WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

Lived experience and family engagement in psychiatry research: A scoping review of reviews

BACKGROUND

A growing body of research is addressing the process and science of engaging people with lived experience (PWLE) of mental health challenges and other psychiatric conditions, and family members, in research activities.

OBJECTIVE

This scoping review of reviews synthesizes literature reviews on the engagement of PWLE and family members in research across the field of psychiatry.

METHOD

Systematic searches were conducted in seven bibliographic databases. Records were independently screened first at the title and abstract level, then at the full-text level. Included were any literature synthesis studies published in English, French, or Spanish in any given year, focusing on the engagement of PWLE and/or family members in research within psychiatry. Twenty records were included. Data were extracted in a spreadsheet and codebook thematic analysis was used across the body of articles to synthesize the findings.

RESULTS

Aspects of PWLE engagement have been synthesized in 20 review articles reviewing 376 articles across psychiatry as a whole and several subpopulations, including youth mental health, dementia, neurodevelopmental disorders, people who use drugs, and forensic mental health. Information specific to family engagement is lacking. Barriers, facilitators, and positive impacts of PWLE engagement have been widely reported across domains of research, with a considerable degree of consensus across subpopulations. Some negative impacts and reporting challenges have also been identified.

DISCUSSION

This scoping review of reviews provides an overarching understanding of the current state of the science of PWLE and family engagement across psychiatry research. The findings can inform future research practices enriched with a genuine and effective engagement with PWLE and families.

PATIENT OR PUBLIC CONTRIBUTION

The authorship team includes members with intersecting lived experience and academic identities. Additional lived experience engagement was not conducted as part of this review.

Mental health stigma and its relationship with mental health professionals - A narrative review and practice implications

The extent and magnitude of the mental health stigma are enormous, with substantial clinical and social implications. There is a complex relationship between mental health stigma and mental health professionals (MHPs); MHPs can be anti-stigma crusaders, victims of stigma, and even a source of stigma. Unfortunately, literature is scarce talking about the relationship between stigma and MHPs. Hence, the current review aims to bridge the existing gap in the literature on various aspects of stigma and the role of MHPs. For the current review, we ran a search in PubMed and Google Scholar databases; we restricted our study to records focusing on the interplay of mental health stigma and the MHPs, published during 2012-2022, in English, and having a full text available. We found that MHPs (psychiatrists, psychologists, and psychiatric nurses) can also be the recipients of the stigma. The stigma faced by the MHPs is determined by the negative stereotypes set by the media, or medical students, or other health professionals; the marginal position of psychiatry in the health system; difficult-to-treat mental disorders; MHPs' own experience of stigma; and the attitude or beliefs of various caders of the MHPs, their professional experience, and expertise in managing various mental health conditions. Notably, MHPs can also be a source of stigma (stigmatizers). MHPs need to be sensitized concerning this, and the anti-stigma interventions must incorporate this aspect of stigma. Novel interventions, such as digital-based programs, should be used instead of traditional anti-stigma programs in order to decrease stigma around mental health issues and make anti-stigma initiatives more appealing and scalable. To address the issues of stigma, there has to be more communication between MHPs, other health professionals, service users, and policymakers.

Introducing palliative care in advanced cancer: a systematic review

BACKGROUND

Negative perceptions about palliative care (PC), held by patients with cancer and their families, are a barrier to early referral and the associated benefits. This review examines the approaches that support the task of introducing PC to patients and families and describes any evaluations of these approaches.

METHODS

A systematic review with a systematic search informed by the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines was performed on the online databases MEDLINE, PsychInfo and CINAHL from May 2022 to July 2022. Identified studies were screened by title and abstract, and included if they were empirical studies and described an approach that supported the introduction of PC services for adult patients. A narrative-synthesis approach was used to extract and present the findings.

RESULTS

Searches yielded 1193 unique manuscripts, which, following title and abstract screening, were reduced to 31 papers subject to full-text review, with a final 12 studies meeting eligibility criteria. A diverse range of included studies described approaches used to introduce palliative care, which may be broadly summarised by four categories: education, clinical communication, building trust and rapport and integrative system approaches.

CONCLUSION

While educational approaches were helpful, they were less likely to change behaviours, with focused communication tasks also necessary to facilitate PC introduction. An established relationship and trust between patient and clinician were foundational to effective PC discussions. A framework to assist clinicians in this task is likely to be multidimensional in nature, although more quantitative research is necessary to establish the most effective methods and how they may be incorporated into clinical practice.

Development of depression assessment tools using humanoid robots -Can tele-operated robots talk with depressive persons like humans?

BACKGROUND

Depression is a common mental disorder and causes significant social loss. Early intervention for depression is important. Nonetheless, depressed patients tend to conceal their symptoms from others based on shame and stigma, thus hesitate to visit psychiatrists especially during early phase. We hypothesize that application of humanoid robots would be a novel solution. Depressed patients may feel more comfortable talking with such robots than humans.

METHODS

We recruited 13 patients with major depressive disorder (MDD) and 27 healthy volunteers as controls. Participants took both tele-operated humanoid robot and human interviews to evaluate severity of depression using the Hamilton Depression Rating Scale (HDRS). In addition, participants completed a self-administered questionnaire asking about their impressions of the robot interview.

RESULTS

Confidence interval and t-test analysis have revealed that the HDRS scores are equally reliable between robot and human interviews. No significant differences were observed between the two interviews regarding "nervousness about the interview" and "hesitancy to talk about depressed moods and suicidal ideation." Compared to human interviews, robot interviews yielded significantly lower scores on shame-related factors especially among patients with MDD.

LIMITATION

Small sample size, and the evaluator is male only.

CONCLUSIONS

This is the first report to show the reliability of tele-operated humanoid robot interviews for assessment of depression. Robot interviews are potentially equally reliable as human interviews. Robot interviews are suggested to be more appropriate in assessing shame-related suppressed emotions and hidden thoughts of depressed patients in clinical practice, which may reduce the stigma associated with depression.

Knowledge, familiarity, and impact of the COVID-19 pandemic on barriers to seeking mental health services among older people: a cross-sectional study

AIM

The COVID-19 pandemic caused drastic changes in older people's daily activities with a negative impact on their mental health, yet older people are less likely to seek mental health services. This study aims to explore the relationship between knowledge of and familiarity with mental health services, along with the impact of the COVID-19 pandemic, and barriers to seeking mental health services among older people.

METHODS

A descriptive cross-sectional study was conducted with a convenience sample of 352 older people, recruited among community-dwelling adults who attended randomly selected postal offices and pension outlets. Three tools were used: a structured interview schedule for sociodemographic and clinical characteristics of older people, the revised version of the Knowledge and Familiarity of Mental Health Services Scale (KFFMHS-R), and the Barriers to Mental Health Services Scale Revised (BMHSS-R).

RESULTS

All participants reported experiencing mental health distress during the COVID-19 pandemic. Intrinsic barriers had a higher mean score than extrinsic barriers, and 27.4% of the variance of overall barriers to seeking mental health could be explained through regression analysis by familiarity, knowledge of mental health services, and age. Overall barriers explained 24.4% of the variance of older people's perceived distress as an impact of the COVID-19 pandemic (F = 22.160, P < 0.001).

CONCLUSIONS

Knowledge of mental health services was the most significant predictor of barriers to seeking mental health services during the COVID-19 pandemic. Higher barriers predicted higher distress as an impact of the COVID-19 pandemic. The results of the study suggest the need for a multidisciplinary mental health team for older people.

Attitudes of psychiatrists towards people with mental illness: a cross-sectional, multicentre study of stigma in 32 European countries

Background

Mental health-related stigma occurs among the public and professionals alike. The lived experience of mental illness has been linked to less stigmatising attitudes. However, data on psychiatrists and the relationship between stigmatising attitudes and psychotherapeutic activity or case discussion groups remains scarce.

Methods

A cross-sectional multicentre study was performed in 32 European countries to investigate the lived experiences and attitudes of psychiatrists toward patients with mental illness as well as the relationship between stigma, psychosocial and professional factors. The self-reported, anonymous, internet-based Opening Minds Stigma Scale for Health Care Providers was used to measure the stigmatising attitudes. The survey was translated into the local language of each participating country. All participants were practising specialists and trainees in general adult or child and adolescent psychiatry. The study took place between 2nd October, 2019 and 9th July, 2021 and was preregistered at ClinicalTrial.gov (NCT04644978).

Findings

A total of 4245 psychiatrists completed the survey. The majority, 2797 (66%), had completed training in psychiatry, and 3320 (78%) worked in adult psychiatry. The final regression model showed that across European countries more favourable attitudes toward people with mental illness were statistically significantly associated with the lived experience of participants (including seeking help for their own mental health conditions (d = -0.92, 95% confidence interval (CI) = -1.68 to -0.15, p = 0.019), receiving medical treatment for a mental illness (d = -0.88, 95% CI = -1.71 to -0.04, p = 0.040), as well as having a friend or a family member similarly affected (d = -0.68, 95% CI = -1.14 to -0.22, p = 0.004)), being surrounded by colleagues who are less stigmatising (d = -0.98, 95% CI = -1.26 to -0.70, p < 0.001), providing psychotherapy to patients (d = -1.14, 95% CI = -1.63 to -0.65 p < 0.001), and being open to (d = -1.69, 95% CI = -2.53 to -0.85, p < 0.001) and actively participating in (d = -0.94, 95% CI = -1.45 to -0.42, p < 0.001) case discussion, supervision, or Balint groups.

Interpretation

Our study highlights the importance of psychotherapy training, supervision, case discussions and Balint groups in reducing the stigmatising attitudes of psychiatrists toward patients. As the findings represent cross-national predictors, Europe-wide policy interventions, national psychiatric education systems and the management of psychiatric institutions should take these findings into consideration.

Funding

National Youth Talent Award (Ministry of Human Resources, Hungary, (NTP-NFTÖ-20-B-0134). All authors received no funding for their contribution.

The rise in acceptance of mental health professionals: help-seeking recommendations of the German public 1990-2020

AIMS

We will first examine whether seeking help for depression and schizophrenia from mental health professionals is nowadays more accepted among the German public than it used to be 30 years ago. Next, we will explore whether changes in help-seeking preferences between 1990 and 2020 are specific to mental health professions or are part of changes in attitudes to professional help-seeking in general. Finally, we will study whether a temporal relationship does exist between the advent of awareness-raising and anti-stigma campaigns after the turn of the millennium and changes in the acceptance of mental health care.

METHODS

In 1990 (n = 2044), 2001 (n = 4005), 2011 (n = 1984) and 2020 (n = 2449) methodologically identical population-based surveys were conducted in Germany. After presentation of an unlabelled case vignette depicting someone with either schizophrenia or depression, we asked about help-seeking recommendations for the person described.

RESULTS

The German public's readiness to recommend seeking help from mental health professionals has markedly grown over the past 30 years. In contrast, in the eyes of the public, turning to a general practitioner has become only slightly more, consulting a priest even less advisable than it used to be three decades ago. Seeing a naturopath is seen with markedly less disapproval today compared to 1990, but explicit recommendation of this helping source has not increased correspondingly in. The most pronounced increase in the German public's propensity to recommend seeking help from mental health professionals occurred already in the 1990s, i.e. before efforts to heighten public awareness had started.

CONCLUSIONS

Today, the German public is more in favour of mental health professionals than it used to be three decades ago. This seems to be a specific trend, and not to reflecting an increasing propensity towards professional help-seeking in general. Our findings counter the narrative that mental health communication efforts and initiatives have created more favourable attitudes towards mental health care among the public, since the observed changes in attitudes have preceded any campaigns. Instead, we tend to interpret the rise of the popularity of mental health professionals as a reflection of general cultural changes that have taken place over the past decades in Germany, as in other western countries.

Stigma as a barrier to early intervention among youth seeking mental health services in Ontario, Canada: a qualitative study

BACKGROUND

Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction.

OBJECTIVE

This study aims to understand how stigma influences service seeking among youth with mental health challenges.

METHODS

Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis.

RESULTS

Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling 'sick enough' and 'not sick enough' to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma's effects on seeking and obtaining services.

CONCLUSION

A constant negotiation between being 'sick enough' or 'not sick enough' is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma's impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.

A Review on Mental Illness and Stigma

The concept of stigma is a universal problem that has been the subject of many studies. The phenomenon of stigmatization in psychiatric disorders is also an issue that should be particularly emphasized. Studies have reported that the diagnostic groups most exposed to stigmatization are psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, and substance use disorders. The stigma process is shaped especially by the clinical features of psychiatric disorders and the society’s attributions to the causes of psychiatric disorders. IIn order for interventions to be developed to prevent stigmatization to be effective, the causes of stigmatization must first be understood.. Therefore, in this study, it is aimed to review the stigmatization processes separately according to the types of psychiatric disorders.

Assessing the impact of stigma reduction interventions in Iran: A qualitative study from the perspective of mental health stakeholders

Introduction

The fear and embarrassment associated with stigmas discourage patients from help seeking behavior, which may explain why even the patients' loved ones advise them to discontinue treatment to avoid being labeled. In addition, stigmas can lead to personal and family issues, causing patients to disregard their illness. As such, their disease may develop into a chronic condition. This being said, the present study aims to investigate the challenges, solutions, and successes associated with stigmatization in Iran from the perspective of mental health stakeholders.

Method

A qualitative study was conducted in the summer of 2022. Purposive sampling was utilized to recruit participants. The primary data collection method involved a focus group interview that lasted 110 min. The project manager monitored the interviews, and all research team members attended the meetings, took notes, and made the necessary preparations. After explaining the study's purpose and ensuring the data's confidentiality, the interviewer led a focus group discussion. The interviews were recorded with the participants' consent. A focus group was used to conduct interviews with 13 individuals until data saturation was reached.

Findings

Ten psychologists, psychiatrists, and managers responsible for mental health, two patients, and one patient's family member participated in the current study as eligible participants. Repeated readings led to the emergence of three main classes under the headings of challenges, solutions, and successes of stigma management in Iran, each containing subclasses.

Conclusion

The majority of the proposed solutions in this study centered on raising awareness and training diverse individuals and groups to lessen stigmas. The most crucial de-stigmatization measure is to offer training that will cause the current stereotypes to change. This must be taken by patients and their families as well as therapists, leaders, policymakers, the general public, and the media. Ideally, younger members of the target groups should be considered for these pieces of training, which must be based on research and derived from cultural and localized needs.

Physicians' and medical students' beliefs and attitudes toward psychotic disorders: A systematic review

OBJECTIVE

The aim of this study was to analyze physicians' and medical students' (MS) beliefs and attitudes toward people with psychotic disorders.

METHODS

This systematic review follows the PRISMA guidelines. It was conducted on 5 databases (Pubmed, PsycINFO, Pascal & Francis, Scopus and EMBASE) with a keyword string combining words for physicians' and students' professional status, attitudes toward people, and psychotic disorders. No limitations on publication dates were imposed.

RESULTS

This review includes 39 articles, among which quantitative studies are in the majority, and general practioners are mainly represented. Schizophrenia is the main condition used to illustrate psychotic disorders and measure stigmatizing attitudes. Physicians' and MS' beliefs toward people with psychotic disorders are mainly represented by dangerousness and unpredictability. They can be reinforced with socio-demographic criteria (age and female gender) or physicians' beliefs about the disease's etiology. The desire for social distance is higher toward patients with schizophrenia compared to other psychiatric disorders, and medical care could be impacted with a tendency to refer them at psychiatric specific care or to anticipate their difficulties and to modify their treatment plan. Stigma scores remain globally high during medical training. Even if specific anti-stigma trainings have a positive impact on beliefs and attitudes, these effects do not last in time.

CONCLUSION

This review highlights the importance to explore physicians' and medical students' representations about patient with psychosis to understand better their difficulties in the management of these patients.

The perspectives of healthcare professionals in mental health settings on stigma and recovery - A qualitative inquiry

BACKGROUND

Mental health stigma is one of the most prominent barriers to recovery, and it is widely known that stigma may manifest differentially in different cultures. Healthcare professionals working closely with persons with mental illnesses (PMI) may provide important insights towards stigma that are otherwise unattainable from caregivers and consumers. However, there is a dearth of literature on healthcare professionals' perspectives on this topic. Thus, this study uses a multilevel approach to explore how stigma affects recovery from the perspectives of healthcare professionals that work closely with PMI in Singapore.

METHODS

Semi-structured interviews were conducted with a total of 17 healthcare professionals who were working in mental health settings in Singapore. Participants were recruited via direct email invitation or through snowball sampling. Data collected was analysed with the inductive thematic analysis method. All coding and inter-rater analyses were performed with NVivo.

RESULTS

The current study themes identified stigma-related factors that influence PMI's recovery from the perspectives of healthcare professionals working closely with PMI. These factors were organised into three overarching themes in a multilevel structure. The three themes were classified as Micro Factors (e.g., internalised stigma), Meso Factors (e.g., discrimination of people associated with the stigmatised group), and Macro Factors (e.g., structural stigma and stigma within healthcare settings).

CONCLUSIONS

The findings of this study gave us a greater understanding of how stigma influences recovery in Singapore, which could be used to guide the development and implementation of future policies and strategies to promote recovery. Importantly, our results suggest that improving mental health literacy, addressing cultural misgivings towards mental illness, implementing recovery-oriented practices, and making insurance more accessible for PMI could mitigate the deleterious impact that stigma has on recovery.

Prescribing stigma in mental disorders: A comparative study of Portuguese psychiatrists and general practitioners

BACKGROUND

Physicians, including psychiatrists and general practitioners (GPs), have been reported as essential sources of stigma towards people diagnosed with a mental disorder (PDMDs), which constitutes an important barrier to recovery and is associated with poorer clinical outcomes. Therefore, psychiatrists and GPs are key populations where it is crucial to examine stigma, improve attitudes and reduce discrimination towards psychiatric patients.

AIMS

This study is the first to explore mental health-related stigma among Portuguese psychiatrists and GPs, examining the differences between these two specialities and assessing whether sociodemographic and professional variables are associated with stigma.

METHOD

A cross-sectional study was performed between June 2018 and August 2019. A consecutive sample of 55 Psychiatrists and 67 GPs working in Porto (Portugal) filled a 25-item self-report questionnaire to assess their attitudes towards PDMDs in clinical practice. The instrument was designed by the authors, based on previous mental health-related stigma studies and validated scales. The questionnaire includes 12 stigma dimensions (Autonomy, Coercion, Incompetence, Dangerousness, Permanence, Pity, Responsibility, Segregation, Labelling, Diagnostic Overshadowing, Shame and Parental Incompetence), and its total score was used to measure Overall Stigma (OS). Sample characteristics were examined using descriptive statistics, and the factors affecting stigma were assessed through regression analysis.

RESULTS

GPs exhibit significantly higher OS levels than psychiatrists, and present higher scores in the dimensions of dangerousness, parental incompetence, diagnostic overshadowing and responsibility. Besides medical speciality, several other sociodemographic variables were associated with sigma, including age, gender, having a friend with a mental disorder, professional category, agreement that Psychiatry diverges from core medicine and physician's interest in mental health topics.

CONCLUSIONS

Our data suggest that both psychiatrists and GPs hold some degree of stigmatizing attitudes towards PDMDs. Overall, these results bring new light to stigma research, and provide information to tailor anti-stigma interventions to Portuguese psychiatrists and GPs.

Patients' attitudes toward conventional and herbal treatments for depression and anxiety: A cross-sectional Israeli survey

BACKGROUND

As many patients view conventional antidepressants and anxiolytics negatively, it is not surprising that the willingness to apply these treatments is far from ideal, thus posing a critical barrier in promoting an effective and durable treatment.

AIM

The present study aimed to explore patients' attitudes toward conventional and herbal treatments for depression and anxiety, while considering cultural and demographic factors, to further elucidate the antecedes that putatively determine the treatment's outcome.

METHODS

During June 2017, a cross-sectional survey was conducted using stratified sampling from a large-scale Israeli volunteer online panel. The final sample included 591 Jewish Israeli adults that reported they were suffering from depression or anxiety.

RESULTS

A heterogeneous range of attitudes toward treatment was found: for example, a large group of patients did not utilize prescription medications (39%), a professional consultation (12.9%), or any form of treatment (17.4%). Interestingly, these patients were significantly more likely to support naturally-derived treatments and were less concerned with scientific proof. Further, adverse effects were demonstrated as a prominent factor in the choice of treatment. A higher incidence of adverse effects was associated with an increased willingness to consider an alternative herbal treatment. Noteworthy attitudes were found in orthodox-Jewish individuals, who showed similar consultation rates, but utilized more psychological, rather than pharmacological treatments.

CONCLUSIONS

It is proposed that patients' perspectives and cultural backgrounds are needed to be taken into consideration during the clinical assessment and choice of treatment. The findings imply that a particular emphasis should be placed on patients that discard conventional pharmacological options and on distinct cultural aspects. Several recommendations for revising the current policy are advocated to promote more culturally-informed and patient-oriented care.

Medical students’ attitudes toward psychiatry in Indonesia

Nearly two-thirds of psychiatric patients are reluctant to seek help from healthcare professionals due to stigma, discrimination, and negligence that evolve around the community, including healthcare providers. Future health professionals should have a positive attitude toward psychiatry and patients with mental health problems. Thus, it is vital to identify medical students’ attitudes toward psychiatry as future healthcare providers. The authors conducted a cross-sectional study by using online questionnaires of “Perceptions of Psychiatry” in Faculty of Medicine Universitas Indonesia, with first- and fourth-year students (before psychiatric rotation), as well as fifth-year students and alumni (after psychiatric rotation). Out of 250 questionnaires distributed, 224 subjects responded, with a response rate 89.6%. Chi-square or fisher analysis was conducted to know the correlation between gender and attitudes towards psychiatry. The frequency distribution method was applied to identify the degree of stigmatization from respondents. A mix of positive and negative perceptions towards psychiatry was identified. The overall response was favorable to both before and after psychiatric rotation groups. Differences in perceptions between male and female psychiatry students as a discipline and career were statistically significant. Correcting misapprehension and removing the stigma on psychiatry during medical education might decrease the stigma in the psychiatric field and patients.

Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.

Clergy's Viewpoint Change Toward Mental Health and Stigma on Mental Illness: A Short Course Training

BACKGROUND

As stigma is one of the main barriers in promoting the mental health, the present study was designed with the purpose of reviewing clergy's viewpoint regarding the effect of mental health workshops on these barriers.

METHODS

For this study, by order of Iran's Health Ministry, a questionnaire was designed to examine the clergy's viewpoint related to mental illnesses and the consequent stigma. Ten faculty members and psychiatrists confirmed the questionnaire's validity after some modifications. In this research, 30 members of the clergy from the main religious city in Iran's "Qom" Seminary attended the training workshops for 2 days. The data obtained from the clergy's responses were analyzed using the SPSS software (ver.16) and descriptive and analytical tests. Also, the significance level was considered p < 0.05 in all tests. The results exhibited that the mean and standard deviation (Mean ± SD) of the clergy's attitude domain and awareness before the workshop was 1.90 ± 26.30 and 8.31 ± 1.64, respectively. Also, average and standard deviation (Mean ± SD) of their attitude domain and awareness after the workshop was 1.95 ± 29.73 and 1.18 ± 10.70, respectively.

DISCUSSION

The present study, which was designed to examine the clergy's viewpoint toward mental illnesses and the consequent stigma in the most considerable religious base in the country, illustrated that one strategy for reducing mental illness stigma in religious communities can be by holding training sessions to promote the clergy's awareness of and attitude toward mental health.

CONCLUSION

There was a significant statistical difference between their awareness and attitude scores before and after the workshop (p < 0.01). In the present research, the awareness and attitude of clergy toward mental health and stigma due to mental illness was relatively good and significantly increased by holding the workshop.

Evaluating the Effects of Experiencing Virtual Reality Simulation of Psychosis on Mental Illness Stigma, Empathy, and Knowledge in Medical Students

OBJECTIVES

Applying technologies such as virtual reality (VR) in education has gained popularity especially in comprehending abstract and subjective phenomena. Previous studies have shown that applying a virtual reality simulation of psychosis (VRSP) is useful in increasing knowledge and empathy toward patients. Here, the efficacy of using VRSP in altering stigma, empathy and knowledge as well as side effects have been assessed in medical students in comparison with the routine education (visiting the patients).

METHOD

After attending one session of lecture about positive psychotic symptoms, medical students were allocated to two groups: experiencing one session of VRSP or visiting patients under supervision as routine practice in the ward. Before and after the first session and after the second one, questionnaires of knowledge, empathy and stigma were filled by students. Finally, the results were compared in two groups.

RESULTS

Both interventions were effective in reducing stigma as well as increasing knowledge and empathy toward patients with psychotic experiences. VRSP could significantly reduce stigma and increase knowledge and empathy compared with the traditional visiting patients under supervision. The side effects were minimal and ameliorated right after the experience.

CONCLUSION

VRSP is an effective tool in decreasing stigma and increasing empathy and knowledge of the students and can be incorporated in psychiatric education with minimal side effects.

Education and training in psychiatry in South Asian countries

"Show me a sane man and I will cure him for you."-Carl Jung. Essentially, Jung was saying that a sane man does not exist. Emotional problems and difficulties are present in a benign form in the vast majority of people. Therefore, psychiatric education should focus on the very common nature of mental and emotional problems. Training of psychiatrists to provide the best quality care and conduct the highest quality research continues to remain a priority across the globe. The treatment and training gaps in many countries continue despite the sustained efforts at improving these, especially in low- and middle-income (LAMI) countries. Although many LAMI countries have improved curricula for undergraduate and postgraduate training, yet the treatment and training gap continues. This article will look to explore education and training in psychiatry in some of the South Asian countries with a special focus on India.

Making It Real: From Telling to Showing, Sharing, and Doing in Psychiatric Education

OBJECTIVE

Innovations in contemporary medical education could inform remedies to address enduring challenges such as the marginalization and stigmatization of psychiatry, of mental illnesses, and of those affected by them.

METHODS

In blending the works of Bleakley, Bligh, and Brown (2011) and of Kumagai and Naidu (2015), we developed an overarching heuristic with practical relevance and concrete applications to psychiatric education.

RESULTS

We identify three areas to enhance psychiatric education embedded into this blended framework: 1) Showing, or the more accurate depiction or imaging of mental illnesses and of psychiatric practice, as exemplified by the incorporation into didactic content of asynchronous video-based clinical materials produced with specific educational objectives in mind; 2) Sharing, or addressing the image problem of mental illnesses, of those living with or affected by them, and of psychiatry as a profession, as exemplified by psychiatrists embracing their role as experts by professional and personal experience when sharing their own journeys with mental illness, treatment, and recovery; and 3) Doing, or reimagining reflective psychiatric practice, as exemplified by the novel methodology of co-constructive patient simulation (CCPS), through which learners can engage in reflective practice and supervision in a participatory and democratic setting that does not privilege participants' hierarchical standing.

CONCLUSION

The blended model and the sample applications we describe offer a range of teaching, learning, and professional development opportunities, should psychiatric educators choose to pursue them and reap their promise.

Bipolar Patients and Bullous Pemphigoid after Risperidone Long-Acting Injectable: A Case Report and a Review of the Literature

Neuropsychiatric disorders are found to be associated with bullous pemphigoid (BP), an autoimmune subepidermal blistering disease. Antipsychotics have emerged as possible inducing factors of BP. However, large sample studies concerning BP associated with antipsychotics, as well as with specific mental disorders, are still lacking. Our review retrieved a few clinical studies and case reports on the topic, producing controversial results. We report for the first time a bipolar patient case presenting BP following five-month therapy with risperidone long-acting injectable (LAI). We hypothesize that the dermatological event is associated with the medication administered. The issue emerged during psychiatric consultation and was confirmed by histological examination, direct and indirect immunofluorescence studies, plus positive plasma and cutaneous BP180 and BP230 IgG. Neurodegeneration or neuroinflammation might represent a primary process leading to a cross-reactive immune response between neural and cutaneous antigens and contributing to self-tolerance failure. Furthermore, the time sequence of the shared biological mechanisms leading to clinical manifestations of the neuropsychiatric disorder and BP remains undefined. BP comorbid with bipolar disorder might occasionally represent a serious health risk and affect patients' physical and psychosocial quality of life. Thus, clinicians treating psychiatric patients should consider BP as a possible adverse effect of psychotropic medications.

Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients

Introduction and hypothesis: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. Methods: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. Results: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.

Discrimination starts with adjectives

Discrimination starts with adjectives.

A multicentric study on stigma towards people with mental illness in health sciences students

BACKGROUND

There is evidence of negative attitudes among health professionals towards people with mental illness but there is also a knowledge gap on what training must be given to these health professionals during their education. The purpose of this study is to compare the attitudes of students of health sciences: nursing, medical, occupational therapy, and psychology.

METHODS

A comparative and cross-sectional study in which 927 final-year students from health sciences university programmes were evaluated using the Mental Illness: Clinicians' Attitudes (both MICA-2 and MICA-4) scale. The sample was taken in six universities from Chile and Spain.

RESULTS

We found consistent results indicating that stigma varies across university programmes. Medical and nursing students showed more negative attitudes than psychology and occupational therapy students in several stigma-related themes: recovery, dangerousness, uncomfortability, disclosure, and discriminatory behaviour.

CONCLUSIONS

Our study presents a relevant description of the attitudes of each university programme for education against stigma in the formative years. Results show that the biomedical understanding of mental disorders can have negative effects on attitudes, and that education based on the psychosocial model allows a more holistic view of the person over the diagnosis.

Quality assessment of a consultation-liaison psychiatry service

BACKGROUND

Consultation-Liaison Psychiatry (CLP) provides services for patients with medical-psychiatric comorbidity at the general hospital. Referral satisfaction is considered as one of the most important outcome measures of CLP interventions. Our aim was to assess the levels of satisfaction with the CLP service amongst medical staff at a university hospital in Denmark.

METHODS

Medical staff answered an online survey regarding their experience with different aspects of inpatient and outpatient CLP services.

RESULTS

There were 152 responses from 16 medical units, with a survey return rate above 85%. Measured on a 5-point Likert scale, there was a median rating of 4 in response to questions regarding communication and organizational aspects, a median rating of 5 in response to questions regarding overall evaluation of the CLP service on both inpatient and outpatient questionnaire. The questions regarding treatment quality were rated with a median of 4 on the inpatient questionnaire and 2 of the outpatient questionnaire items, and with a median of 5 on 2 outpatient items. Physicians´ evaluations were statistically more positive than nurses´. As a group, respondents already employed before the CLP unit was established and those who used the CLP services more were statistically significantly more satisfied then respondents employed after the establishment of the CLP unit and those who used the CLP service less.

CONCLUSION

The CLP services were positively appreciated and considered to be valuable among medical hospital staff. We believe that Consultation-Liaison Psychiatry deserves further help to implement and expand its services in general hospital settings. In addition, our results underline the feasibility of surveys as quality measures of clinical care.

Future perspectives of robot psychiatry: can communication robots assist psychiatric evaluation in the COVID-19 pandemic era?

PURPOSE OF REVIEW

Direct face-to-face interview between a psychiatrist and a patient is crucial in psychiatric evaluation, however, such traditional interviews are becoming difficult to conduct because of the infection risk in the COVID-19 era. As telepsychiatry, video interviews using internet are suggested to be useful to evaluate and assist individuals with mental disorders. However, some patients especially with social phobia, depression, and autism spectrum disorder (ASD) hesitate to use even such face-to-face-like tools. Communication robots have been proposed as future assistant tools for such patients. Herein, we summarize recent advancements in robot psychiatry, and propose the benefits of communication robots in psychiatric evaluation.

RECENT FINDINGS

Recent studies have suggested that communication robots are effective in assisting people with ASD. As a pilot trial, we herein conducted semi-structured interviews to evaluate depression and hikikomori, a form of pathological social withdrawal, using a communication robot and a psychiatrist, respectively. There was almost identical evaluation between the two. Interestingly, a person with hikikomori answered that the robot was easier to disclose.

SUMMARY

Robots can reduce the burden of human resources and the infection risk in the COVID-19 era. Robot interview is expected to be implemented for future evaluation system in psychiatry.

Video cases as tricksters, in medical students´ transition to psychiatric clerkship. A liminal perspective

This article was migrated. The article was marked as recommended.

OBJECTIVE

This study introduced a lens of liminal theory, drawn from anthropological classical ritual theory, to explore how a preparatory teaching format using video casesinfluenced medical students' patient approaches in their subsequent psychiatric clerkship. The video cases portrayed simulated patient-doctor encounters in diagnostic interview situations and were hypothesized to function as a liminal trickster.

METHODS

The study applied a qualitative explorative design using individual rich picture interviews. We asked the students to draw their experiences, which we investigated using a semi-structured interview guide designed to capture and unfold the students' perspectives. We explored how students navigated insights from the preparatory teaching in their clerkship using liminal theory concepts in a mixed inductive and deductive thematic analysis.

RESULTS

The results from 8 rich picture interviews demonstrated that students' ability to navigate insight gained from the video cases in their clerkship varied according to their roles in the clinical diagnostic interview situations. Students having active roles in the diagnostic interview situation adopted a patient-centred focus demonstrating empathic engagement and self-reflexivity related to their learning experiences with the video cases. Students with passive roles described a focus on how to adopt an appropriate appearance and copied the behaviour of the simulated doctors in the video cases.

CONCLUSION

The liminal ritual theory perspective to explore the influence of preparatory teaching was useful for demonstrating how video cases could affect students' patient-centred learning. Without guidance and active roles in clerkship, medical students' learning experiences may lead to a prolonged liminal phase and may not capitalise on the potentially positive effects of the preparatory teaching. Liminal theory may further inform our understanding of students' learning considering patient cases in educational technology arrangements as tricksters.

The beliefs of non-psychiatric doctors about the causes, treatments, and prognosis of schizophrenia

OBJECTIVES

To examine the causal beliefs about schizophrenia of non-psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors' views about treatments and prognosis.

DESIGN AND METHODS

Three hundred and five non-psychiatric doctors working in outpatient community centres completed the 'Opinions on mental disorders Questionnaire' after reading a clinical description of people with schizophrenia.

RESULTS

The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy-five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty-two per cent of respondents thought it 'completely true' that drugs are useful in schizophrenia, and 33.9% thought it 'completely true' that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia.

CONCLUSIONS

These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed.

PRACTITIONER POINTS

Viewing schizophrenia as mainly due to a biological cause is associated with greater confidence in the usefulness of drugs, higher belief in the need for lifelong pharmacological treatments, and greater prognostic pessimism. Belief in a biologically oriented model of schizophrenia may lead doctors to underestimate the value of psychologists. Prognostic pessimism among doctors may negatively influence clinical decisions, the information doctors provide to their clients, and clients' own beliefs about their chances of recovery. Belief in the need for lifelong pharmacological treatments in schizophrenia may lead doctors to resist drug withdrawal in case of severe side effects.

[Quality psychiatry and destigmatization : Can quality psychiatry and psychotherapy contribute to destigmatization of mental illnesses?]

BACKGROUND

Among the many reasons for the stigmatization of mental illnesses and those affected by it, the supposedly insufficient treatability plays a central role. In fact, treatability is not worse compared to various somatic diseases, although different factors impair the use and thus the effect of optimal treatment options. This is where measures to optimize treatment and care within the framework of quality psychiatry and psychotherapy come into play, whose resource-backed systematic introduction and implementation can contribute to overcoming stigma.

OBJECTIVE

This article examines whether and how the quality of psychiatric treatment and care can contribute to reducing stigmatizing attitudes in the general public and the stigma experienced or anticipated by persons with mental illnesses.

METHODS

Components of quality assured psychiatric treatment and care were identified at the conceptual level, which can hypothetically contribute to the destigmatization of persons with mental illnesses.

RESULTS AND CONCLUSION

The components of quality psychiatry that can contribute to the destigmatization of persons with mental illnesses include the implementation of regularly updated evidence-based treatment guidelines, the individualization of psychiatric treatment (precision psychiatry) and the application of quality indicators within the framework of comprehensive quality management. The postulated relationships must be empirically verified, further analyzed and communicated to the public to be made systematically useful for the destigmatization of mental illnesses.

Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries

Background.

Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.

Methods.

The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.

Results.

We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.

Conclusions.

We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

Stigmatization Toward Patients with Mental Health Diagnoses: Tehran’s Stakeholders’ Perspectives

Background: The stigma associated with mental health disorders has an enormous impact on decisions concerning receiving mental health services. Objectives: The current qualitative study aimed to describe the stigma toward mental disorders in Tehran, Iran. Methods: The current grounded theory study conducted from 2013 to 2016 in Tehran (Iran). Fourteen participants were sampled using purposive and theoretical sampling techniques. Data were collected through face-to-face interviews, focused groups, and written narratives. The Corbin and Strauss coding paradigm (2008) was used to analyze data. Results: Three main categories of stigmatization toward patients with mental health diagnoses were extracted: (1) barriers to stigma reduction; (2) strategies to reduce stigma; and (3) outcomes of stigma reduction such as negative consequences of stigma toward mental disorders and positive impacts of stigma reduction toward mental disorders. Conclusions: To improve mental health services for patients in Tehran (Iran), it is imperative to reduce the stigma toward mental disorders, educate the community, including the general population and healthcare professionals, and remove existing barriers to receive mental health services.

Psychological interventions during COVID-19: Challenges for low and middle income countries

At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from China has spread to the world. There have been increasing numbers of confirmed cases and deaths around the globe. The COVID-19 pandemic has paved the way for considerable psychological and psychosocial morbidity among the general public and health care providers. An array of guidelines has been put forward by multiple agencies for combating mental health challenges. This paper addresses some of the mental health challenges faced by low and middle income countries (LMIC). It is worthwhile to note that these are challenges at the current stage of the pandemic and may change with the course of the pandemic itself.

EPA guidance on the quality of mental health services

The main aim of this guidance of the European Psychiatric Association is to provide evidence-based recommendations on the quality of mental health services in Europe. The recommendations were derived from a systematic search of the best available evidence in the scientific literature, supplemented by information from documents retrieved upon reviewing the identified articles. While most recommendations could be based on empirical studies (although of varying quality), some had to be based on expert opinion alone, but were deemed necessary as well. Another limitation was that the wide variety of service models and service traditions for the mentally ill worldwide often made generalisations difficult. In spite of these limitations, we arrived at 30 recommendations covering structure, process and outcome quality both on a generic and a setting-specific level. Operationalisations for each recommendation with measures to be considered as denominators and numerators are given as well to suggest quality indicators for future benchmarking across European countries. Further pan-European research will need to show whether the implementation of this guidance will lead to improved quality of mental healthcare, and may help to develop useful country-specific cutoffs for the suggested quality indicators.

The Impact of Mental Illness Stigma on Psychiatric Emergencies

Psychiatric emergencies are severe behavioral changes secondary to worsening mental illness. Such situations present a risk to the patient and other people, so they need immediate therapeutic intervention. They are associated with feelings of fear, anger, prejudice, and even exclusion. The attitudes of professionals and factors related to the workplace culture in health can help to perpetuate stereotypes and interfere with the quality of care. Stigma has undesirable consequences in patients with mental disorders. Certain measures can reduce stigma and provide a more dignified way for patients to recover from the crisis. This article aims to discuss the causes of stigma, ways of dealing with it, and achievements that have been made in psychiatric emergency care settings.

Association between attitudes of stigma toward mental illness and attitudes toward adoption of evidence-based practice within health care providers in Bahrain

The health care system is one of the key areas where people with mental illnesses could experience stigma. Clinicians can hold stigma attitudes during their interactions with patients with mental illness. To improve the quality of mental health services and primary care, evidence-based practices should be disseminated and implemented. In this study, we evaluated the attitudes of health care providers in Bahrain toward people with mental illness and adoption of evidence-based practice using the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) and Evidence-Based Practice Attitude Scale (EBPAS). We conducted a cross-sectional study across 12 primary health care centers and a psychiatric hospital (the country's main mental health care facility). A self-report questionnaire was distributed among all health care providers. A total of 547 health care providers participated, with 274 from mental health services and 273 from primary care services. Results of the OMS-HC indicated differences between both main groups and subgroups. Regression model analysis reported significant outcomes. There was no statistical difference found between both groups in EBPAS scores. A weak but statistically significant negative association was reported between both scales. Participants showed varying stigma attitudes across different working environments, with less stigma shown in mental health services than in primary care services. Providers who were more open to adopting evidence-based practices showed less stigma toward people with mental illness. Comparing our findings with previous research showed that health care providers in Bahrain hold more stigma attitudes than other groups studied. We hope that this study serves as an initial step toward future campaigns against the stigma of mental illness in Bahrain and across the region.

Three-Year Longitudinal Follow-up of the Psychiatry Early Experience Program (PEEP): Gaining and Sustaining Positive Attitudes Towards Psychiatry in Students at a UK Medical School

OBJECTIVE

The Psychiatry Early Experience Programme (PEEP) is a novel enrichment activity at Kings College London medical school. Throughout their five-year degree, students shadow trainee psychiatry doctors. The study aimed to evaluate whether more regular early exposure affects attitudes towards psychiatry.

METHODS

Forty first-year medical students joined PEEP and completed a baseline survey, including questions on demographics, current top three choices of medical specialty and the 30-item Attitudes Towards Psychiatry questionnaire (ATP-30). Participants completed annual follow up surveys, incorporating free-text questions about what students had learned and whether their views about psychiatry had changed.

RESULTS

Over three years there was a sustained improvement in mean ATP-30 scores (8.27 points higher at three years than at baseline [95% CI 2.86-13.7, T=3.2, p=0.005]). There was no significant difference between baseline specialty choice and specialty choice at three-year follow-up. At three years there was a 55% response rate. There was no significant association between non-responders at three years and baseline ATP-30, specialty choice or demographic factors. Thematic analysis of qualitative data suggested that PEEP challenged preconceptions towards psychiatry and highlighted its relevance in medicine.

CONCLUSIONS

The results offer some support that exposure to clinical psychiatry through longitudinal shadowing experiences can sustain positive attitudes. Areas for development include using a control group and following-up participants to the point when they specialize. It remains unclear whether it is most effective to select participants based on established commitment to psychiatry or to try to influence students who are still undecided.

"I am a Genetic Counselor": A qualitative exploration of field leaders' perceptions of the title "genetic counselor"

The genetic counseling profession is 50 years old, and is growing and diversifying. Despite this evolving context, no studies have formally explored the continuing relevance or appropriateness of the title "genetic counselor." We used a qualitative research methodology (interpretive description) to explore this concept among thought leaders within the genetic counseling profession. We conducted 12 semi-structured telephone interviews, which ranged in length from 18 to 50 min, and transcribed them verbatim. Analysis and data collection unfolded in parallel. The following themes regarding participants' perceptions of the title "genetic counselor" emerged from the data: (1) others misunderstand "genetic counselor"; (2) the term "counselor" in our title produces complex and conflicting emotions; (3) risks of changing our title outweigh the benefit; and (4) we need to own the narrative surrounding our title. Despite recognition that the title "genetic counselor" may not capture the full range of diverse roles members of the profession play, our data reveal overall support for the continued relevance and appropriateness of the title, for the value of the strength that comes from unity within the profession, and for efforts to highlight that which unites us across roles, disciplines, and specialties.

Evaluating the effectiveness of video cases to improve patient-centeredness in psychiatry: a quasi-experimental study

OBJECTIVES

To evaluate the effectiveness of including interactive video-based patient cases in preparatory lectures on medical students' patient-centredness and attitudes towards psychiatry.

METHODS

This study was designed as a quasi-experimental intervention study. A preparatory lecture on diagnostic interviewing was given to 204 fourth-year medical students before a 4-week psychiatry clerkship. The students were divided into two groups. One group (n=102) received a preparatory lecture including an interactive video case portraying a doctor performing a diagnostic interview with a simulated patient (intervention group). The other group (n=102) received a conventional preparatory lecture using text-based instructional material (control group). We conducted a paired sample t-test to compare the students' confidence in exhibiting patient-centred communication and their attitudes towards psychiatry before receiving the preparatory lecture and after having completed a minimum of three weeks of clerkship training.

RESULTS

A total of 102 students, 51 in each group, completed a questionnaire at both measurement points. In the intervention group, we found a statistically significantly difference for the students' patient-centredness before (M=69.4, SD=10.0) and after (M=73.8, SD=8.6) the intervention t(97)=2.38, p= 0.02, but no changes in attitudes t(98) =1.07, p=0.28. In the control group, we found no changes in patient-centredness or attitudes.

CONCLUSIONS

Video cases in preparatory lectures appear to be better than text-based material at improving students' patient-centredness in psychiatry. However, neither video cases nor text-based material seem to influence the students' attitudes.

Psychiatry as a specialization: influential factors and gender differences among medical students in a low- to middle-income country

OBJECTIVES

To assess the perception of Ghanaian medical students about factors influencing their career interest in psychiatry and to explore gender differences in these perceptions.

METHODS

This is a cross-sectional quantitative survey of 5th and 6th year medical students in four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics using SPSS version 20.

RESULTS

Responses were obtained from 545 medical students (response rate of 52%). Significantly, more male medical students expressed that stigma is an important consideration for them to choose or not to choose a career in psychiatry compared to their female counterparts (42.7% v. 29.7%, respectively). Over two-thirds of the medical students perceived that psychiatrists were at risk of being attacked by their patients, with just a little over a third expressing that risk was an important consideration for them to choose a career in psychiatry. There were no gender differences regarding perceptions about risk. Around 3 to 4 out of 10 medical students will consider careers in psychiatry if offered various incentives with no gender differences in responses provided.

CONCLUSION

Our study presents important and novel findings in the Ghanaian context, which can assist health policy planners and medical training institutions in Ghana to formulate policies and programs that will increase the number of psychiatry residents and thereby increase the psychiatrist-to-patient ratio in Ghana.

Associative stigma among mental health professionals in Singapore: a cross-sectional study

OBJECTIVES

(1) Investigate and explore whether different classes of associative stigma (the process by which a person experiences stigmatisation as a result of an association with another stigmatised person) could be identified using latent class analysis; (2) determine the sociodemographic and employment-related correlates of associative stigma and (3) examine the relationship between associative stigma and job satisfaction, among mental health professionals.

DESIGN

Cross-sectional online survey.

PARTICIPANTS

Doctors, nurses and allied health staff, working in Singapore.

METHODS

Staff (n=462) completed an online survey, which comprised 11 associative stigma items and also captured sociodemographic and job satisfaction-related information. Latent class analysis was used to classify associative stigma on patterns of observed categorical variables. Multinomial logistic regression was used to examine associations between sociodemographic and employment-related factors and the different classes, while multiple linear regression analyses were used to examine the relationship between associative stigma and job satisfaction.

RESULTS

The latent class analysis revealed that items formed a three-class model where the classes were classified as 'no/low associative stigma', 'moderate associative stigma' and 'high associative stigma'. 48.7%, 40.5% and 10.8% of the population comprised no/low, moderate and high associative stigma classes, respectively. Multinomial logistic regression showed that years of service and occupation were significantly associated with moderate associative stigma, while factors associated with high associative stigma were education, ethnicity and occupation. Multiple linear regression analyses revealed that high associative stigma was significantly associated with lower job satisfaction scores.

CONCLUSION

Associative stigma was not uncommon among mental health professionals and was associated with sociodemographic factors and poorer job satisfaction. Associative stigma has received comparatively little attention from empirical researchers and continued efforts to address this understudied yet important construct in conjunction with future efforts to dispel misconceptions related to mental illnesses are needed.

Opinions and Expectations Related to Job Placement of Individuals with Schizophrenia: A Qualitative Study Including Both Patients and Employers

The present study was conducted to identify the problems related to the placement of individuals with schizophrenia into jobs, the conditions allowing them to keep working and to reveal obstacles to their employment. The depth-interview technique was used for obtaining information from both patients with schizophrenia (n = 25) and the human resource managers of selected companies (n = 8). All interviews were recorded, transcribed and assessed using a thematic analysis approach. After the evaluation of qualitative data, the main emerging themes included the problems and suggestions of the patients, the worries of the employers about persons with schizophrenia and things that they could do about employment. The results of this study can be used to identify solutions to the problem as they were obtained from the individuals who were personally experiencing employment difficulties and from the employers, who were in a position to help solve the problems.

Health Professionals' Stigma towards the Psychiatric Ill in Nigeria

Background

Stigma affects the quality of life of the mentally ill, and health professionals are considered to be involved in possessing negative attitudes towards them. We evaluated the prevalence of stigmatization among different health professionals in Nigerian hospitals.

Methods

This study was a descriptive, cross-sectional and comparative survey assessing attitudinal views of health professionals (doctors, pharmacists, and nurses) regarding mental illness in two hospitals in Eastern Nigeria. The survey utilized the 40-item Community Attitude to Mental Illness, CAMI-2 questionnaire. The prevalence and the factors that contribute to negative attitudes among this cohort were assessed. Statistical analysis using T-tests, ANOVA and Pearson Correlation were conducted.

Results

Attitudes to all the four constructs of the CAMI-2 were non-stigmatizing. Stigmatizing attitudes were significantly higher among pharmacists, doctors and then nurses (p<0.006). Health professionals who did not have contact with the mentally ill (p<0.0001), who were males (p=0.008) and had lower years of working experience (p=0.031) expressed significantly higher stigmatizing attitudes towards the mentally ill. Conclusions: Nigerian health professionals were largely non-stigmatizing towards the mentally ill. However, being a pharmacist, of male gender, and working in a non-psychiatric hospital were associated with stigmatizing attitudes when they exist.

How does familiarity impact the stigma of mental illness?

This paper reviews studies on familiarity of mental illness to determine the relationships that familiarity has with public stigma. We propose a U-shaped relationship between familiarity and stigma that includes the expected inverse distribution (greater familiarity leads to less public stigma) and a provocative, positive relationship (familiarity in some groups leads to worse public stigma). Note that despite many studies in this arena, the U-shaped curve is not definitively supported by existing research. We believe its value, however, lies as a heuristic for hypotheses development to better understand the relationship between familiarity and public stigma. After reviewing research, we focus on two roles that comprise the surprising positive relationship: nuclear family members and mental health service providers like clinical psychologists. We then review research that suggests burden and associative stigma might account for the positive relationship between these groups and stigma. We end by using these findings to propose directions for future research, including on the development and evaluation of anti-stigma approaches.

An Integrative Program to Reduce Stigma in Primary Healthcare Workers Toward People With Diagnosis of Severe Mental Disorders: A Protocol for a Randomized Controlled Trial

Background: People with severe mental disorders (SMDs) have higher disease and death rates than the general population. Stigma (negative attitudes and perceptions) contributes to limited access to health services and a lower quality of medical assistance in this population, and it is manifested as negative attitudes, social distance, and discrimination toward this social group. For these reasons, healthcare workers are a priority group for anti-stigma interventions. This study aims to assess the effectiveness of a program specifically designed to decrease negative attitudes and social distance and increase inclusive behaviors in healthcare workers toward people with SMD. Methods: The study will be a randomized clinical trial. A minimum of 210 healthcare workers from 11 primary care centers in the province of Concepción, Chile, will be randomly chosen to receive the program or be part of the control group. There will be a pre-, post-, and 4-months evaluation of social distance, attitudes, and behaviors of participants toward people with SMD using standardized scales such as the social distance scale, which is a scale of clinician attitude toward mental illness adapted from attitudes of clinicians toward mental illness, and self-reports. The intervention program will consist of education strategies, direct, and indirect contact with people diagnosed with SMD, and skill development. There will be six face-to-face sessions directly with the participants and two additional sessions with the directors of each healthcare center. The program will involve a facilitator who will be a healthcare professional and a co-facilitator who will be a person diagnosed with SMD. Discussion: This study will evaluate an intervention program especially designed to reduce stigma in healthcare workers toward people with SMD, a topic on which there is little background information, particularly in low- and middle-income countries. It is important to have interventions with proven effectiveness for this purpose to ensure equity in healthcare services. Trial Registration: This study was registered under ISRCTN.com (ISRCTN46464036).

Changes in newspaper coverage of mental illness from 2008 to 2016 in England

AIMS

Since 2008 England's anti-stigma programme Time to Change has lobbied media outlets about stigmatising coverage and worked with them to promote accurate and non-stigmatising coverage. While this may have an impact on coverage and hence attitudes, it is also possible that coverage can change in response to improving attitudes, through the creation of a market demand for less stigmatising coverage. This study evaluates English newspaper coverage of mental health topics between 2008 and 2016.

METHOD

Articles covering mental health in 27 newspapers were retrieved using keyword searches on two randomly chosen days each month in 2008-2016, excluding 2012 and 2015 due to restricted resources. Content analysis used a structured coding framework. Univariate logistic regression models were used to estimate the odds of each hypothesised element occurring in 2016 compared with 2008 and Wald tests to assess the overall statistical significance of the year variable as the predictor.

RESULTS

The sample retrieved almost doubled between 2008 (n = 882) and 2016 (n = 1738). We found a significant increase in the proportion of anti-stigmatising articles (odds ratio (OR) 2.26 (95% confidence interval (CI) 1.86-2.74)) and a significant decrease in stigmatising articles (OR 0.62 (95% CI 0.51-0.75)). Reports on all diagnoses except for schizophrenia were more often anti-stigmatising than stigmatising.

CONCLUSIONS

This is the first clear evidence of improvement in coverage since the start of Time to Change. However, coverage of schizophrenia may be less affected by this positive shift than that of other diagnoses. The increase in the level of coverage identified in 2016 requires further investigation, as it may also influence public conceptualisation of what constitutes mental illness, attitudes to mental illness in general and/or specific diagnoses. While most anti-stigma programmes are not diagnosis specific, we suggest their evaluation would benefit from a diagnosis specific approach to allow fuller interpretation of their effects. This could include media analysis driven by hypotheses based on diagnoses to ascertain whether variations by diagnosis over time occur both in the nature and in the proportion of coverage.

Students' Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video: A Qualitative Study

OBJECTIVES

The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students' perceptions of psychiatric patients and students' reflections on meeting and communicating with psychiatric patients.

METHODS

The authors conducted group interviews with 30 medical students who volunteered to participate in interviews and applied inductive thematic content analysis to the transcribed interviews.

RESULTS

Students taught with text-based patient cases emphasized excitement and drama towards the personal clinical narratives presented by the teachers during the course, but never referred to the patient cases. Authority and boundary setting were regarded as important in managing patients. Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients.

CONCLUSION

The format of patient cases included in teaching may have a substantial impact on students' patient-centeredness. Video-based patient cases are probably more effective than text-based patient cases in fostering patient-centered perspectives in medical students. Teachers sharing stories from their own clinical experiences stimulates both engagement and excitement, but may also provoke unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry.

Attitudes of U.S. Psychiatry Residents and Fellows towards Mental Illness and its Causes: a Comparison Study with Medical Students

Stigma towards people with mental illness remains a burden for patients and healthcare providers. This study at a large US university examined the attitudes of psychiatry residents and fellows towards mental illness and its causes, and whether their attitudes differed from the medical student attitudes previously studied utilizing the same survey method. An electronic questionnaire examining attitudes toward people with mental illness, causes of mental Illness, and treatment efficacy was used to survey the attitudes of psychiatry residents and fellows. Exploratory factor analysis derived from the authors' medical student survey was used to examine attitudinal factors. The study response rate was 54.2% (n = 94). Factor analysis employed three factors previously identified reflecting social acceptance of mental illness, belief in supernatural causes, and belief in biopsychosocial causes. Residents and fellows reporting more personal experiences with mental illness, both as a group and when compared with medical students, were significantly more willing to socialize with the mentally ill. Respondents who had more professional (work) experience other than medical school or post-graduate training were less likely to believe in supernatural causes of mental illness. Female residents and fellows were more willing to socialize with the mentally ill, and were less likely to believe in supernatural causes for mental illness than their male counterparts. In our study, increased social acceptance of the mentally ill relates to having personal experiences, advanced training in psychiatry, and female gender. Both professional experiences outside of training and female gender reduced the belief in supernatural causes.