the materials. Descriptive statistics and a Foucauldian-informed Narrative Analysis were employed to analyse responses, producing a summary of utility and two narrative chapters. The emergent chapters, 'Breaking the Stigma' and 'Recognising the Many', highlight the need for greater understanding and awareness of multiplicity, with psychoeducation materials viewed as helpful. Inclusive language can reduce stigma and normalise multiplicity as a response to trauma. With greater understanding, practitioners and researchers can collaborate with young people through trauma wise care, providing multiplicity sensitive language and support. Overall, the term 'parts' was viewed as problematic by the participants as it could imply the plural system is not coexisting as a whole. Additionally, opinions varied as to how much diagnostic language could and should be used to describe multiplicity; linguistically and conceptually. Importantly, compassion was seen as particularly essential for younger selves within the system; older in their years and presence, but often more vulnerable within the societies in which the system resides.
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Affiliation(s)
- Sarah Parry
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
| | - Zarah Eve
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
| | - Gemma Myers
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
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Nikolaou E, Petkari E. Stigma towards schizophrenia in Cyprus: Does studying a mental health related programme make a difference? Int J Soc Psychiatry 2022; 68:891-897. [PMID: 33845608 DOI: 10.1177/00207640211010208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Students from mental health related programmes may display stigmatising attitudes towards people of schizophrenia, however there are no data available on this population in Cyprus. The purpose of the present study was (a) to examine the levels of contact and stigma towards schizophrenia in Cypriot students of programmes related to mental health and students of other programmes and (b) to examine whether the successful recognition of a person with schizophrenia through a vignette and the estimation of severity levels was related to stigmatising attitudes. METHODS The participants were undergraduate students purposively selected across Cypriot universities (N = 152). A vignette depicting a person with schizophrenia, followed by the OMI to examine stigma and the BAE to examine contact with mental illness were used to collect the data. RESULTS The results showed that studying a mental health related programme and being a man was associated with more positive views related to social integration. No further stigma dimensions were predicted by the included variables. Similarly, level of contact and being able to identify the mental condition and estimate its severity was not related to stigma. CONCLUSION The results emphasise the need to develop educational interventions to tackle stigma across students independently of their study programme and enhance mental health related programmes with opportunities for structured contact with patients with mental illness.
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Affiliation(s)
| | - Eleni Petkari
- European University of Cyprus, Nicosia, Cyprus.,Universidad Internacional de la Rioja, Logroño, Spain
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213
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Gavan L, Hartog K, Holland WC, Koppenol-Gonzalez G, Gronholm PC, Feddes AR, Kohrt BA, Jordans MJ, Peters RH. Assessing stigma in low- and middle-income countries: A systematic review of scales used with children and adolescents. Soc Sci Med 2022; 307:115121. [DOI: 10.1016/j.socscimed.2022.115121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
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214
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Sarikoc G, Attoe C, Elcin M, Ortega Vega M. Simulated Patients’ Beliefs Towards Mental Illness. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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215
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Withers M, Jahangir T, Kubasova K, Ran MS. Reducing stigma associated with mental health problems among university students in the Asia-Pacific: A video content analysis of student-driven proposals. Int J Soc Psychiatry 2022; 68:827-835. [PMID: 33827300 DOI: 10.1177/00207640211007511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Studies have demonstrated that mental health problems among university students may be increasing in both prevalence and severity. This study aimed to identify ways to reduce stigma and improve students' utilization of mental health services. METHODS We performed a content analysis on video proposals to address stigma and mental health at universities, submitted by 15 teams from nine Asian-Pacific countries as part of a case competition. We examined five domains: (1) tone; (2) cultural context; (3) mental health issue of focus; (4) prevention versus secondary prevention; and (5) main intervention strategies. RESULTS Five main intervention strategies emerged: (1) educational campaigns; (2) peer interaction and support; (3) counseling; (4) screening; and (5) self-management. The results suggest that mental health literacy is low among students. Educational campaigns and events to increase awareness and reduce stigma were the most commonly incorporated strategy, through film screenings, mental health days, and social media. Building empathy through personal stories from celebrities and other students was also highly recommended. Second, counseling was incorporated in 80% of proposals, with a preference for peers and staff support, and web-based therapy over professional counselors, except in severe cases. Programs to increase social contact were the third most common strategy, suggesting students may feel isolated and disconnected. Creating common spaces for students to interact and pairing of students with and without mental health issues were widely suggested. The use of technology was recommended for self-management of mental health and for mandatory mental health screening, which was generally only recommended for incoming students. CONCLUSIONS Our analysis provides insight into student-generated intervention approaches to prevent and address stigma associated with mental health issues among students. A greater university commitment is needed to provide a range of resources, including education and counseling, to leverage technology, and to foster stronger support networks among students.
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Affiliation(s)
- Mellissa Withers
- Department of Preventive Medicine, University of Southern California, Los Angeles, USA
| | - Tasfia Jahangir
- Department of Preventive Medicine, University of Southern California, Los Angeles, USA
| | - Ksenia Kubasova
- School of Global Studies, Thammasat University, Pathum Thani, Thailand
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, China
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Zhao S, Ren L, Wang Q, Long M, Wu H, Wang Y. Predictors of prolonged grief disorder in Chinese elderly shidu parents: The role of perceived stigma and perceived stress. Asia Pac Psychiatry 2022; 14:e12489. [PMID: 34590778 DOI: 10.1111/appy.12489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Parents who have lost their only child and over the age of 60 are known as elderly shidu parents. This study aimed to investigate predictors of prolonged grief disorder (PGD) among Chinese elderly shidu parents. METHODS Two hundred and ninety-eight elderly shidu parents from Shenyang were included in this cross-sectional study. Participants completed a questionnaire including the Prolonged Grief questionnaire-13 (PG-13), the PTSD (post-traumatic stress disorder) Checklist for DSM-5 (PCL-5), the Center for Epidemiologic Studies Depression Scales (CES-D), the Self-Rating Anxiety Scale (SAS), and the Perceived Stress Scale-10 (PSS-10). Multiple linear regression was used to examine socio-demographic, bereavement-related and perceived stress associated with PGD symptoms. RESULTS The prevalence of PGD among Chinese elderly shidu parents was 13.8%. Among the 41 PGD patients, 29, 39, 36 patients had comorbidity of PTSD, depressive symptoms and anxiety, respectively. Perceived stress, higher educational level, lower annual household income, perceived stigma, violent death of the child, and being in debt were associated with severer PGD symptoms. DISCUSSION The present study revealed the prevalence of PGD and the important role of PGD in diagnosing other mental disorders in Chinese elderly shidu parents. Providing financial help, eliminating social stigma, and stress should be included in PGD prevention among Chinese elderly shidu parents.
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Affiliation(s)
- Shuang Zhao
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Longfei Ren
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Qiong Wang
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Meijun Long
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Hui Wu
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Yang Wang
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
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Laird B, Puzia M, Larkey L, Ehlers D, Huberty J. A Mobile App for Stress Management in Middle-Aged Men and Women (Calm): Feasibility Randomized Controlled Trial. JMIR Form Res 2022; 6:e30294. [PMID: 34989677 PMCID: PMC9132144 DOI: 10.2196/30294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/23/2021] [Accepted: 09/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app-based studies have reported a low proportion of or even no male participants. OBJECTIVE This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions. METHODS This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ≥15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance. RESULTS Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed. CONCLUSIONS A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men. TRIAL REGISTRATION ClinicalTrials.gov NCT04272138; https://clinicaltrials.gov/ct2/show/NCT04272138.
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Affiliation(s)
- Breanne Laird
- Arizona State University, Phoenix, AZ, United States
| | - Megan Puzia
- Behavioral Research and Analytics, LLC, Salt Lake City, UT, United States
| | - Linda Larkey
- Arizona State University, Phoenix, AZ, United States
| | - Diane Ehlers
- University of Nebraska Medical Center, Omaha, NE, United States
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Abi Hana R, Arnous M, Heim E, Aeschlimann A, Koschorke M, Hamadeh RS, Thornicroft G, Kohrt BA, Sijbrandij M, Cuijpers P, El-Chammay R. Mental health stigma at primary health care centres in Lebanon: qualitative study. Int J Ment Health Syst 2022; 16:23. [PMID: 35525972 PMCID: PMC9077642 DOI: 10.1186/s13033-022-00533-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mental health-related stigma is a global public health concern and a major barrier to seeking care. In this study, we explored the role of stigma as a barrier to scaling up mental health services in primary health care (PHC) centres in Lebanon. We focused on the experiences of Healthcare Providers (HCPs) providing services to patients with mental health conditions (MHCs), the views of policy makers, and the perceptions of stigma or discrimination among individuals with MHCs. This study was conducted as part of INDIGO-PRIMARY, a larger multinational stigma reduction programme. METHODS Semi-structured qualitative interviews (n = 45) were carried out with policy makers (n = 3), PHC management (n = 4), PHC staff (n = 24), and service users (SUs) (n = 14) between August 2018 and September 2019. These interviews explored mental health knowledge, attitudes and behaviour of staff, challenges of providing treatment, and patient outcomes. All interviews were coded using NVivo and a thematic coding framework. RESULTS The results of this study are presented under three themes: (1) stigma at PHC level, (2) stigma outside PHC centres, and (3) structural stigma. SUs did not testify to discrimination from HCPs but did describe stigmatising behaviour from their families. Interestingly, at the PHC level, stigma reporting differed among staff according to a power gradient. Nurses and social workers did not explicitly report incidents of stigma but described patients with MHCs as uncooperative, underscoring their internalized negative views on mental health. General practitioners and directors were more outspoken than nurses regarding the challenges faced with mental health patients. Mental health professionals revealed that HCPs still hold implicitly negative views towards patients with MHCs however their attitude has improved recently. Our analysis highlights five layers of stigma affecting SUs. CONCLUSION This qualitative study reveals that stigma was still a key concern that affects patients with MHC. SUs reported experiencing overt stigmatising behaviour in the community but less explicit discrimination in a PHC setting. Our findings emphasise the importance of (1) combatting structural stigma through legal reform, (2) addressing interpersonal stigma, (3) committing PHC management to deliver high quality mental health integrated services, and (4) reducing intrapersonal stigma by building public empathy.
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Affiliation(s)
- Racha Abi Hana
- Ministry of Public Health, National Mental Health Programme, Beirut, Lebanon.
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Maguy Arnous
- Ministry of Public Health, National Mental Health Programme, Beirut, Lebanon
| | - Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | | | - Mirja Koschorke
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Randa S Hamadeh
- Primary Healthcare Department at Ministry of Public Health, Beirut, Lebanon
- Global Health Team of Experts (GHTE), Beirut, Lebanon
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, Division of Global Mental Health George Washington University, Washington, DC, USA
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Rabih El-Chammay
- Ministry of Public Health, National Mental Health Programme, Beirut, Lebanon
- Department of Psychiatry, Saint Joseph University, Beirut, Lebanon
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Ran MS, Wang YZ, Lu PY, Weng X, Zhang TM, Deng SY, Li M, Luo W, Wong IYL, Yang LH, Thornicroft G, Lu L. Effectiveness of enhancing contact model on reducing stigma of mental illness among family caregivers of persons with schizophrenia in rural China: A cluster randomized controlled trial. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 22:100419. [PMID: 35257121 PMCID: PMC8897707 DOI: 10.1016/j.lanwpc.2022.100419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Contact-based intervention has been documented and proved effective on reducing stigma of mental illness in high-income countries, but it is still unclear about the effectiveness of the contact-based intervention among family caregivers of persons with schizophrenia (FCPWS) in low- and middle-income countries including rural China. Methods We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin district of Chengdu city in Southwest China. The FCPWS in these townships were randomly allocated to the Enhancing Contact Model (ECM), Psychoeducational Family Intervention (PFI), or Treatment as Usual (TAU) group. FCPWS in three groups were provided specific interventions and follow-ups. By using a mixed-effect model, our goal was to examine the differences in affiliate self-stigma scale (ASSS) scores among three groups with the data collected at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up timepoints, respectively. This trial is registered with ChiCTR, number ChiCTR2000039133. Findings In April 2019, 253 FCPWS from 8 townships were randomly assigned to receive either ECM (cluster=3, n=90), PFI (cluster=2, n=81), or TAU (cluster=3, n=82). Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower ASSS scores at 9-month follow-up (estimated parameter [EP]= -5.51, 95% CI -10.27 to -0.74, p=0.02). There were no statistically significantly different ASSS scores at 9-month follow up between ECM and PFI groups. Compared with participants in the PFI group, younger (<60 years old), with higher monthly income and other caregiver (e.g., parent, sibling, child) participants in the ECM group had statistically significantly lower ASSS scores in the 3-month follow-up (EP = -5.66, 95% CI -10.13 to -1.19, p<0.01; EP = -7.82, 95% CI -11.87 to -3.78, p<0.001; EP = -6.79, 95% CI -10.69 to -2.90, p<0.001, respectively). Interpretation This first trial in rural China shows that ECM intervention, a new anti-stigma intervention model, is a promising method for reducing affiliate stigma among FCPWS. The ECM intervention is more effective and stable than the PFI on reducing affiliate stigma among FCPWS. Further research needs to explore whether a long-term intervention could produce a more positive anti-stigma outcome trajectory. Funding General Research Fund, University Grants Committee, Hong Kong SAR (GRF, Grant No. 17605618, 2018-2021, PI: Dr. M.S. Ran).
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Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Corresponding author at: Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China.
| | - Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Pei-Yi Lu
- Department of Political Science, Iowa State University, United States
| | - Xue Weng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Shu-Yu Deng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Ming Li
- Chengdu Xinjin Second People's Hospital, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, China
| | - Irene Yin-Ling Wong
- School of Social Policy and Practice, University of Pennsylvania, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, New York University, United States
- Department of Epidemiology, Columbia University, United States
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
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Kitay BM, Walde T, Robertson D, Cohen T, Duvivier R, Martin A. Addressing Electroconvulsive Therapy Knowledge Gaps and Stigmatized Views Among Nursing Students Through a Psychiatrist-APRN Didactic Partnership. J Am Psychiatr Nurses Assoc 2022; 28:225-234. [PMID: 32727255 DOI: 10.1177/1078390320945778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Knowledge gaps and stigmatized perceptions regarding electroconvulsive therapy (ECT) among patients and health providers contribute to the underutilization of an important therapeutic modality. The proactive education of future advanced practice registered nurses (APRNs) provides an opportunity to optimize the use of this evidence-based clinical practice. AIMS: As part of a general course in psychiatry during the first year of nursing school, we dedicated 1 hour to treatment-refractory depression, including ECT, and a second hour to a summary discussion of mood disorders. We evaluated the efficacy of this didactic offering, which was co-taught by a psychiatrist and a psychiatric APRN. METHOD: At baseline, consenting students (n = 94) provided three words they associated with ECT and then completed three validated instruments: (a) Questionnaire on Attitudes and Knowledge of ECT, (b) Opening Minds Stigma Scale for Health Care Providers, and (c) Self-Stigma of Seeking Help. Among the 67 students who repeated the assessment at endpoint, 39 attended the ECT didactic (Intervention group, 58%) and 28 did not (Control, 42%). RESULTS: After completion of the 3-month course, students showed improvement across all measures (p < .001). The only outcomes that improved differentially between the Intervention and Control groups were the Questionnaire on Attitudes and Knowledge of ECT Attitudes and Knowledge scales (p = .01). Word choice valence associated with ECT shifted favorably by endpoint (p < .001). CONCLUSIONS: An educational intervention co-led by a psychiatric-mental health APRN had a significant impact on nursing students' knowledge and perceptions of ECT. This approach can be readily implemented at other institutions. Future refinements will include the videotaped depiction of a simulated patient undergoing the consent, treatment, and recovery phases of ECT.
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Affiliation(s)
- Brandon M Kitay
- Brandon M. Kitay, MD, PhD, Yale University, New Haven, CT, USA
| | - Tina Walde
- Tina Walde, DNP, APRN, PMHNP, Yale University, Orange, CT, USA
| | - Dilice Robertson
- Dilice Robertson, DNP, APRN, PMHNP, Yale University, Orange, CT, USA
| | - Tammy Cohen
- Tammy Cohen, APRN, Yale Psychiatric Hospital, New Haven, CT, USA
| | - Robbert Duvivier
- Robbert Duvivier, MD, PhD, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrés Martin
- Andrés Martin, MD, MPH, Yale University, New Haven, CT, USA
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Bamgbose Pederson A, Waldron E, Burnett-Zeigler I, Clark CT, Lartey L, Wisner K. Perspectives on Mental Illness Stigma Among African Immigrant Pregnant and Post-Partum Women in an Urban Setting: A Brief Report. Health Equity 2022; 6:390-396. [PMID: 35651359 PMCID: PMC9148647 DOI: 10.1089/heq.2021.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: This study assessed the perspectives of pregnant and postpartum African immigrant women on mental illness. Methods: We conducted a focus group session (n=14) among pregnant and postpartum African immigrant women in June 2020. We used an inductive driven thematic analysis to identify themes related to mental health stigma. Results: Five core themes emerged: conceptualization of mental health, community stigmatizing attitudes, biopsychosocial stressors, management of mental health, and methods to reduce stigma. Conclusion: Understanding the perspectives of pregnant African immigrant women at the intersection of their race, ethnicity, gender, and migration are necessary to improve engagement with mental health services.
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Affiliation(s)
| | - Elizabeth Waldron
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Crystal T. Clark
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lynette Lartey
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Katherine Wisner
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Amsalem D, Valeri L, Jankowski SE, Yang LH, Bello I, Nossel I, Malinovsky I, Smith S, Ngo H, Lieff SA, Pagdon S, Lipp A, Markowitz JC, Neria Y, Dixon LB. Reducing public stigma toward individuals with psychosis across race and gender: A randomized controlled trial of young adults. Schizophr Res 2022; 243:195-202. [PMID: 35397250 DOI: 10.1016/j.schres.2022.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Social contact-based interventions effectively reduce stigma toward psychosis. We recently demonstrated the efficacy of a 90-second video intervention in reducing stigma. The current randomized controlled study presents four briefer videos differing in presenter's gender/race, with baseline, postintervention, and 30-day follow-up assessments. The study replicates previous findings and examine whether concordance of presenter's and viewer's race/gender enhanced the anti-stigma effect. METHODS Using a crowdsourcing platform, we recruited 1993 participants ages 18-35 years to one of four brief video-based interventions (Black/White female, Black/White male presenters) or a nonintervention control condition. In the videos, a young presenter with psychosis humanized their illness through an evocative description of living a meaningful and productive life. RESULTS Group-by-time ANOVA showed a significant group-by-time interaction for the total score of all five stigma domains: social distance, stereotyping, separateness, social restriction, and perceived recovery. One-way ANOVA showed greater reductions in video intervention groups than control at post-intervention and 30-day follow-up, but no differences between video groups. Matching race/gender did not further reduce stigma. CONCLUSIONS This randomized controlled study replicated and extended previous research findings, by showing stigma reduction across videos that differ in the presenter's gender and race, thus enhancing generalizability. The videos described the experience of psychosis and reduced stigma, suggesting their potential utility on social media platforms to increase the likelihood of seeking services and ultimately may improve access to care among young individuals with psychosis. Future research should address intersectional stigma experiences by focusing on race/gender and culturally tailoring the narrative.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America.
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, United States of America
| | - Samantha E Jankowski
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, New York, NY, United States of America
| | - Iruma Bello
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Ilana Nossel
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Igor Malinovsky
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Stephen Smith
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Hong Ngo
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Sarah A Lieff
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States of America
| | - Shannon Pagdon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Amanda Lipp
- Department of Human Ecology, University of California, Davis, United States of America
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Yuval Neria
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America; Department of Epidemiology, Columbia University Irving Medical Center, United States of America
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
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Public opinion on sharing data from health services for clinical and research purposes without explicit consent: an anonymous online survey in the UK. BMJ Open 2022. [PMID: 35477868 DOI: 10.1101/2021.07.19.21260635v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES UK National Health Service/Health and Social Care (NHS/HSC) data are variably shared between healthcare organisations for direct care, and increasingly de-identified for research. Few large-scale studies have examined public opinion on sharing, including of mental health (MH) versus physical health (PH) data. We measured data sharing preferences. DESIGN/SETTING/INTERVENTIONS/OUTCOMES Pre-registered anonymous online survey, measuring expressed preferences, recruiting February to September 2020. Participants were randomised to one of three framing statements regarding MH versus PH data. PARTICIPANTS Open to all UK residents. Participants numbered 29 275; 40% had experienced an MH condition. RESULTS Most (76%) supported identifiable data sharing for direct clinical care without explicit consent, but 20% opposed this. Preference for clinical/identifiable sharing decreased with geographical distance and was slightly less for MH than PH data, with small framing effects. Preference for research/de-identified data sharing without explicit consent showed the same small PH/MH and framing effects, plus greater preference for sharing structured data than de-identified free text. There was net support for research sharing to the NHS, academic institutions, and national research charities, net ambivalence about sharing to profit-making companies researching treatments, and net opposition to sharing to other companies (similar to sharing publicly). De-identified linkage to non-health data was generally supported, except to data held by private companies. We report demographic influences on preference. A majority (89%) supported a single NHS mechanism to choose uses of their data. Support for data sharing increased during COVID-19. CONCLUSIONS Support for healthcare data sharing for direct care without explicit consent is broad but not universal. There is net support for the sharing of de-identified data for research to the NHS, academia, and the charitable sector, but not the commercial sector. A single national NHS-hosted system for patients to control the use of their NHS data for clinical purposes and for research would have broad support. TRIAL REGISTRATION NUMBER ISRCTN37444142.
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Jones LA, Nelder JR, Fryer JM, Alsop PH, Geary MR, Prince M, Cardinal RN. Public opinion on sharing data from health services for clinical and research purposes without explicit consent: an anonymous online survey in the UK. BMJ Open 2022; 12:e057579. [PMID: 35477868 PMCID: PMC9058801 DOI: 10.1136/bmjopen-2021-057579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES UK National Health Service/Health and Social Care (NHS/HSC) data are variably shared between healthcare organisations for direct care, and increasingly de-identified for research. Few large-scale studies have examined public opinion on sharing, including of mental health (MH) versus physical health (PH) data. We measured data sharing preferences. DESIGN/SETTING/INTERVENTIONS/OUTCOMES Pre-registered anonymous online survey, measuring expressed preferences, recruiting February to September 2020. Participants were randomised to one of three framing statements regarding MH versus PH data. PARTICIPANTS Open to all UK residents. Participants numbered 29 275; 40% had experienced an MH condition. RESULTS Most (76%) supported identifiable data sharing for direct clinical care without explicit consent, but 20% opposed this. Preference for clinical/identifiable sharing decreased with geographical distance and was slightly less for MH than PH data, with small framing effects. Preference for research/de-identified data sharing without explicit consent showed the same small PH/MH and framing effects, plus greater preference for sharing structured data than de-identified free text. There was net support for research sharing to the NHS, academic institutions, and national research charities, net ambivalence about sharing to profit-making companies researching treatments, and net opposition to sharing to other companies (similar to sharing publicly). De-identified linkage to non-health data was generally supported, except to data held by private companies. We report demographic influences on preference. A majority (89%) supported a single NHS mechanism to choose uses of their data. Support for data sharing increased during COVID-19. CONCLUSIONS Support for healthcare data sharing for direct care without explicit consent is broad but not universal. There is net support for the sharing of de-identified data for research to the NHS, academia, and the charitable sector, but not the commercial sector. A single national NHS-hosted system for patients to control the use of their NHS data for clinical purposes and for research would have broad support. TRIAL REGISTRATION NUMBER ISRCTN37444142.
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Affiliation(s)
- Linda A Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jenny R Nelder
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Joseph M Fryer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | | | - Rudolf N Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Liaison Psychiatry Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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225
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Graves J, Flynn E, Woodward-Kron R, Hu WCY. Supporting medical students to support peers: a qualitative interview study. BMC MEDICAL EDUCATION 2022; 22:300. [PMID: 35449038 PMCID: PMC9027875 DOI: 10.1186/s12909-022-03368-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 04/12/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Students may be the first to recognise and respond to psychological distress in other students. Peer support could overcome medical student reluctance to seek help despite their high rates of mental ill-health. Yet, despite the adoption of peer support programs, there is little evidence of impact on students. Peer support programs may assume that medical students accept and view peer support positively. We explored these assumptions by asking students about their experiences and views on peer support. METHODS Qualitative semi-structured interviews exploring peer support experiences and views on peer support were conducted with ten medical students at two contrasting medical schools. Informed by a constructivist stance, interview transcripts underwent thematic analysis. RESULTS Three groups of themes were identified: participants' experiences of peer support encounters, concerns about providing support, and views on students' roles in peer support. Participants readily recalled signs of peer distress. Encounters were ad hoc, informal, and occurred within relationships based on friendship or by being co-located in the same classes or placements. Concerns about initiating and offering support included lack of expertise, maintaining confidentiality, stigma from a mental health diagnosis, and unclear role boundaries, with implications for acceptance of student roles in peer support. CONCLUSIONS Our study emphasised the centrality of social relationships in enabling or discouraging peer support. Relationships developed during medical studies may anticipate the collegial relationships between medical professionals. Nevertheless, only some students are willing to undertake peer support roles. We suggest different strategies for promoting informal peer support that can be offered by any student, to those promoting formal support roles for selected students. Future research focusing on the impact for both the students who receive, and on the students who provide peer support is called for.
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Affiliation(s)
- Jane Graves
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Eleanor Flynn
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | | | - Wendy C. Y. Hu
- School of Medicine, Western Sydney University, Sydney, Australia
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226
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Davis B, McDaniel CC, Wang CH, Garza KB. Mental Health and Psychotropic Stigma Among Student Pharmacists. Front Public Health 2022; 10:818034. [PMID: 35419335 PMCID: PMC8995784 DOI: 10.3389/fpubh.2022.818034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To gain a better understanding of student pharmacists' stigma toward mental health and psychotropic medications. Methods A cross-sectional study was conducted via paper and online surveys amongst all student pharmacists enrolled in a Doctor of Pharmacy program in the Southeastern United States (n = 501). The Perceived Devaluation and Discrimination (PDD) Scale was used to measure mental health stigma. The Beliefs about Medicines Questionnaire (BMQ) was modified to measure psychotropic stigma. MANOVAs were conducted to investigate relationships between student pharmacists' characteristics with mental health and psychotropic stigma. A paired t-test was used to determine if there was a difference between degree of mental health stigma and psychotropic stigma. Results A total of 390 participants completed the survey (65%). The sample was mostly female (67%), white (79%), and non-Hispanic (96%). Ages were predominantly within the 19–24-year range (80%), and the majority of respondents reported previous interactions with patients who have mental health conditions (55%) or patients on psychotropic medications (65%). Student personal preferences for mental health treatment were primarily psychologic (42%) or both psychologic and psychotropic (40%). Degree of psychotropic stigma was significantly greater than that of mental health stigma. A statistically significant association was found between student personal preference for treatment and the psychotropic stigma. No difference was found in degree of either type of stigma across cohorts. Conclusions Student pharmacists demonstrated both mental health and psychotropic stigmas. Future research should be performed to determine what effects these stigmas have on care of patients with mental health conditions.
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Affiliation(s)
- Brandy Davis
- Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, United States
| | - Cassidi C McDaniel
- Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, United States
| | - Chih-Hsuan Wang
- Educational Foundations, Leadership, and Technology, Auburn University, Auburn, AL, United States
| | - Kimberly B Garza
- Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, United States
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227
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Riches S, Vasile R, Steer N, Murray A, Goneni A, Orehova A, Temple R, Thompson R, Houston F, Fisher HL. A myth-busting mental health tour of the National Gallery in London: facilitators and challenges to its development and evaluation. Arts Health 2022; 15:185-199. [PMID: 35411841 DOI: 10.1080/17533015.2022.2056212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper describes a mental health-awareness audio tour of the National Gallery, London, and evaluates the development and implementation of the tour. This smartphone-based audio tour was co-produced by Gallery staff, young people with lived experience of mental health issues, academics, and technologists. Interviews (N = 22) were conducted with developers and data-collectors (who had gathered feedback from Gallery visitors who undertook the tour) with responses analysed thematically. Participants highlighted the value of the arts to raise awareness about mental health, and the importance of teamwork, lived experience, and co-production, but also raised the challenges of integrating low-budget projects into large-scale venues.
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Affiliation(s)
- Simon Riches
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK
| | - Ruxandra Vasile
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK.,King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Sussex Partnership NHS Foundation Trust, Worthing UK
| | - Natalie Steer
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK.,King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Anna Murray
- The National Gallery, Trafalgar Square, London, UK
| | - Amber Goneni
- The National Gallery, Trafalgar Square, London, UK
| | | | | | | | | | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
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228
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Ritvo P, Gratzer D, Knyahnytska Y, Ortiz A, Walters C, Katz J, Laposa J, Baldissera C, Wayne N, Pfefer-Litman D, Tomlinson G, Daskalakis Z. Comparing Online and On-Site Cognitive Behavior Therapy in Major Depressive Disorder: Protocol for a Noninferiority Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e29726. [PMID: 35393942 PMCID: PMC9022777 DOI: 10.2196/29726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background The incidence of mental health disorders in Canada is increasing with costs of CAD $51 billion (US $40 billion) per year. Depression is the most prevalent cause of disability while cognitive behavioral therapy (CBT) is the best validated behavioral depression treatment. CBT, when combined with mindfulness meditation (CBT-M), has strong evidence for increased efficacy. While randomized controlled trials (RCTs) have demonstrated online CBT-M efficacy, comparisons with in-office delivery are lacking. Objective The aim of this research is to assess whether online group CBT-M (with standard psychiatric care) is non-inferior in efficacy and more cost-effective than office-based, on-site group CBT-M at post-intervention and 6-months follow-up in major depressive disorder. The study will also assess whether digitally recorded data (ie, online workbooks completed, Fitbit step count, and online text messages) predict depression symptom reduction in online participants. Methods This single-center, two-arm, noninferiority RCT employs assessor-blinded and self-report outcomes and economic evaluation. The research site is the Centre for Addiction and Mental Health (Toronto), a research-based psychiatry institution where participants will be identified from service wait lists and through contacts with other Toronto clinics. Inclusion criteria are as follows: (1) aged 18-60 years, any ethnicity; (2) Beck Depression Inventory-II (BDI-II) of mild severity (score ≥14) with no upper severity limit; (3) Mini-International Neuropsychiatric Interview-confirmed, psychiatric major depressive disorder diagnosis; (4) fluent in English. All patients are diagnosed by staff psychiatrists. Exclusion criteria are as follows: (1) receipt of weekly structured psychotherapy; (2) observation of Diagnostic and Statistical Manual of Mental Disorders (5th Edition) criteria for severe alcohol or substance use disorder (in past 3 months), borderline personality disorder, schizophrenia (or other primary psychotic disorder), bipolar disorder, or obsessive-compulsive disorder; (3) clinically significant suicidal ideation (imminent intent or attempted suicide in the past 6 months); and (4) treatment-resistant depression. All participants receive standard psychiatric care, experimental participants receive online group CBT-M, and controls receive standard care in-office group CBT-M. The online group program (in collaboration with NexJ Health, Inc) combines smartphone and computer-accessed workbooks with mental health phone counselling (16 hours in 16 weeks) that coordinates software interactions (eg, secure text messaging and Fitbit-tracked walking). The primary outcome is BDI-II, and secondary outcomes are anxiety (Beck Anxiety Inventory), depression (ie, Quick Inventory of Depressive Symptomatology and 17-item Hamilton Depression Rating Scale), mindfulness (Five-Facet Mindfulness Questionnaire), quality of life (European Quality of Life Five Dimension), and pain (Brief Pain Inventory). Results Based on prior studies with the BDI-II and 80% power to reject an inferiority hypothesis with a 1-sided type I error rate of 5%, a sample of 78 per group is adequate to detect small-to-medium–effect sizes. Conclusions This study assesses online CBT-M efficacy and noninferiority in relation to in-person CBT, and the cost-effectiveness of both interventions. Trial Registration ClinicalTrials.gov NCT04825535; https://www.clinicaltrials.gov/ct2/show/NCT04825535 International Registered Report Identifier (IRRID) DERR1-10.2196/29726
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Affiliation(s)
- Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - David Gratzer
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Abigail Ortiz
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Joel Katz
- Department of Medicine, University Health Network and Mt. Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Judith Laposa
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Noah Wayne
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.,NexJ Health, Inc., Toronto, ON, Canada
| | | | - George Tomlinson
- Department of Medicine, University Health Network and Mt. Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Zafiris Daskalakis
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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229
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Jankowski S, Ferreira K, Mascayano F, Donovan E, Rahim R, Birnbaum ML, Yum-Chan S, Medoff D, Marcogliese B, Fang L, Nicholson T, Dixon L. A Serious Game for Young People With First Episode Psychosis (OnTrack>The Game): Qualitative Findings of a Randomized Controlled Trial. JMIR Ment Health 2022; 9:e33526. [PMID: 35384847 PMCID: PMC9021940 DOI: 10.2196/33526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have shown the benefits of coordinated specialty care (CSC) for individuals with first episode psychosis; however, pathways to care are marred by lack of knowledge, stigma, and difficulties with treatment engagement. Serious games or video interventions may provide a way to address these factors. OBJECTIVE This study focuses on qualitative results of a randomized controlled trial comparing OnTrack>The Game (OTG) with recovery videos (RVs) on engagement, stigma, empowerment, hope, recovery, and understanding of psychosis in clients receiving CSC. Clinicians are also interviewed regarding their perceptions of the interventions and suggestions for improvement. METHODS A total of 16 clients aged 16-30 years, with first episode psychosis attending a CSC program in New York State, and 9 clinicians participated in the qualitative interviews. Interviews were analyzed using the rapid identification of themes from audio recordings method. RESULTS For clients, themes included relatability of game content, an increased sense of hope and the possibility of recovery, decreased self-stigma and public stigma, increased understanding of the importance of social support, and increased empowerment in the OTG group. Clinicians had a preference for RV and provided suggestions for dissemination and implementation. CONCLUSIONS Themes that may help inform future research in this area, particularly regarding dissemination and implementation of OTG and RV, emerged. TRIAL REGISTRATION ClinicalTrials.gov NCT03390491; https://clinicaltrials.gov/ct2/show/NCT03390491.
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Affiliation(s)
- Samantha Jankowski
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Kathleen Ferreira
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Franco Mascayano
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Effy Donovan
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Reanne Rahim
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Michael L Birnbaum
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Sabrina Yum-Chan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Deborah Medoff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Bethany Marcogliese
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Lijuan Fang
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Lisa Dixon
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
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230
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Martin A. Healer, Reveal Thyself. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:269-270. [PMID: 34751938 DOI: 10.1007/s40596-021-01555-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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231
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Gast M, Lehmann J, Schwarz E, Hirning C, Hoelzer M, Guendel H, Balint EM. A Single-Day Training for Managers Reduces Cognitive Stigma Regarding Mental Health Problems: A Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074139. [PMID: 35409821 PMCID: PMC8998400 DOI: 10.3390/ijerph19074139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/04/2022]
Abstract
Background: Mental illnesses have received increasing attention in the work context in recent years, yet they are still often accompanied by stigma. One starting point for stigma reduction is interventions in the workplace. The present study evaluated a one-day workshop for managers in a large company. Method: Enrolled managers (n = 70) were randomly assigned to the intervention group and the waiting control group. The training included a theoretical section on mental and stress-related diseases as well as the interplay between work and health, group work on personal stress experience, theoretical input on dealing with mentally ill employees, and a group discussion on this topic along with case studies. Both groups completed the following questionnaires at baseline and three months after training: Effort–Reward Imbalance Questionnaire, Patient Health Questionnaire, Mental Health Knowledge Schedule, Social Distance Scale, and the Irritation Scale. Results: Compared to the waiting group, the intervention group showed a significant improvement in the Mental Health Knowledge Schedule (U = 417.00, p = 0.040) and an increase in the Irritation Scale (U = 371.50 p = 0.011). All other scales remained unchanged. Conclusion: The content and duration of the training were adequate to reduce cognitive stigma towards mental illness. However, the present approach was not sufficient for an improvement in the subjective stress level of the participating managers.
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Affiliation(s)
- Michael Gast
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, 89081 Ulm, Germany; (M.G.); (J.L.); (E.S.); (C.H.); (E.M.B.)
| | - Janina Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, 89081 Ulm, Germany; (M.G.); (J.L.); (E.S.); (C.H.); (E.M.B.)
| | - Elena Schwarz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, 89081 Ulm, Germany; (M.G.); (J.L.); (E.S.); (C.H.); (E.M.B.)
| | - Christian Hirning
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, 89081 Ulm, Germany; (M.G.); (J.L.); (E.S.); (C.H.); (E.M.B.)
| | | | - Harald Guendel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, 89081 Ulm, Germany; (M.G.); (J.L.); (E.S.); (C.H.); (E.M.B.)
- Correspondence: ; Tel.: +49-731-500-61801
| | - Elisabeth Maria Balint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, 89081 Ulm, Germany; (M.G.); (J.L.); (E.S.); (C.H.); (E.M.B.)
- Privatklinik Meiringen, 3860 Meiringen, Switzerland
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232
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Monnapula-Mazabane P, Petersen I. Feasibility and acceptability of a mental health stigma intervention for low-income South African caregivers: A qualitative investigation. S Afr J Psychiatr 2022; 28:1824. [PMID: 35402016 PMCID: PMC8991039 DOI: 10.4102/sajpsychiatry.v28i0.1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Common mental health illnesses such as depression and anxiety disorders are increasing globally. There remain significant gaps in health services provision and support for mental illness linked to stigma in developing countries. Aim Our study aimed to assess the feasibility and acceptability of a mental health intervention for caregivers of mental health service users. Setting Low-income South African communities. Method Our study qualitatively assessed the feasibility of an anti-stigma mental health intervention for family caregivers in low-income settings. The intervention was structured into five sessions delivered over three days. Caregivers attended all the sessions at a centralised community venue. Semi-structured qualitative interviews were held separately with caregivers (n = 10) and their service users (n = 9) eight weeks post-intervention. Interviews were translated verbatim from local languages to English prior to framework analysis. Results Post-intervention, service users reported improved family relations and understanding of mental illness among family members. The intervention was reported as acceptable and helpful by caregivers as it increased knowledge, fostering better relationships with service users. Group discussions were noted as a critical driver of intervention success. Widespread mental health stigma within communities remained a key concern for caregivers and service users. Conclusion With the government’s drive for deinstitutionalisation, the need to integrate anti-stigma interventions within community mental health services is vital, as is the need for population-wide anti-stigma interventions to support the integration of mental health service users within communities.
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Affiliation(s)
- Portia Monnapula-Mazabane
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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233
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Griffin E, O’Connell S, Ruane-McAteer E, Corcoran P, Arensman E. Psychosocial Outcomes of Individuals Attending a Suicide Bereavement Peer Support Group: A Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074076. [PMID: 35409760 PMCID: PMC8998629 DOI: 10.3390/ijerph19074076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 11/17/2022]
Abstract
Individuals bereaved by suicide represent an important group in terms of postvention. While peer support groups are often accessed by those bereaved, few studies have examined their impact in terms of physical and mental health wellbeing. The aim of this study was to examine psychosocial outcomes of individuals attending suicide bereavement peer support groups in Ireland. Between August 2020 and June 2021, all members were invited to complete a survey, with new members also surveyed at three- and six-month follow-up, to examine changes in wellbeing, depressive symptoms and grief reactions. Results were analyzed using descriptive statistics and mixed linear regression models. The 75 participants were mostly female, with lower levels of overall wellbeing and a higher prevalence of depressive symptoms and suicidal ideation than the general population. Participants also reported high levels of social adjustment difficulties and grief reactions, which were more pronounced for those more recently bereaved. At follow-up (n = 28), a significant improvement in wellbeing and a reduction in grief reactions were found, adjusting for time since bereavement. Participants identified the groups as creating a safe space and providing a sense of belonging and hope. Notwithstanding the small number of participants at follow-up, these findings underline the enduring mental health challenges for those bereaved by suicide and provide further evidence for the role of peer support in postvention.
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Affiliation(s)
- Eve Griffin
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (S.O.); (E.R.-M.); (E.A.)
- National Suicide Research Foundation, T12 XF62 Cork, Ireland;
- Correspondence:
| | - Selena O’Connell
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (S.O.); (E.R.-M.); (E.A.)
- National Suicide Research Foundation, T12 XF62 Cork, Ireland;
| | - Eimear Ruane-McAteer
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (S.O.); (E.R.-M.); (E.A.)
| | - Paul Corcoran
- National Suicide Research Foundation, T12 XF62 Cork, Ireland;
| | - Ella Arensman
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (S.O.); (E.R.-M.); (E.A.)
- National Suicide Research Foundation, T12 XF62 Cork, Ireland;
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Fong THC, Mak WWS. Effects of Internet-based Storytelling Programs (Amazing Adventure Against Stigma) in Reducing Mental Illness Stigma with Mediation by Interactivity and Stigma Content: A Randomized Controlled Trial (Preprint). J Med Internet Res 2022; 24:e37973. [PMID: 35969460 PMCID: PMC9419045 DOI: 10.2196/37973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mental illness stigma has been a global concern, owing to its adverse effects on the recovery of people with mental illness, and may delay help-seeking for mental health because of the concern of being stigmatized. With technological advancement, internet-based interventions for the reduction of mental illness stigma have been developed, and these effects have been promising. Objective This study aimed to examine the differential effects of internet-based storytelling programs, which varied in the levels of interactivity and stigma content, in reducing mental illness stigma. Methods Using an experimental design, this study compared the effects of 4 storytelling websites that varied in the levels of interactivity and stigma content. Specifically, the conditions included an interactive website with stigma-related content (combo condition), a noninteractive website with stigma-related content (stigma condition), an interactive website without stigma-related content (interact condition), and a noninteractive website without stigma-related content (control condition). Participants were recruited via mass emails to all students and staff of a public university and via social networking sites. Eligible participants were randomized into the following four conditions: combo (n=67), stigma (n=65), interact (n=64), or control (n=67). The participants of each group viewed the respective web pages at their own pace. Public stigma, microaggression, and social distance were measured on the web before the experiment, after the experiment, and at the 1-week follow-up. Perceived autonomy and immersiveness, as mediators, were assessed after the experiment. Results Both the combo (n=66) and stigma (n=65) conditions were effective in reducing public stigma and microaggression toward people with mental illness after the experiment and at the 1-week follow-up. However, none of the conditions had significant time×condition effects in reducing the social distance from people with mental illness. The interact condition (n=64) significantly reduced public stigma after the experiment (P=.02) but not at the 1-week follow-up (P=.22). The control condition (n=67) did not significantly reduce all outcomes associated with mental illness stigma. Perceived autonomy was found to mediate the effect of public stigma (P=.56), and immersiveness mediated the effect of microaggression (P=.99). Conclusions Internet-based storytelling programs with stigma-related content and interactivity elicited the largest effects in stigma reduction, including reductions in public stigma and microaggression, although only its difference with internet-based storytelling programs with stigma-related content was not statistically significant. In other words, although interactivity could strengthen the stigma reduction effect, stigma-related content was more critical than interactivity in reducing stigma. Future stigma reduction efforts should prioritize the production of effective stigma content on their web pages, followed by considering the value of incorporating interactivity in future internet-based storytelling programs. Trial Registration ClinicalTrials.gov NCT05333848; https://clinicaltrials.gov/ct2/show/NCT05333848
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Affiliation(s)
- Tiffany H C Fong
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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235
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Martinengo L, Stona AC, Tudor Car L, Lee J, Griva K, Car J. Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines. J Med Internet Res 2022; 24:e28942. [PMID: 35262489 PMCID: PMC8943550 DOI: 10.2196/28942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/08/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. OBJECTIVE The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. METHODS A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. RESULTS The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50%; iOS apps: n=29, 50%). Of the 58 included apps, 37 (64%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21% (12/58) of apps provided non-evidence-based information. Furthermore, 88% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% (22/58) of the apps, whereas suicide risk was mentioned by 71% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76%) highlighted the importance of help seeking, 29 (50%) emphasized the importance of involving the user's support network. In addition, 52% (30/58) of apps referenced their content, and 17% (10/58) included advertisements. CONCLUSIONS Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non-evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential.
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Affiliation(s)
- Laura Martinengo
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Anne-Claire Stona
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jimmy Lee
- Department of Psychosis & North Region, Institute of Mental Health, Singapore, Singapore.,Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Konstadina Griva
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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236
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Giralt Palou R, Prat Vigué G, Romeu-Labayen M, Tort-Nasarre G. Analysis of Stigma in Relation to Behaviour and Attitudes towards Mental Health as Influenced by Social Desirability in Nursing Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063213. [PMID: 35328900 PMCID: PMC8955242 DOI: 10.3390/ijerph19063213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 01/24/2023]
Abstract
The training undergraduate nursing students receive, both in terms of theoretical input and clinical practice, may help to instil a less stigmatising perception of mental health. To analyse the perceived evolution of attitudes and expected behaviours, a longitudinal repeated measures study was conducted in a population of student nurses during their undergraduate mental health education. The Mental Illness: Clinicians’ Attitudes Scale, a Scale for measuring attitudes to the mentally ill among future Health workers, and the Reported and Intended Behaviour Scale were completed. A mixed linear model was used to assess the effect of each factor in the questionnaires before and after the various stages of the students’ training in mental health. The overall effect of each factor was assessed by testing the interaction between factor and group, both with and without adjustment with the Social Desirability Scale. The results showed that the clinical practice stage, due to the proximity to care for people with mental health problems, improves attitudes and behaviours towards mental health in students who have not had mental health problems, and also in younger students. In conclusion, integrated, holistic training during the period of clinical practice was associated with positive changes in the attitudes and intended behaviour.
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Affiliation(s)
- Rosa Giralt Palou
- Faculty of Nursing and Physiotherapy, University of Lleida, 25003 Lleida, Spain;
- SaMIS Group, Division of Mental Health, Althaia Foundation-UVic, 08243 Barcelona, Spain;
- Correspondence: or
| | - Gemma Prat Vigué
- SaMIS Group, Division of Mental Health, Althaia Foundation-UVic, 08243 Barcelona, Spain;
| | - Maria Romeu-Labayen
- Adult Mental Health Center Horta Guinardo, Department of Public Health, Mental Health and Mother-Infant Nursing, University of Barcelona, 08007 Barcelona, Spain;
| | - Glòria Tort-Nasarre
- Faculty of Nursing and Physiotherapy, University of Lleida, 25003 Lleida, Spain;
- Health Education Research Group, Nursing and Phisioterapy Department, University of Lleida, 25003 Lleida, Spain
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237
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Waumans RC, Muntingh ADT, Draisma S, Huijbregts KM, van Balkom AJLM, Batelaan NM. Barriers and facilitators for treatment-seeking in adults with a depressive or anxiety disorder in a Western-European health care setting: a qualitative study. BMC Psychiatry 2022; 22:165. [PMID: 35247997 PMCID: PMC8898419 DOI: 10.1186/s12888-022-03806-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/17/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Previous research on barriers and facilitators regarding treatment-seeking of adults with depressive and anxiety disorders has been primarily conducted in the Anglosphere. This study aims to gain insight into treatment-seeking behaviour of adults with depressive and anxiety disorders in a European healthcare system. METHODS In-depth semi-structured interviews were conducted with 24 participants, aged ≥18 years and diagnosed with an anxiety disorder and/or depressive disorder according to DSM-IV. Participants were purposively sampled from an outpatient department for mental health care in the Netherlands. The seven steps of framework analysis were used to identify relevant themes emerging from the interviews. RESULTS Data analysis suggested an interplay between individual aspects, personal social system, healthcare system and sociocultural context influences. Amongst the most relevant themes were mental health illiteracy, stigma, a negative attitude toward professional help, the influence of significant others and general practitioner, and waiting time. Financial barriers were not of relevance. CONCLUSIONS Even in a country with a well-developed mental health care system and in absence of financial barriers, there are many barriers to treatment-seeking in adult patients with depressive and anxiety disorders. National campaigns to increase awareness and decrease stigma in the general population, and to empower the social environment might reduce the treatment gap.
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Affiliation(s)
- Ruth C. Waumans
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit (VU) Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Anna D. T. Muntingh
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit (VU) Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Stasja Draisma
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit (VU) Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Klaas M. Huijbregts
- grid.491146.f0000 0004 0478 3153GGNet, Mental Health – RGC Winterswijk, Winterswijk, The Netherlands
| | - Anton J. L. M. van Balkom
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit (VU) Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Neeltje M. Batelaan
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit (VU) Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Specialised Mental Health Care, Amsterdam, The Netherlands
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238
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 301] [Impact Index Per Article: 150.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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239
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Ran MS, Peng MM, Yau YY, Zhang TM, Li XH, Wong IYL, Ng S, Thornicroft G, Chan CLW, Lu L. Knowledge, contact and stigma of mental illness: Comparing three stakeholder groups in Hong Kong. Int J Soc Psychiatry 2022; 68:365-375. [PMID: 33622065 DOI: 10.1177/0020764021997479] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND It remains unknown what the impacts of multiple dimensions of contact (e.g. level, quantity and quality) are on the stigma of mental illness. AIMS To explore the relationship between the multiple dimensions of contact and stigma of mental illness among family members (FM), mental health workers (MHW) and community residents (CR) in Hong Kong. METHODS The stigma, contact and knowledge were measured in FM, MHW and CR in Hong Kong. Multiple regression analyses were used. RESULTS MHW (n = 141) had higher knowledge, more contact and lower stigma of mental illness than CR (n = 95) or FM (n = 62). Knowledge and contact quality were significantly associated with lower stigma of mental illness in the three groups. However, contact level and contact quantity were not significantly associated with most stigma components. The contact level was positively associated with stigma of mental illness among FM and CR. CONCLUSIONS The results of this study highlight the differences in knowledge, contact and stigma of mental illness among different stakeholder groups. This study suggests that positive contact (e.g. equal, supportive, voluntary and pleasant contact) reduces stigma of mental illness, while negative contact (e.g. unfriendly, unsupportive, unpleasant contact) may increase stigma. The Enhancing Contact Model (ECM) should be tested in future anti-stigma interventions.
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Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong SAR, China
| | - Man-Man Peng
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong SAR, China
| | - Yuen Yum Yau
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong SAR, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Xu-Hong Li
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong SAR, China
| | - Irene Yin Ling Wong
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, USA
| | - Siuman Ng
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong SAR, China
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong SAR, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
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240
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Pérez-Corrales J, Huertas-Hoyas E, García-Bravo C, Güeita-Rodríguez J, Palacios-Ceña D. Volunteering as a Meaningful Occupation in the Process of Recovery From Serious Mental Illness: A Qualitative Study. Am J Occup Ther 2022; 76:23213. [PMID: 35201298 DOI: 10.5014/ajot.2022.045104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Volunteering is an activity that facilitates social welfare, a sense of connection to others, and the construction of links with other people and the community. OBJECTIVE To describe the experience of a group of people with serious mental illness (SMI) who engaged in community volunteer work. DESIGN Qualitative, phenomenological study using purposeful sampling and an inductive thematic analysis. SETTING Several mental health community centers in Madrid and Catalonia, Spain. PARTICIPANTS People with SMI engaged in community volunteer work. Outcomes and Measures: In-depth interviews were used to collect data. RESULTS Two themes, with four subthemes each, emerged from the data: (1) engaging in a meaningful occupation enhances the recovery process (subthemes: undergoing positive experiences, performing or resuming a meaningful occupation, living in the present moment, and relating with one's social and family environment) and (2) a process of mutual support (subthemes: in helping others, you help yourself; helping others on the basis of one's first-person experience; recover before you can help others; and role of professionals in volunteering). CONCLUSIONS AND RELEVANCE Volunteering is perceived as a meaningful occupation. Helping others generates a reciprocal benefit that favors the recovery process and contributes to the establishment of personal and social bonds. What This Article Adds: This study provides a basis for understanding the potential of volunteering to be a meaningful occupation in the recovery process of people with SMI. It can help occupational therapy practitioners develop volunteer-based intervention programs that support the recovery process.
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Affiliation(s)
- Jorge Pérez-Corrales
- Jorge Pérez-Corrales, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Elisabet Huertas-Hoyas
- Elisabet Huertas-Hoyas, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability, Universidad Rey Juan Carlos, Madrid, Spain;
| | - Cristina García-Bravo
- Cristina García-Bravo, MSc, OTR, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability, Universidad Rey Juan Carlos, Madrid, Spain
| | - Javier Güeita-Rodríguez
- Javier Güeita-Rodríguez, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Domingo Palacios-Ceña, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
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241
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Bamgbose Pederson A, Waldron EM, Fokuo JK. Perspectives of Black Immigrant Women on Mental Health: The Role of Stigma. WOMEN'S HEALTH REPORTS 2022; 3:307-317. [PMID: 35415711 PMCID: PMC8994434 DOI: 10.1089/whr.2021.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/12/2022]
Abstract
Background: Black immigrants are a major growing segment of the United States population. The intersection of race, gender, and migration places black immigrant women at the confluence of multiple social determinants of health, and thus, black immigrant women experience ongoing mental health disparities. Understanding their perspectives, mental health needs, and associated stigma is critical to promoting positive mental health outcomes. Methods: We conducted five focus groups (N = 22) among women from two black immigrant community organizations from February 2019 to June 2019. We used an inductive driven thematic analysis to identify codes and themes related to mental health and the role of stigma. Results: Overall five core themes associated with mental health and associated stigma concepts were found: The critical role of trusted sources and confidentiality, Conceptualization of mental illness and anticipated discrimination, Acculturative influence and migration as a source of emotional distress, Spirituality as a source of support and source of stigma, and Management of mental illness and addressing stigma. Conclusion: The conceptualization of mental illness and the associated stigma may be rooted in cultural and religious belief systems among black immigrants. Cultural beliefs and biopsychosocial models can coexist positively without interrupting the pathway toward optimized engagement in mental health care. Our mental health systems need to take these factors into consideration to implement programs that effectively serve black immigrant women's mental health needs.
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Affiliation(s)
- Aderonke Bamgbose Pederson
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth M. Waldron
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - J. Konadu Fokuo
- Department of Psychiatry, College of Medicine, University of Illinois, Chicago, Illinois, USA
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242
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McKenzie SK, Oliffe JL, Black A, Collings S. Men's Experiences of Mental Illness Stigma Across the Lifespan: A Scoping Review. Am J Mens Health 2022; 16:15579883221074789. [PMID: 35125015 PMCID: PMC8832600 DOI: 10.1177/15579883221074789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The stigma of men's mental illness has been described as having wide-reaching and profound consequences beyond the condition[s] itself. Stigma negatively impacts men's mental health help-seeking and the use of services amid impeding disclosures, diminishing social connection and amplifying economic hardship. Although men often face barriers to discussing their struggles with, and help-seeking for mental illness challenges, research focused on men's lived experiences of mental illness stigma is, at best, emergent. This scoping review explores men's mental illness related stigmas synthesizing and discussing the findings drawn from 21 published qualitative articles over the last 10 years. Four thematic findings were derived: (a) the weight of societal stigma, (b) stigma in male-dominated environments, (c) inequity driven stigmas, and (d) de-stigmatizing strategies. Despite evidence that stigma is a common experience for men experiencing diverse mental illness challenges, the field remains underdeveloped. Based on the scoping review findings, research gaps and opportunities for advancing the field are discussed.
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Affiliation(s)
- Sarah K McKenzie
- Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, University of Melbourne, Victoria, Australia
| | - Alice Black
- Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Sunny Collings
- School of Health, Te Herenga Waka-Victoria University of Wellington, New Zealand
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Zhou Y, Draghici A, Abbas J, Mubeen R, Boatca ME, Salam MA. Social Media Efficacy in Crisis Management: Effectiveness of Non-pharmaceutical Interventions to Manage COVID-19 Challenges. Front Psychiatry 2022; 12:626134. [PMID: 35197870 PMCID: PMC8859332 DOI: 10.3389/fpsyt.2021.626134] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
The new identified virus COVID-19 has become one of the most contagious diseases in human history. The ongoing coronavirus has created severe threats to global mental health, which have resulted in crisis management challenges and international concerns related to health issues. As of September 9, 2021, there were over 223.4 million patients with COVID-19, including 4.6 million deaths and over 200 million recovered patients reported worldwide, which has made the COVID-19 outbreak one of the deadliest pandemics in human history. The aggressive public health implementations endorsed various precautionary safety and preventive strategies to suppress and minimize COVID-19 disease transmission. The second, third, and fourth waves of COVID-19 continue to pose global challenges to crisis management, as its evolution and implications are still unfolding. This study posits that examining the strategic ripostes and pandemic experiences sheds light on combatting this global emergency. This study recommends two model strategies that help reduce the adverse effects of the pandemic on the immune systems of the general population. This present paper recommends NPI interventions (non-pharmaceutical intervention) to combine various measures, such as the suppression strategy (lockdown and restrictions) and mitigation model to decrease the burden on health systems. The current COVID-19 health crisis has influenced all vital economic sectors and developed crisis management problems. The global supply of vaccines is still not sufficient to manage this global health emergency. In this crisis, NPIs are helpful to manage the spillover impacts of the pandemic. It articulates the prominence of resilience and economic and strategic agility to resume economic activities and resolve healthcare issues. This study primarily focuses on the role of social media to tackle challenges and crises posed by COVID-19 on economies, business activities, healthcare burdens, and government support for societies to resume businesses, and implications for global economic and healthcare provision disruptions. This study suggests that intervention strategies can control the rapid spread of COVID-19 with hands-on crisis management measures, and the healthcare system will resume normal conditions quickly. Global economies will revitalize scientific contributions and collaborations, including social science and business industries, through government support.
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Affiliation(s)
- Yunye Zhou
- Law School, Chongqing University, Chongqing, China
| | - Anca Draghici
- Faculty of Management in Production and Transportation, Politehnica University of Timisoara, Timisoara, Romania
| | - Jaffar Abbas
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| | - Riaqa Mubeen
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Maria Elena Boatca
- Faculty of Management in Production and Transportation, Politehnica University of Timisoara, Timisoara, Romania
| | - Mohammad Asif Salam
- Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia
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244
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Kumar S, Schess J, Velleman R, Nadkarni A. Stigma towards dependent drinking and its role on caregiving burden: A qualitative study from Goa, India. Drug Alcohol Rev 2022; 41:778-786. [PMID: 35128746 PMCID: PMC9304139 DOI: 10.1111/dar.13438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
Introduction Stigma towards alcohol use disorders is prevalent in India and can lead to social exclusion and hamper treatment access and outcomes. Family members of individuals with dependent drinking are often their primary caregivers and play a key role in decisions around help‐seeking, treatment and recovery. The nature and role of stigma in caregiving, and the consequent burden on family caregivers of those with dependent drinking, has not been qualitatively studied in India. Methods We conducted in‐depth interviews with: (i) men with probable alcohol dependence (n = 11); (ii) family caregivers (n = 12); and (iii) doctors with experience of treating alcohol dependence (n = 13) in community settings in Goa. Data were analysed using inductive thematic analysis. Results Two primary themes were identified from the data: (i) stigma in the form of ignorance, prejudice and discrimination; and (ii) the impact of this stigma on caregiving decisions and the mental health of caregivers. Discussion and Conclusions We found that stigma functioned as a barrier to a proper course of treatment and care, as well as a detrimental factor for caregiver's mental health and caregiving decision‐making. Stigma towards dependent drinking in the forms of ignorance, prejudice and discrimination is prevalent within homes, workplaces and health systems and might exacerbate the caregiving burden among female family caregivers. Policies, educational programs and campaigns aimed at preventing stigma in these forms would likely enable access to more inclusive and appropriate health services, benefit the health of family caregivers and improve the treatment outcomes of drinkers.
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Affiliation(s)
- Sonali Kumar
- Addictions Research Group Sangath Community NGO Porvorim India
| | - Jaclyn Schess
- Addictions Research Group Sangath Community NGO Porvorim India
- Ross School of Business University of Michigan Ann Arbor USA
| | - Richard Velleman
- Addictions Research Group Sangath Community NGO Porvorim India
- Department of Psychology University of Bath Bath UK
| | - Abhijit Nadkarni
- Addictions Research Group Sangath Community NGO Porvorim India
- Centre for Global Mental Health, Department of Population Health London School of Hygiene and Tropical Medicine London UK
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245
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Amsalem D, Martin A. Reducing depression-related stigma and increasing treatment seeking among adolescents: randomized controlled trial of a brief video intervention. J Child Psychol Psychiatry 2022; 63:210-217. [PMID: 33821507 DOI: 10.1111/jcpp.13427] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Confronting stigma early in life could enhance receptivity to seeking treatment. We evaluated the efficacy of social contact interventions to reduce stigma toward depression and to enhance treatment-seeking intentions among adolescents. We hypothesized that the brief video-based interventions would be more effective than their matched controls. METHOD Using crowdsourcing, we recruited and randomly assigned 1,183 participants aged 14-18 to one of four video-based stimuli on a 4:4:1:1 ratio: (a) adolescent girl with depression; (b) adolescent boy with depression; (c) same girl, without depression; or (d) same boy, without depression. In each of the ~100-second-long videos, two simulated patients (SPs) depicted empowered presenters sharing their personal stories. In the depression conditions, SPs described how social support from family, friends, and professionals helped them overcome their symptoms and recover. RESULTS We found a significant effect for the Depression Stigma Scale (DSS) between active and control groups (F = 27.4, p < .001). We found a significant increase in treatment-seeking intentions, as measured by the General Help-Seeking Questionnaire (GHSQ; p < .001). Secondary analyses revealed that racial (but not gender) congruence between protagonists and participants resulted in greater stigma reduction and treatment seeking, as compared to racially incongruent pairings (t = 2.9, p = .004). CONCLUSION A brief video-based intervention effectively reduced stigma toward depression and increased treatment seeking among adolescents. Favorable changes were greater when race (but not gender) was congruent between protagonists and participants. Future studies should explore how to optimize brief contact-based interventions according to adolescents' race and ethnicity and how to scale such interventions to novel online platforms of dissemination.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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246
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Harper CA, Lievesley R, Blagden NJ, Hocken K. Humanizing Pedophilia as Stigma Reduction: A Large-Scale Intervention Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:945-960. [PMID: 34716500 PMCID: PMC8888370 DOI: 10.1007/s10508-021-02057-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 05/05/2023]
Abstract
The stigmatization of people with pedophilic sexual interests is a topic of growing academic and professional consideration, owing to its potential role in moderating pedophiles' emotional well-being, and motivation and engagement in child abuse prevention schemes. Thus, improving attitudes and reducing stigmatization toward this group is of paramount importance. Prior research has suggested that narrative humanization-presenting personal stories of self-identified non-offending pedophiles-could be one route to doing this. However, this work has only been conducted with students or trainee psychotherapists, meaning the public generalizability of this method is still unknown. In this study, we compared two stigma interventions to test whether narratives reduce stigma toward people with pedophilic interests more effectively than an informative alternative (scientific information about pedophilia). Using a longitudinal experimental design with a lack of non-intervention control (initial N = 950; final N = 539), we found that narratives had consistently positive effects on all measured aspects of stigmatization (dangerousness, intentionality), whereas an informative alternative had mixed results, and actually increased perceptions of pedophiles' levels of deviance. These effects were still present four months after the initial presentation. We discuss these data in relation to ongoing debates about treating pedophilia as a public health issue requiring a broad societal approach to well-being and child abuse prevention.
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Affiliation(s)
- Craig A Harper
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK.
| | - Rebecca Lievesley
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Nicholas J Blagden
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Kerensa Hocken
- Freedom Psychology Ltd, Nottingham, UK
- Her Majesty's Prison and Probation Service, Nottingham, UK
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247
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Amsalem D, Halloran J, Penque B, Celentano J, Martin A. Effect of a Brief Social Contact Video on Transphobia and Depression-Related Stigma Among Adolescents: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220376. [PMID: 35212749 PMCID: PMC8881766 DOI: 10.1001/jamanetworkopen.2022.0376] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Transphobia and stigma remain barriers to seeking mental health care for gender-diverse adolescents. OBJECTIVE To examine the utility of brief social contact-based video interventions of transgender protagonists with depression to reduce transphobia and depression-related stigma and increase treatment-seeking intentions among adolescents in the general population. DESIGN, SETTING, AND PARTICIPANTS During August 2021, a total of 1437 participants were recruited and randomly assigned to 1 of 4 video-based conditions in a 2:2:1:1 ratio: (1) transgender adolescent girls, (2) transgender adolescent boys, (3) cisgender adolescent girls, or (4) cisgender adolescent boys. INTERVENTIONS In each of the approximately 110-second videos, an empowered presenter shared their personal story about coping with depression and reaching out for help. MAIN OUTCOMES AND MEASURES The primary outcome was the score on the Attitudes Toward Transgender Men and Women (ATTMW) scale. Secondary outcomes were (1) a "gender thermometer" rating for warmth in transgender perception, (2) the Depression Stigma Scale (DSS) score, and (3) the General Health-Seeking Questionnaire (GHSQ) score. RESULTS Of the 1437 randomized participants, 1098 (76%) completed the postintervention assessment and passed all the validity tests (mean [SD] age, 16.9 [1.2] years; 481 [44%] male; 640 [58%] White). A significant change in attitudes toward transgender youth was found within the intervention group only (mean [SD] ATTMW scores: intervention group, 34.6 [23.1] at baseline to 32.8 [24.2] after intervention; P < .001; control group, 33.5 [23.4] at baseline to 32.4 [24.1] after intervention; P = .01). The mean (SD) total DSS scores decreased significantly across study groups (intervention: 1.3 [3.3]; control: 1.7 [3.3]; P < .001). A significant increase in intention to seek help from a parent was found in the intervention (mean [SD] GHSQ score, 0.2 [1.1]) and control (mean [SD] GHSQ score, 0.3 [1.2]) groups (P < .001), as was a decrease in those not wanting to seek help from anyone (mean [SD] GHSQ score: intervention, 0.2 [1.6], P = .009; control, 0.3 [1.2], P < .001) Secondary analyses revealed significant differences in baseline ATTMW scores and intervention effects between transgender and gender-diverse and cisgender participants and between lesbian, gay, bisexual, or queer (LGBQ) and straight participants (F = 36.7, P < .001) and heterosexual participants (F = 37.0, P < .001). A significant difference was also found in mean (SD) transgender warmth scores from baseline to after intervention between groups (2.6° [13.1°] in the intervention group vs 0.4° [8.3°] in the control group; P < .001). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, brief social contact-based videos proved efficacious in reducing transphobia and depression-related stigma and in increasing treatment-seeking intentions among adolescents in the general population. By personifying, individualizing, and providing face and voice to the experience of transgender youth, other adolescents, especially those who are cisgender and/or of a heterosexual orientation, can gain empathetic insights into the lives of their often marginalized and stigmatized fellow youth. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04969003.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Justin Halloran
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Brent Penque
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Jillian Celentano
- Department of Social Work and Marriage and Family Therapy, Southern Connecticut State University, New Haven
- Simulated Participant Program, Teaching and Learning Center, Yale School of Medicine, New Haven, Connecticut
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
- Simulated Participant Program, Teaching and Learning Center, Yale School of Medicine, New Haven, Connecticut
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248
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Miller PK, Cuthbertson CA, Loveridge S. Social Status Influence on Stigma Towards Mental Illness and Substance Use Disorder in the United States. Community Ment Health J 2022; 58:249-260. [PMID: 33817761 DOI: 10.1007/s10597-021-00817-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/24/2021] [Indexed: 01/26/2023]
Abstract
We describe the relationship between socio-demographic membership and stigma towards any mental illness (AMI) and substance use disorder (SUD) in the United States using a national survey (N = 2512). We hypothesize that participants from higher status socio-demographic groups may be more likely to report stigmatizing attitudes than participants from lower status socio-demographic groups. We find support for our hypothesis using multiple linear regression. Participants who were college-educated, male, or had household incomes above the national median were more likely to report stigmatizing attitudes toward both AMI and SUD in comparison to participants that were not college-educated, were female, or had household incomes below the national median. In contrast to our hypothesis, we find that participants who identified as Hispanic were more likely to report stigmatizing attitudes toward AMI than non-Hispanic whites. Younger and urban participants were more likely to report stigmatizing attitudes than their older and non-urban counterparts.
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Affiliation(s)
- Paula K Miller
- Department of Sociology and Anthropology, Ohio University, Athens, OH, USA.
| | - Courtney A Cuthbertson
- Human Development and Family Studies, University of Illinois At Urbana-Champaign, Urbana, IL, USA
| | - Scott Loveridge
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, USA
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249
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Scott W, Jackson SE, Hackett RA. Perceived discrimination, health, and well-being among adults with and without pain: a prospective study. Pain 2022; 163:258-266. [PMID: 35029597 DOI: 10.1097/j.pain.0000000000002368] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/12/2021] [Indexed: 01/07/2023]
Abstract
ABSTRACT Discrimination negatively influences health and well-being in the general population, but its impact on people with pain is unclear. This study assessed discrimination, health, and well-being in people with and without pain. Data were from 5871 participants from the English Longitudinal Study of Ageing. Experiences of discrimination were reported in 2010 to 2011. Pain, self-rated health, depressive symptoms, quality of life, life satisfaction, and loneliness were assessed in 2010 to 2011 and 2016 to 2017. A quarter (26%, n = 1524) of the sample reported pain at baseline. Participants with pain were more likely to report discrimination than those without pain (odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.13-1.46). Cross-sectionally, those with pain who perceived discrimination had poorer self-rated health (OR = 1.28, 95% CI 1.02-1.61), greater depressive symptoms (OR = 1.90, 95% CI 1.48-2.45), were more likely to be lonely (β = 0.21, 95% CI 0.15-0.26), and had lower quality of life (β = -4.01, 95% CI -4.88 to -3.14), and life satisfaction (β = -1.75, 95% CI -2.45 to -1.06) than those with pain who did not perceive discrimination. Prospectively, discrimination in those with pain was associated with greater depression (OR = 1.67, 95% CI 1.19-2.34) and loneliness (β = 0.11, 95% CI 0.05-0.17), adjusting for baseline values. In those without pain in 2010 to 2011, discrimination predicted pain in 2016 to 2017, controlling for covariates (OR = 1.29, 95% CI 1.06-1.56). People with pain are more likely to report discrimination than those without pain, and this experience is associated with increased depression and loneliness. Discrimination was predictive of incident pain in pain-free adults. These findings highlight the need to tackle discrimination to improve well-being in those with pain and to potentially reduce the risk of pain onset.
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Ruth A Hackett
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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250
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Campion J, Javed A, Lund C, Sartorius N, Saxena S, Marmot M, Allan J, Udomratn P. Public mental health: required actions to address implementation failure in the context of COVID-19. Lancet Psychiatry 2022; 9:169-182. [PMID: 35065723 PMCID: PMC8776278 DOI: 10.1016/s2215-0366(21)00199-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022]
Abstract
Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.
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Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London, UK; Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK.
| | - Afzal Javed
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Shekhar Saxena
- Department of Global Health and Population at the Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Michael Marmot
- Institute of Health Equity, Department of Epidemiology and Public Health, UCL, London, UK
| | - John Allan
- Office of the President, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia; Mental Health, Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia; Mayne Academy of Psychiatry, University of Queensland Medical School, University of Queensland, Brisbane, QLD, Australia
| | - Pichet Udomratn
- Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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