Age differences in public stigma, self-stigma, and attitudes toward seeking help: A moderated mediation model

Somebody to Lean on: Understanding Self-Stigma and Willingness to Disclose in the Context of Addiction

Substance use self-stigma is a barrier to treatment and can negatively impact individuals' well-being and treatment engagement. Given the mixed findings in previous research and the limited specific investigation into the concept of self-stigma within the context of opioid misuse, examining factors associated with self-stigma in the context of opioid use disorder (OUD) is warranted. The current study examines the influence of individual-level factors (race, sex, urban/rural status, support group attendance) on self-stigma and willingness to disclose opioid use. Data for this study were from a larger study of OUD-related stigma among adults in Pennsylvania, U.S. The current study included participants who indicated a personal past or current history with OUD were included (n = 84). Exploratory factor analysis and multiple indicators, multiple causes (MIMIC) model were used to explore the associations between demographic factors (i.e., sex, age, race/ethnicity, urban/rural status), attendance at mutual support groups, and self-stigma factors. Results indicated that sex and attendance at mutual support groups significantly predicted levels of self-stigma. Women and individuals with no previous experience attending mutual support groups endorsed lower levels of self-stigma. Additionally, attendance at mutual support groups predicted willingness to self-disclose past and present opioid use. Individuals who reported no history of attending mutual support groups demonstrated less willingness to disclose past and present OUD use compared to participants who were support group attendees. The current research findings enhance the understanding of OUD-related self-stigma by examining its relationship with individual-level factors, disclosure, and attendance to mutual support groups. The results offer insights into the influence of sex and support group attendance on self-stigma and disclosure. These findings have significant clinical implications for developing future interventions and promoting health policy changes.

Communication of the diagnosis to Klinefelter subjects: an observational study on a key moment of the patient's life

PURPOSE

Klinefelter syndrome (KS) is the most prevalent sex chromosome disorder among males. The communication of the KS diagnosis holds significant implications for the diagnosis's acceptance. Recently, the increased use of prenatal diagnostic procedures has raised the question of whether, when, and by whom information, once provided to parents, should be communicated to their children/adolescents. Currently, there is limited information on this topic. This study aims to investigate the most suitable timing, content, and healthcare professionals (HCPs) according to KS patients' suggestions for conveying the diagnosis, analyzing the impact of communicating the KS diagnosis on patients and their reception of the communication in real-life situations. Furthermore, research entails a comparison of the actual communication and the patients' preferred mode of communication.

METHODS

Self-reported interview data was collected from 196 adults diagnosed with KS. The interview was structured, consisting of 32 multiple-choice questions covering various areas related to diagnosis communication.

RESULTS

Most patients with Klinefelter syndrome reported that earlier communication would have been beneficial. Communication before the age of 18 and by parents increased the likelihood of overcoming negative consequences and relying on psychological support.

CONCLUSION

To mitigate the adverse effects of poorly timed and inadequately delivered communication, typically by a single person, it is advisable that such communication be carried out at the onset of adolescence by an interdisciplinary team of HCPs (including psychologists, geneticists, endocrinologists) and parents. The information provided should not solely concentrate on hormonal and fertility aspects, but also consider other factors such as psychological variables.

Art on the skin, lifesaving within: Exploring the role of tattoo artists in suicide prevention

Different populations experience suicide at different rates. Some studies have found an increased risk of suicide among individuals with tattoos. Studies indicate a higher prevalence of mental health disorders among individuals with one or more tattoos. These findings signal a need to explore suicide prevention in tattoo shops. The aim of this project is to determine the feasibility, acceptability, and interest of providing education on suicide prevention among tattoo artists. We conducted a cross-sectional survey with tattoo artists. Survey items assessed artists' experiences with clients expressing mental health issues or suicidal thoughts, their comfort level assisting clients, and general perceptions around suicide and stigma. Seventy-nine surveys were collected. Most artists reported that they have had at least one situation in which a client mentioned something that made them concerned about that client's mental health. Most respondents reported that a client has expressed suicidal thoughts to them at least once. Our study demonstrated that tattoo artists encounter clients who express mental health challenges as well as suicidal ideation, underscoring the potential role for tattoo artists in supporting individuals at risk for suicidal thoughts and behaviors.

Predictors of psychiatric treatment-seeking attitudes in older adults

OBJECTIVES

Understanding the factors that contribute to treatment-seeking attitudes among older adults-a growing population with frequent mental health concerns-is vital. Although past research has identified some demographic and belief-based predictors of mental health treatment attitudes among this population, previous studies are limited by only evaluating these variables in isolation and not distinguishing between different types of treatment (e.g. medication and psychotherapy).

METHODS

In a pre-registered online survey of 606 older adults (age 60 years and older), we evaluated stigmatizing attitudes, etiological beliefs about depression, psychological symptoms, and health literacy as well as attitudes about psychotherapy and medication separately.

RESULTS

Pre-registered linear regression analyses showed that greater stigmatizing attitudes uniquely predicted more negative attitudes for both therapy and medication treatment seeking over and above gender, education, income, extrinsic barriers, health literacy, depression, and anxiety. Additionally, loneliness was a significant predictor of less favorable medication attitudes. Exploratory analysis revealed that attributing depression to a chemical imbalance predicted positive attitudes about medication, but not psychotherapy.

CONCLUSION

These findings indicate that older adults' treatment-seeking behaviors are separately influenced by stigma, etiological beliefs, and loneliness.

Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains

This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.

Treatment-seeking threshold and accessibility of psychiatric outpatient services in Switzerland: the relationship with stigma and self-esteem

Perceived stigmatization and low self-esteem are linked to poorer mental health outcomes, but their impact on treatment-seeking thresholds and the importance of outpatient service location remain unclear. The study included 525 outpatients of the University Psychiatric Clinic (UPK) Basel, Switzerland, of whom 346 were treated at inner city services and 179 at services located on the main site of the UPK at the outer city limits. Perceived discrimination and devaluation (PDD), self-esteem (SE), treatment-seeking threshold (TST), and accessibility were measured via a self-reported questionnaire. The PDD consisted of 12 items evaluating beliefs about the level of stigma towards individuals with mental illness in the general population on a 5-point Likert scale. SE, TST and accessibility were assessed through single-item 7-point Likert scales. PDD and SE were positively correlated (p < 0.001), suggesting that lower perceived stigma was linked to higher self-esteem, and were not associated with TST. The relationship between PDD and SE remained consistent after controlling for age, gender, and nationality. Age was negatively correlated with TST (p = 0.022), while gender did not significantly influence any of the variables. There was little variation regarding PDD, with emergencies at the site of the psychiatric clinic and substance use disorder (SUD) patients reporting higher levels of stigmatization. Emergency patients and those with SUD and personality disorder reported the lowest SE ratings. TST showed a broad range and was highest for emergency services and transcultural psychiatry patients. Differences in accessibility were mainly linked to the location, with outpatient service users in the inner city reporting better accessibility (p < 0.001) and higher SE (p = 0.009). In comparison to patients using services with planned contacts only, patients in emergency settings differed by higher TST (p = 0.018) and better ratings of accessibility (p = 0.004). In conclusion, there was a relevant amount of stigmatization, impaired self-esteem, and, for some outpatient services, high thresholds to seek treatment. Future research should explore other factors influencing TST. The findings highlight the need to address stigmatization and accessibility when planning mental health services.

Mental health treatment stigma, maladaptive personality trait domains, and treatment-seeking attitudes and behaviors

OBJECTIVES

A barrier to seeking mental health care is treatment stigma, a form of stigma associated with seeking/receiving mental health treatment. Prior research has also demonstrated relationships between five-factor model personality traits and treatment-seeking attitudes. However, findings in this area are mixed and research has tended not to include assessments of maladaptive personality traits outlined in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition Section III: Emerging Measures and Models. The present study sought to examine relationships between maladaptive personality traits, treatment stigma, and treatment-seeking attitudes and behavior in an adult sample.

METHODS

Participants (N = 500) completed a series of questionnaires assessing current and past mental health treatment-seeking behaviors, treatment stigma, attitudes toward treatment seeking, and maldaptive personality traits.

RESULTS

Results revealed all five maladaptive personality traits were positively associated with increased treatment stigma, and in models controlling for the shared variance across maladaptive personality traits, negative affect, antagonism, psychoticism, and stigma exhibited unique associations with one's perceived value and need of mental health treatment, whereas negative affect, detachment, and stigma were uniquely associated with openness to seeking mental health treatment for emotional problems. While the five maladaptive personality traits were associated with a history of treatment-seeking behaviors at the bivariate level and after controlling for stigma, only negative affect was uniquely associated with treatment-seeking behaviors in a model including all five personality trait domains. Exploratory moderation analyses revealed associations between stigma and openness to seeking treatment varied as a function of maladaptive personality traits.

CONCLUSIONS

This study extends prior research on the role of personality traits in understanding treatment-seeking attitudes and behaviors and may have clinical implications for the use of maladaptive personality trait screeners in practice.

Personal and perceived stigma in relation to diverse domains of quality of life among patients with major depressive disorder having residual symptoms: a hospital-based cross-sectional study in Thailand

PURPOSE

Depression is a debilitating disease with residual symptoms that negatively impact patients' quality of life (QoL). Stigma is associated with poor QoL; however, knowledge regarding stigma subtypes and each QoL domain concerning residual depression is limited. We aimed to investigate the association of residual depression symptoms with QoL and stigma among patients with major depressive disorder (MDD).

METHODS

This cross-sectional study was conducted at an outpatient clinic among patients with MDD (March-July 2022). We administered the Thai version of the Patient Health Questionnaire-9, World Health Organization Quality of Life Brief, and Mental Health Consumers' Experience of Stigma to assess patients' levels of depression, QoL, and personal and perceived stigma, respectively. We performed correlational and logistic regression analyses to evaluate the association of demographics, QoL, stigma, and stress with residual depression.

RESULTS

Of 384 patients with MDD (median age = 39.5, females = 73.2%), 54.4% had residual depression. Among those with residual depression, depression was negatively correlated with QoL (ρ = - 0.58, p < 0.001) and positively correlated with stigma (ρ = 0.24, p < 0.001). The risk of residual depression decreased as the QoL score increased (adjusted OR per 1-point increase 0.93 [0.91, 0.96], p < 0.001); residual depression was significantly associated with personal stigma.

CONCLUSION

Stigma and QoL exhibit an inverse relationship. Physical-, psychological-, and environmental-health domains of QoL and personal stigma are key contributing factors to residual MDD symptoms. Improvement of QoL and stigma requires further theoretical research and should be of concern in clinical practice. Longitudinal studies on relatively diverse populations and subsyndromal symptoms are needed.

Understanding the social and leisure needs of lonely and socially isolated older adults living in residential care: a qualitative study

Objectives: Rates of loneliness and social isolation increase following the transition to residential care and are associated with poor health outcomes. One way to mitigate these experiences is through meaningful recreation, however, there is research to suggest that currently available programming does not meet the needs of lonely and socially isolated residents. Therefore, the objectives of the current study were to investigate: (1) the lived experience of loneliness and social isolation in residential care, (2) engagement and use of available resources by these residents, and (3) insights as to how programming can further address their needs.Methods: Qualitative interviews were conducted with ten staff members and 14 residents. Interviews were transcribed and analysed using thematic analysis.Results: Three themes emerged from the data: (1) Feelings of loneliness and social isolation (subthemes: loneliness and social isolation differ, contributors, and coping strategies), (2) Recreation and social participation (subthemes: program engagement and barriers to participation), and (3) Supporting residents' needs (subthemes: suggestions for meaningful recreation and resources).Conclusion: Loneliness and social isolation are idiographic experiences. Contributors to loneliness and social isolation are also reported as barriers to attending programming. Recommendations are made, many of which rely on greater staffing resources and psychoeducation.

Knowledge, attitudes, and behaviours towards schizophrenia, bipolar disorder, and autism: a pilot study

OBJECTIVES

Lack of knowledge and discriminatory attitudes and behaviours towards individuals with mental disorders is a worldwide problem but may be particularly damaging for young people. This pilot study examined knowledge, attitudes and behaviours towards schizophrenia, bipolar disorder and autism within a large sample of adults in Ireland, a country with the youngest population in Europe, in order to better understand public views on these groups.

METHODS

In a correlational, cross-sectional design, 307 adults in Ireland over the age of 18 completed a questionnaire over Google Forms examining knowledge, attitudes and behaviours towards schizophrenia, bipolar disorder and autism. Responses to questions specifically relating to each diagnosis were compared using trimmed mean ANOVA to examine whether responses to questions differed depending on diagnosis.

RESULTS

Results indicate varied knowledge, attitudes and behaviours towards these groups, but a majority believe it should be a research priority. ANOVA and post hoc tests revealed significant differences in knowledge, attitudes and behaviours towards each of schizophrenia, bipolar disorder, and autism (p < 0.005), and reported attitudes and behaviours towards schizophrenia were more negative than either bipolar disorder or autism. A majority of participants (54.8%) felt not informed enough about mental health by the media.

CONCLUSIONS

In our Irish sample, type and level of stigma varies according to mental health diagnosis. Our sample also report feeling inadequately informed about mental health by the media. Thus future policy and campaigns could consider targeting individual mental health diagnoses, with a focus on increasing familiarity and knowledge.

Identifying factors related to stigma toward psychiatric illness and mental health services and attitudes of help-seeking among Japan Ground Self-Defense Force members

The stigma that military personnel feel toward mental illness and mental healthcare hinders their access to mental health services. Stigma is influenced by culture-specifically, that held by military personnel is closely related to military culture. To our knowledge, this is the first large-scale investigation aimed at identifying the factors, including demographic factors and elements of military culture, related to stigma among members of the Japan Ground Self-Defense Force. An anonymous questionnaire was administered to 4754 members. The questionnaire included items regarding demographic factors, history of psychiatric visits, military rank, overseas deployment experience, disaster relief experience, supervisor leadership, unit cohesion, general psychological distress, stigma toward perceived mental illness, and attitudes toward help-seeking. Multiple regression analysis was used to identify the various factors related to stigma. Responses were obtained from 4305 (90.5%) participants, among which 3723 (78.3%) were valid. Multiple regression analyses revealed that a variety of factors including age, psychiatric consultation, leadership, and cohesiveness were markedly associated with stigma and attitudes toward help-seeking. This study revealed that various factors including demographic factors and military culture factors such as supervisor leadership and unit cohesion are related to stigma and attitudes toward mental health services among Japan Ground Self-Defense Force personnel. Further studies are needed to examine the results in depth.

Assessing self-stigma levels and associated factors among substance use disorder patients at two selected psychiatric hospitals in Egypt: a cross-sectional study

BACKGROUND

Substance use disorder is a growing problem worldwide, and the stigma associated with it remains a significant barrier to treatment and recovery. This study aimed to assess the perceived stigma among individuals with substance use disorders and its correlation with their socio-demographic characteristics and clinical history Parameters.

METHODS

A cross-sectional study was conducted among 552 patients with substance use disorders admitted to the outpatient clinics of Mansoura University Hospital, Addiction Treatment Unit of the Psychiatry Department, and Port Said Mental Hospital, Addiction Department. Participants completed a self-administered questionnaire, which included demographic information, clinical history parameters, and the Perceived Stigma of Substance Abuse Scale (PSAS).

RESULTS

The study found that almost half of the participants were aged 29 or younger, married, and had a median stigma score of 20. The vast majority of participants were male, had no previous legal problems, and had a median stigma score of 19. The most common type of substance used was opioids, and more than half of the participants were still using drugs. The highest mean stigma scores were for the items "Most people think less of a person who has been in treatment for substance use" and "Most employers will pass over the application of someone who has been treated for substance use in favor of another applicant." The perceived stigma score was significantly correlated with the severity of use but not with age or duration of use.

CONCLUSION

Our study investigates self-stigma in substance use disorder (SUD), revealing its variance across demographics and clinical groups. We found that self-stigma correlates with use severity and possibly decreases with abstinence. Notably, societal bias contributes significantly to self-stigma, necessitating societal interventions. The impact of self-stigma on patient well-being highlights the need for personalized treatments and stigma reduction strategies.

Leishmania species and clinical characteristics of Pacific and Amazon cutaneous leishmaniasis in Ecuador and determinants of health-seeking delay: a cross-sectional study

BACKGROUND

Cutaneous Leishmaniasis (CL) affects up to 5.000 people in Ecuador each year. L. guyanensis and L. braziliensis are the most common of the eight CL-causing Leishmania species. Earlier CL research concentrated on the easily accessible Pacific region. This study aims to describe the Leishmania species in Pacific and Amazon ecoregions, to analyze regional differences in CL patient clinical presentation, and to identify determinants of health-seeking delay.

METHODS

All cases in this cross-sectional study were diagnosed using smear slide microscopy, PCR, or both. Cytochrome B gene sequencing was used to identify the causative Leishmania species in qPCR-positive samples.

RESULTS

This study included 245 patients, with 154 (63%) infected in the Pacific region and 91 (37%) infected in the Amazon. Causative Leishmania species were identified in 135 patients (73% of qPCR positives). L. guyanensis was identified in 76% (102/135) of the samples and L. braziliensis in 19% (26/135). The Pacific region had a low prevalence of 6% (5/89) of L. braziliensis. For the first time, we report L. guyanensis from the central Amazon, L. braziliensis from the northern Pacific, and L. lainsoni from both the central Amazon and northern Pacific. Amazon cases had a longer median health-seeking delay in months (2.0, IQR 3.0) than Pacific cases (1.0, IQR 1.5). Prolonged health-seeking delay was associated with older age, Amerindian ethnicity, infection at lower altitudes, non-ulcerative lesions, and lesions on the lower limbs.

CONCLUSIONS

In the Pacific region, health-seeking delay is relatively short and L. braziliensis prevalence remains low. Limited access to health care and stigma might explain the prolonged health-seeking delay in the Amazon. We recommend larger studies on the distribution of Leishmania species in Amazon CL cases and additional regional research into diagnostic test accuracy. Furthermore, the determinants of health-seeking delay in Ecuador should be investigated further.

A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain

Objectives

Research comparing mental and physical health stigma is scarce. The aim of this study was to compare social exclusion towards hypothetical males and females with depression or chronic back pain. Furthermore, the study investigated whether social exclusion is associated with participant's empathy and personality traits, while controlling for their sex, age and personal exposure to mental/physical chronic health conditions.

Design

This study employed a cross-sectional questionnaire design.

Methods

Participants (N = 253) completed an online vignette-based questionnaire and were randomly allocated to either a depression or chronic back pain study condition. Measures of social exclusion through respondents' willingness to interact with hypothetical individuals, empathy and the Big Five personality traits were completed.

Results

Willingness to interact scores did not significantly differ depending on the diagnosis or sex of the hypothetical person in the vignette. For depression, higher levels of conscientiousness significantly predicted less willingness to interact. Whilst being a female participant and having higher empathy significantly predicted greater willingness to interact. For chronic back pain, higher empathy significantly predicted greater willingness to interact, with no significant predictors found from the Big Five personality traits.

Conclusion

Findings indicate that females and males with depression or chronic back pain face similar levels of social exclusion, with empathy being a core variable driving social exclusion behaviours. These findings enhance our understanding of potential variables driving social exclusion, in-turn informing campaign development to reduce public stigma towards depression and chronic back pain.

The mediating role of anxiety in feelings of stigma and quality of life of post-epidemic hemiplegic patients with cerebral hemorrhage

OBJECTIVE

To analyze factors influencing the sense of shame, anxiety and quality of life of hemiplegic patients after cerebral hemorrhage and to verify the intermediary role of anxiety in the post-epidemic period.

METHODS

240 hemiplegic patients with cerebral hemorrhage were enrolled from a third class a hospital in Hubei Province and interrogated by questionnaire and convenience sampling method.

RESULTS

Some ICH patients demonstrated problems related to sense of shame, anxiety, and poor quality of life. Sense of shame was positively related to anxiety and shame and anxiety were negatively related to the quality of life. Multivariate regression analysis indicated that age, educational level, occupational status, per capita monthly income, medical payment method, disease duration, sense of shame and anxiety influenced quality of life and together explained 55.8% of the variability. Anxiety mediated prediction of illness and shame on quality of life and the mediating effect accounted for 55.6% of the total effect.

CONCLUSION

The current study examined correlations between anxiety, stigma and quality of life while testing the hypothesis that anxiety mediated the quality of life. Anxiety was related to quality of life. As such, treatment of anxiety may present an opportunity to improve quality of life after ICH.

Self-Consciousness and Self-Awareness: Associations between Stable and Transitory Levels of Evidence

The theory of objective self-awareness predicts the assessment of stable or dispositional self-consciousness and transitory or situational self-awareness. The aim of the present research was to investigate potential associations between patterns of experiential self-description to scores on self-report measures of dispositional self-consciousness. A total of 64 Brazilian volunteers (M_age = 29.7, SD = 8.79, 64.1% female) responded to the Revised Self-Consciousness Scale, the Philadelphia Mindfulness Scale, and the Rumination-Reflection Questionnaire before participating in an experience sampling protocol. The protocol consisted of random daily requests for up to four self-description experiences across seven consecutive days. Participants recorded audio messages on their mobile phones in reply to each request describing their current experience. Reports were analyzed through a reflexive thematic analysis that produced twenty sub-themes accounting for descriptive markers of experience. Based on those descriptive markers, the qualitative data were then transformed into quantitative data for the situational self-awareness indexes. Evidence of association between self-consciousness and self-awareness was stronger for the awareness subscale in a positive correlation with affective situational self-awareness and in a negative correlation with mental representational transitory self-awareness. Although relational evidence has been provided, the data reinforced the theoretical distinction between self-consciousness and self-awareness.

A Preliminary Examination of Treatment Barriers, Preferences, and Histories of Women with Symptoms of Social Anxiety Disorder

Social anxiety disorder (SAD) is a common mental health condition that is characterised by a persistent fear of social or performance situations. Despite effective treatments being available, many individuals with SAD do not seek treatment or delay treatment seeking for many years. The aim of the present study was to examine treatment barriers, treatment histories, and cognitive behavioural therapy (CBT) delivery preferences in a sample of women with clinically relevant SAD symptoms. Ninety-nine women (Mage = 34.90, SD = 11.28) completed the online questionnaires and were included in the study. Participants were recruited from advertisements on community noticeboards and posts on social media. The results demonstrated that less than 5% of those who received psychological treatment in the past were likely to have received best-practice CBT. The most commonly cited barriers to accessing treatment for women with SAD related to direct costs (63%) and indirect costs (e.g., transport/childcare) (28%). The most preferred treatment delivery method overall was individual face-to-face treatment (70%). The study demonstrates a need to provide a variety of treatment options in order to enhance access to empirically supported treatment for women with SAD.

The Roles of Endorsement and Stigma in Suicidal Ideation and Behavior among Chinese College Students

Previous studies have suggested that stereotypes towards suicide, including endorsement of suicide and stigma toward suicide, may contribute to suicidal ideation and behaviors. However, this has not been examined directly. In this study, we examined whether endorsement of suicide and stigma toward suicide are involved in the pathway from suicidal ideation to suicide attempts among college students. To this end, we used the Suicidal Ideation Attributes Scale (SIDAS), the Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the Stigma of Suicide Scale (SOSS) to assess suicidal ideation, suicide attempts, endorsement of suicide, and stigma toward suicide, respectively, in a sample of 944 Chinese college students (mean age, 20.97 years). Using mediation analysis, we found that suicidal ideation partially mediated the relationship between endorsement of suicide and suicide attempts and between stigma toward suicide and suicide attempts. These findings provide novel evidence that endorsement of suicide and stigma toward suicide are closely associated with suicide attempts, but partially through the influences of suicidal ideation. Future studies should elaborate on their longitudinal relationships. Implications of these findings for clinical practices are discussed with reference to the ideation-to-action framework of suicide, aiming to reduce suicidal behaviors.

Palestinian Muslim College Students' Attitudes to Mental Health Treatment: A Comparative Study

This study examined the association between the degree of religiosity, combined with cultural beliefs, social stigmas, and attitudes towards mental-health treatment in two groups, who, despite having similar cultural and religious affiliation, have experienced different socio-political contexts: Palestinian Muslim college students living in the Occupied Palestinian Territory (OPT) and Israel. The study was guided by Tanhan and Young's (2021) conceptual framework. Methods: A snowball recruitment strategy was applied, using a cross-sectional survey. A total sample size was 214 students, 105 from the OPT and 109 from Israel. Results indicate that students from the OPT (n = 105) did not differ from those living in Israel (n = 109) on religiosity using the Islamic Belief scale, or Attitudes Towards Mental Health treatment (F(1, 189) = 1.07, p = 0.30). However, students from the OPT had higher confidence in mental-health professionals (M = 15.33) than their counterparts (M = 14.59), and women had higher confidence (M = 16.03) than men (M = 13.90). The reliance on traditions for Muslim students over Western mental-health approaches is a critical factor in predicting the attitudes towards students' mental problems and their chosen treatment. Sociopolitical context played a significant role in shaping attitudes toward mental-health providers.

Stigma and its associated factors among patients with COVID-19 in Dhaka City: evidence from a cross-sectional investigation

Background

Coronavirus disease 2019 (COVID-19) has become a significant disease pandemic. Dhaka City alone has contributed about one-third to the total COVID-19 cases in Bangladesh. Globally, patients with infectious diseases, including COVID-19, experience stigma. There was no quantitative estimate of stigma experienced by patients with COVID-19 in the country. Therefore, this study aimed to assess the prevalence of stigma and its associated factors among patients with COVID-19 in Dhaka.

Methods

A cross-sectional study was conducted among 384 respondents aged 18 years or older who had been hospitalized or had stayed at home and were tested negative 15 days to 6 months before the day of data collection. Data collection was done through in-person and telephone interviews using a semi-structured survey questionnaire. A 15-item COVID-19-related stigma scale questionnaire was used to assess stigma. Binary logistic regression analysis was performed to identify the predictors of stigma.

Results

More than half (53.1%) of the respondents experienced stigma when they were COVID-19 positive. Females were at a 3.24 times higher risk of experiencing stigma than their male counterparts. Respondents from the 60+ age group and 40-59 age group were 63.0% and 48.0% less likely to experience stigma than those from the 18-39 age group. Non-hospitalised patients had 1.67 times higher odds of facing stigma than those hospitalised.

Conclusions

This study reported a high prevalence of stigma among the patients with COVID-19 in Dhaka City. The current evidence base of stigma experience among patients with COVID-19 offers a solid foundation for creating effective strategies and policies and designing appropriate interventions to counter stigma, which will improve the psychological well-being of patients with COVID-19 in Bangladesh.

Professional help-seeking behaviour for mental health problems among veterinarians in Norway: a nationwide, cross-sectional study (The NORVET study)

Background

Veterinarians have a relatively high prevalence of mental health problems; however, research on professional help-seeking is limited. The main purpose of the present study was to investigate the prevalence of mental health problems and professional help-seeking behaviour for such problems, and the independent factors associated with help-seeking behaviour among veterinarians in Norway.

Method

This cross-sectional study included all veterinarians in Norway (response rate 75%, 70% women). Logistic regression was used to calculate odds ratios (OR) for professional help-seeking for mental health problems. Analyses were controlled for socio-demographic, individual (personality trait reality weakness, SCL-5, attitudes toward mental illness), and work-related factors (work field, job stress).

Results

The prevalence of self-reported mental health problems in need of treatment was 30% (746/2494), significantly higher among women than men (36% vs. 15%). Fifty-four percent had sought professional help, women significantly more often (56%) than men (41%). Among veterinarians with serious suicidal thoughts, 50% (69/139) had sought help. Veterinarians most frequently related mental health problems to work problems (47%), women significantly more often (49%) than men (34%). Factors significantly associated with help-seeking were being female, OR = 2.11 (95% CI: 1.24–3.60), working with production animals, OR = 0.35 (0.13–0.98), public administration, OR = 2.27 (1.15–4.45), academia/research, OR = 4.78 (1.99–11.47) or ‘other’ fields, OR = 2.79 (1.23–6.32), and attitudes toward mental illness, OR = 1.32 (1.03–1.68).

Conclusions

Thirty percent of veterinarians in Norway reported mental health problems in need of treatment, and only half of them had sought professional help. A low degree of help-seeking was also seen among those with serious suicidal thoughts. Being female, positive attitudes toward treatment of mental illness, working in public administration, academia/research and ‘other’ field were associated with more help-seeking, while working in production animal practice was associated with less help-seeking. Interventions to increase help-seeking behaviour for mental health problems among veterinarians are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13710-y.

Development of a self-help cognitive behavioral therapy programme for reducing the stigma of stroke survivors: a modified delphi study

BACKGROUND

Stigma is a common psychological consequence for stroke survivors that aggravates their physical and psychological burden and hinders their rehabilitation. Currently, there are few interventions targeted at the stigma of stroke survivors.

OBJECTIVES

This study reports on the development of a self-help cognitive behavioral therapy (CBT) programme driven by a logical model of stigma in stroke survivors, CBT and the advice of multidomain experts.

METHODS

A logical model of stigma in stroke survivors was derived from a systematic search of the literature and semistructured interviews with 21 patients to identify factors influencing stigma. The item content of the programme was generated based on this logical model in combination with CBT. A modified Delphi process with an expert panel of multidomain experts was used to evaluate and refine the content of the programme. SPSS 20.0 was used for data analysis.

RESULTS

Seventeen experts accepted the invitation to participate, and all completed two rounds of the Delphi survey. Six sections and 26 items were identified. Consensus was reached among experts that the self-help CBT programme included the following six sections: health education, understanding stigma, cognition change, skills training and self-care, self-acceptance and relapse prevention.

CONCLUSIONS

The self-help CBT programme includes health education and psychological education. This study extends the limited body of research on stroke-related stigma interventions, and the next step is to evaluate its efficacy in trials.

Perceived Need, Mental Health Literacy, Neuroticism and Self- Stigma Predict Mental Health Service Use Among Older Adults

OBJECTIVES

Older adults are the least likely age group to seek mental health services. However, few studies have explored a comprehensive range of sociodemographic, psychological, and social barriers and facilitators to seeking treatment in later life.

METHODS

A cross-sectional, national sample of Canadian older adults (55+, N = 2,745) completed an online survey including reliable and valid measures of predisposing, enabling, and need characteristics, based on Andersen's behavioral model of health, as well as self-reported use of mental health services. Univariate and hierarchical logistic regressions predicted past 5-year mental health service use.

RESULTS

Mental health service use was most strongly and consistently associated with greater perceived need (OR = 11.48) and mental health literacy (OR = 2.16). Less self-stigma of seeking help (OR = .65) and greater neuroticism (OR = 1.57) also predicted help-seeking in our final model, although their effects were not as strong or consistent across gender, marital status, and age subgroups.

CONCLUSIONS

The need category was crucial to seeking help, but predisposing psychological factors were also significant barriers to treatment.

CLINICAL IMPLICATIONS

Interventions that target older adults high in neuroticism by improving perceptions of need for treatment, mental health literacy, and self-stigma of seeking help may be particularly effective ways of improving access to mental health services.

Self-compassion promotes mental help-seeking in older, not in younger, counselors

While self-compassion and mental help-seeking are two important aspects emphasized in mental health literature and counseling practice, very little research has focused on how these two are associated particularly among counseling professionals-individuals providing mental health support to others but whose mental health are often overlooked. This cross-sectional study investigated a moderated mediation model examining the role of age and attitudes in the positive influence of self-compassion on mental help-seeking intention. Using a paper-and-pencil survey, data were collected from a total of 158 Filipino counseling professionals. Results revealed that mental help-seeking attitudes significantly and partially mediated the positive association between self-compassion and mental help-seeking intention. Additionally, age significantly moderated the positive relationship between self-compassion and mental help-seeking attitudes. The significant positive influence of self-compassion on mental help-seeking attitudes was strong among older participants, weak among middle-age, and diminished among younger participants. The findings provided insights on the importance of a self-compassion-based approach to counselor training. The implications of preserving counselors' mental health in counseling practice were discussed.

The Important Role of Stereotypes in the relation between Mental Health Literacy and Stigmatization of Depression and Psychosis in the Community

Increased mental health literacy (MHL) has not reduced stigmatization of people with mental disorder. Thus, we examined the role of stereotypes in the interplay of MHL (correct labelling, causal explanations) and the wish for social distance (WSD) from people with depressive and psychotic symptoms in a community sample of 1526 German-speaking participants in the Swiss 'Bern Epidemiological At-Risk' study (age 16-40 years; response rate: 60.1%). Following the presentation of an unlabelled case vignette of depression or psychosis, MHL, stereotypes and WSD were assessed in a questionnaire survey. Their interrelations were studied using structural equation modelling. MHL was not directly linked to WSD, only the psychosocial causal model was directly negatively associated with WSD. Perceived dangerousness particularly increased WSD, this was increased by a biogenetic causal model and decreased by a psychosocial causal model. Awareness-campaigns that, next to biological causes, emphasize psychosocial causes of mental disorders might better reduce stigmatization.

Community support groups for men living with depression: barriers and facilitators in access and engagement with services

Approximately 10% of the general population will experience depression in adulthood. Concerningly, men with depression are more likely to take their own lives and less likely to seek professional support. Given men's preference for community-based support, this study employed interviews with service providers to explore the barriers and facilitators involved in community support groups for men living with depression. Nine interviews were conducted with service providers across Greater Manchester, UK. Data were analyzed via thematic analysis and revealed four themes: 'Mental Health as a Weakness,' 'Empowering Practice,' 'Trust and Security' and 'Group Support as a Gateway to Treatment.' Men living with depression experience identity conflict, which reduces help-seeking. Community support groups facilitate access and engagement with treatment by providing safe spaces to resolve internal conflicts. Gender-specific group support may facilitate access to support and address long waiting lists of statutory services. Implications for practice, policy and future research are discussed.

Predictors of help-seeking behaviour in people with mental health problems: a 3-year prospective community study

BACKGROUND

The majority of people with mental illness do not seek help at all or only with significant delay. To reduce help-seeking barriers for people with mental illness, it is therefore important to understand factors predicting help-seeking. Thus, we prospectively examined potential predictors of help-seeking behaviour among people with mental health problems (N = 307) over 3 years.

METHODS

Of the participants of a 3-year follow-up of a larger community study (response rate: 66.4%), data of 307 (56.6%) persons with any mental health problems (age-at-baseline: 16-40 years) entered a structural equation model of the influence of help-seeking, stigma, help-seeking attitudes, functional impairments, age and sex at baseline on subsequent help-seeking for mental health problems.

RESULTS

Functional impairment at baseline was the strongest predictor of follow-up help-seeking in the model. Help-seeking at baseline was the second-strongest predictor of subsequent help-seeking, which was less likely when help-seeking for mental health problems was assumed to be embarrassing. Personal and perceived stigma, and help-seeking intentions had no direct effect on help-seeking.

CONCLUSIONS

With only 22.5% of persons with mental health problems seeking any help for these, there was a clear treatment gap. Functional deficits were the strongest mediator of help-seeking, indicating that help is only sought when mental health problems have become more severe. Earlier help-seeking seemed to be mostly impeded by anticipated stigma towards help-seeking for mental health problems. Thus, factors or beliefs conveying such anticipated stigma should be studied longitudinally in more detail to be able to establish low-threshold services in future.

High Social Coping Self-Efficacy Associated With Lower Sweat Interleukin-6 in Older Adults With Chronic Illness

Inflammation, particularly interleukin-6 (IL-6), is associated with chronic disease in older adults, but not all older adults have the same progression of poor health outcomes. Self-efficacy may play a role in buffering the inflammatory burden in chronic disease. To evaluate associations between self-efficacy and IL-6, 159 community-dwelling older adults (N = 159, M_age = 82 years, SD = 6.3 years) with one or more chronic illnesses were recruited for this cross-sectional study. Sweat IL-6 was collected using a noninvasive sweat patch worn for 72 hrs. Multiple linear regression with bootstrapping showed a significant association between social coping self-efficacy and IL-6 (β = -0.534, p = .010) after adjustment for age, sex, race, body mass index, financial strain, chronic conditions, and social support. Although preliminary, this study creates a rationale to explore the self-efficacy inflammatory biomarker association further. Enhancing self-efficacy might be a viable nonpharmacological treatment to lower or slow the inflammatory burden in older adults.

Exploring older adults’ experiences seeking psychological services using the network episode model

Older adults’ mental health problems are a growing public health concern, especially because their rate of mental health service use is particularly low. Decades of mental health service utilisation models have been developed, yet key assumptions from these models focus primarily on factors that facilitate or inhibit access into the treatment system without taking into considering the dynamics of how individuals respond to their mental health problems and engage in service utilisation. More recently, dynamic models like the Network Episode Model (NEM-II) have been developed to challenge the underlying, rational choice assumption of traditional utilisation models. Given the multifaceted and complex nature of older adults’ mental health problems, the objective of this study was to examine whether the NEM-II is a helpful and appropriate model for understanding the dynamic process of how older adults navigate the mental health system, including factors that advanced and delayed help-seeking. Our qualitative analyses from 15 interviews with older adults revealed that their backgrounds, social supports and treatment systems influence, and are influenced by, their illness careers. Factors that delayed help-seeking included: a lack of support, ‘inappropriate’ referrals/advice from treatment professionals and poor mental health literacy. This research suggests the NEM-II is a helpful and appropriate theory for understanding older adults’ pathways to treatment, and has implications to enhance older adults’ access to psychological services.