Public attitudes to depression in urban Turkey - the influence of perceptions and causal attributions on social distance towards individuals suffering from depression

The long-term effects of war exposure on psychological health: An experimental study with Turkish conscript veterans

The study of the effects of war exposure on the psychological health of combatants has so far been constrained by possible selection biases which limits the establishment of causality, the clear identification of dynamics, and the generalizability of findings. In this study, we make use of a population-level natural experiment enabled by the strict military conscription system in Turkey which uses a draft lottery to randomly allocate conscripts to bases across the country, including those south-eastern areas experiencing a long running civil conflict. We build on this setting with a representative field survey of 5024 adult males. Our results indicate that those exposed to high intensity armed conflict environments during their service are more likely to experience depressive symptoms even long after their discharge. Further detailing conflict exposure, we find war traumas to be the primary drivers of the effects we observe.

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.

Risk factors associated with experienced stigma among people diagnosed with mental ill-health: a cross-sectional study

PURPOSE

to examine the relationship between religiosity, social support, trauma, quality of life and experienced stigma of mental illness amongst a population diagnosed with mental ill-health.

METHODS

A cross-sectional survey of day service users in Northern Ireland (n = 295) covering a range of issues including religiosity, social support, quality of life and prior experience of trauma. Stigma was measured using a recognised stigma scale. We used multinomial logistic regression to examine risk factors associated with experienced stigma.

RESULTS

Univariate analysis showed significant associations between stigma and age, number of friends, social support, quality of life and prior experience of trauma. Age, quality of life, and trauma remained independently associated with stigma in a multivariate logistic regression model (x2(12) = 98.40, p < 0.001).

CONCLUSION

Younger people, those with less social support, prior experience of trauma and with poorer quality of life are at increased risk of experiencing stigma related to their diagnosis of mental illness. The findings provide further understanding of stigma and are useful for those overseeing programmes to improve access to mental health treatment.

Public attitudes towards depression and schizophrenia in an urban Turkish sample

Stigma towards mental illness influences help-seeking behavior and prevents individuals with a mental illness from seeking the appropriate treatment for their condition. In Turkey, a shift from inpatient psychiatric mental health care towards a community-based, low-threshold system highlights the importance of understanding public attitudes towards the mentally ill. This study aims to underpin developments in mental health care through culturally sensitive research. Public stigma towards schizophrenia and depression is examined for the first time simultaneously in a community sample. Unlabeled case vignettes of either schizophrenia or depression as well as an assessment of mental illness attribution and the desire for social distance (SDS) were presented to an urban Turkish sample (N = 295). Analysis of variance revealed that attribution to mental illness determines significant levels of stigma for schizophrenia, however not for depression. Furthermore, desire for social distance (SDS) was significantly higher for the schizophrenia condition compared to depression. Depression and schizophrenia evoke different reactions within the Turkish population, specifically the attribution to mental illness increases stigma. This finding is discussed in light of the contact hypothesis, and furthermore contextualized within literature on familiarity with depression symptoms on the one hand, and perceived dangerousness and symptom severity of schizophrenia on the other hand. Implementation of timely and culturally sensitive adapted interventions within the ongoing reform of the Turkish mental health care system is recommended.

The first clinical practice experiences of psychiatric nursing students: A phenomenological study

OBJECTIVE

The purpose of this study was to evaluate student nurses clinical experiences during their first clinical contacts with psychiatric patients by using a qualitative phenomenological approach.

DESIGN

A phenomenological approach was used. Face-to-face interviews were conducted to collect data focusing on the reality of student nurses' experience.

SETTINGS

This study was conducted at a university in the capital city of Turkey.

PARTICIPANTS

The participants were undergraduate nursing students. A purposive sampling of 15 students who had completed their first psychiatric clinical practicum was used in this study.

METHODS

The data were collected by using unstructured interviews. The data were analysed by using Colaizzi's seven-step phenomenological method.

RESULTS

Four themes were identified: theoretical information insufficient to break the stigma; breaking down the mental illness stigma; communication: the medication of mental illness; and personal development.

CONCLUSION

At the end of clinical practice, stigma towards mental illness was reduced with empathy through the development of therapeutic relationships. The students stated that communication had a very important place in the treatment of mental illnesses and that psychiatric clinical practice helped them develop interpersonal relations. The results of this study can provide guidance for educators on the planning and development of clinical education.

The Variability of Nursing Attitudes Toward Mental Illness: An Integrative Review

Mental illnesses are common worldwide, and nurses' attitudes toward mental illness have an impact on the care they deliver. This integrative literature review focused on nurses' attitudes toward mental illness. Four databases were searched between January 1, 1995 to October 31, 2015 selecting studies, which met the following inclusion criteria: 1) English language; and 2) Research in which the measured outcome was nurses' attitudes toward mental illness. Fourteen studies conducted across 20 countries that 4282 participants met the inclusion criteria. No study was conducted in the United States (U.S.). Studies reported that nurses had mixed attitudes toward mental illness, which were comparable to those of the general public. More negative attitudes were directed toward persons with schizophrenia. Results indicate the need for further research to determine whether attitudes among nurses in the U.S. differ from those reported from other countries and to examine potential gaps in nursing curriculum regarding mental illness.

Females' Attitudes Toward Mental Illness: A Sample From Rural Istanbul, Turkey

BACKGROUND

The beliefs, attitudes and behaviors of the society toward mentally ill patients may prevent these people from seeking help and accessing a successful treatment.

OBJECTIVES

The current study aimed to investigate mental illness among Turkish females residing in rural areas and their attitudes toward mental illness.

PATIENTS AND METHODS

The current study was inferential cross-sectional. The population of this study consisted of 1000 households registered at the primary healthcare centre in Ademyavuz area who met the study inclusion criteria. The sample size was 387 females. Using the simple random sample selection method, certain females living in these households were included in the study. The socioeconomic status of the population in this region is low and middle-class. The adult population of the region is 10,960. Females comprise 39.8% of Ademyavuz population. The prevalence of mental illness in the district is unknown. Data were collected by face-to-face interviews using a researcher made questionnaire and the opinions about mental illness scale (OMI) in autumn 2008. The interviews were conducted at the participants' houses and lasted for 20 - 30 minutes. The females gave their informed consent and were assured that their information would be treated as strictly confidential.

RESULTS

The females in the rural research area had negative attitudes and stigmas about mental illness. The subject of the current study exhibited a total mean score of 155.6 ± 24.5 in terms of their attitudes toward mental illness. Mean scores in the unsophisticated benevolence sub-scale were 42.5 ± 8.2, 34.2 ± 7.9 in the authoritarianism sub-scale, 25.5 ± 6.3 in the mental illness ideology sub-scale, 34.0 ± 7.4 in the social restrictiveness sub-scale, and 20.0 ± 6.0 for the interpersonal etiology sub-scale. The current study found that individuals exhibited more positive attitudes towards mental illnesses as they got older ((Kvx2) = 19.42; P < 0.0001), married people exhibited a more positive attitude towards mental illnesses than singles did (Kvx(2) = 19.42; P < 0.0001), those who considered themselves to have a good economic status exhibited a more negative attitude towards mental illnesses compared to the ones who thought their economic status as poor or average (Kvx(2) = 5.11; P = 0.024).

CONCLUSIONS

Nurses have an important role in creating and maintaining a mentally healthy society. It is advisable to provide the public with training and consultancy services within the context of primary healthcare services, especially during home visits to change the negative attitudes of individuals against the mentally ill and prevent approaches that promote social isolation and denouncement.

Impact of Community Interventions on the Social Representation of Depression in Rural Gujarat

There is a pressing need to develop community interventions that will address stigma against mental illness in rural India. This cross-sectional study will compare social representations of depression in villages where educational programs have targeted mental illness and stigma versus control villages. Participants from the villages exposed to the educational interventions (n = 146) will be compared with a sample from six control villages (n = 187) in the same geographic region, using a structured questionnaire. The impact of the intervention as a predictor for questionnaire score will be assessed along with socio-demographic variables. The intervention villages showed higher levels of literacy regarding depression and lower levels of stigma, after adjusting for all other socio-demographic variables. While some demographic factors associated with the knowledge and attitudes towards depression are not modifiable, our research provides evidence in favor of the positive influence a community grassroots intervention can have on mental health literacy in rural settings.

Stigma and mental health treatment of adolescents with depression in jordan

Stigma is a fundamental barrier to seeking and engaging in mental health treatment for individuals managing depression. This study examines stigma perceptions of mental health treatment for Arab adolescents managing depression using a vignette survey completed by adults in public spaces in Amman, Jordan (n = 108). The vignette was systematically changed across four different conditions that varied the described youth's gender and whether or not they were receiving treatment for their depression. Two-way ANOVAs found that gender and receipt of mental health treatment influenced perceptions of stigma. Seeking treatment, however, did not increase perceived stigma, and receiving mental health treatment rather than no treatment was found as more likely to be a helpful approach for both males and females. Findings indicate that personal level stigma may have greater effects on females whereas public stigma may exert more influence on males. Participants endorsed that adolescents with depression are most likely to be helped when a family sought treatment rather than not seeking treatment. Findings also indicate that the community seems to appreciate the need for treatment and the likelihood of benefiting from formal mental health services.

Technology-based interventions for psychiatric illnesses: improving care, one patient at a time

Worldwide, individuals with severe psychiatric illnesses struggle to receive evidence-based care. While science has made remarkably slow progress in the development and implementation of effective psychiatric treatments, we have witnessed enormous progress in the emergence and global penetration of personal computing technology. The present paper examines how digital resources that are already widespread (e.g., smartphones, laptop computers), can be leveraged to support psychiatric care. These instruments and implementation strategies can increase patient access to evidenced-based care, help individuals overcome the barriers associated with the stigma of mental illness, and facilitate new treatment paradigms that harness wireless communication, sensors and the Internet, to enhance treatment potency. Innovative digital treatment programmes that have been used successfully with a range of conditions (i.e., schizophrenia, posttraumatic stress disorder and borderline personality disorder) are presented in the paper to demonstrate the utility and potential impact of technology-based interventions in the years ahead.

Professional care seeking for mental health problems among women and men in Europe: the role of socioeconomic, family-related and mental health status factors in explaining gender differences

PURPOSE

This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries.

METHODS

Data from the Eurobarometer 248 (2005-2006) for 29 European countries is used and country-specific logistic regression analyses are performed.

RESULTS

Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women's poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women's higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women's care use.

CONCLUSIONS

Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.

Heart Disease and Depression

Purpose: This article seeks to review and discuss the evidence linking depression, coronary heart disease (CHD), and culture. Method: PsychInfo, CINAHL, PubMed, and Google were searched for pertinent evidence linking depression, culture, and CHD, and retrieved articles were analyzed using thematic content analysis. Findings: Identified themes were the followings: depression is a factor in development and prognosis of CHD and affects the capacity to self-manage and adhere to treatment recommendations; culture mediates mental health/illness representations and treatment-seeking behaviors; screening and assessment of depression can be affected by cultural factors; and there is a need for culturally appropriate screening and therapeutic strategies. Discussion and Conclusions: As depression is a predictor and moderating variable in the genesis and progression of CHD, understanding how factors such as culture affect screening and management of the disease is important to inform the development of culturally and linguistically competent strategies that ensure accurate screening, detection, and treatment of depression in cardiac patients in clinical practice.

Belief in the dangerousness of people with mental disorders: a review

BACKGROUND

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to help make sense of this confusion, the present review focuses on research on one of the most commonly measured components - belief in dangerousness.

METHOD AND RESULTS

The review examines: measurement of belief in dangerousness; prevalence of belief in dangerousness; characteristics of people who believe in dangerousness; experiences associated with belief in dangerousness; characteristics of people that elicit belief in dangerousness; the effects of psychiatric labelling; the effects of causal explanations; interventions to reduce belief in dangerousness; and effects on help-seeking.

CONCLUSION

It is concluded that future research needs to focus on rigorous evaluation of interventions to reduce belief in dangerousness and the impact of this belief on people affected by mental disorders.

Development and validation of the Intellectual Disability Literacy Scale for assessment of knowledge, beliefs and attitudes to intellectual disability

Research into the general public's responses to individuals with intellectual disabilities has been dominated by attitudinal research. While this approach has unquestionably generated useful findings, it ignores important aspects, such as lay knowledge, explanatory models and beliefs about suitable interventions that can produce a multi-faceted understanding of public responses. This paper describes the development of a measure designed to assess respondents' intellectual disability literacy. Following a pilot with 114 participants, the IDLS was revised and then completed by 1376 members of the public (aged 18-78 years) from diverse cultural backgrounds. The measure was able to distinguish respondents who showed good intellectual disability literacy. Confirmatory factor analyses revealed four causal beliefs factors (adversity, biomedical, fate, environment) that accounted for 55% of the variance and three intervention beliefs factors (lifestyle, expert help, religion/spiritual,) that explained 52% of the variance. Test-retest reliability for these factors was good for all ethnic groups. The four-item social distance scale had good internal consistency for all ethnic groups and acceptable concurrent validity. The IDLS is a useful new tool to evaluate knowledge, beliefs and social distance to intellectual disability in lay people, is suitable for cross-cultural research and allows comparison of intellectual disability and mental health literacy in any given population.

The Attitudes of Preclinical and Clinical Turkish Medical Students Toward Suicide Attempters

Background: Interest in studies of stigma toward patients with mental disorders is growing. Research on the attitudes of medical students toward suicide attempters does not exist; although as medical personnel, they will encounter suicide attempters in emergency rooms. Aims: We aimed to investigate the attitudes of preclinical and clinical medical students toward suicide attempters and to compare their attitudes with nonmedical students. Methods: Participants were asked to fill out questionnaires those were searching the attitudes toward suicide attempters. These questionnaires used a social distance scale, skillfulness assessment scale, and dangerousness scale. Results: More than 73% of students had a negative attitude toward “renting a room of their home to a suicide attempter.” More than 90% would not want “a suicide attempter to supervise their children for few hours.” Significantly more preclinical than clinical students would not want their children to marry a suicide attempter. Conclusions: Social distance, skillfulness, and attitudes concerning the dangerousness of suicide attempters are problematic for medical students and need educational intervention.

DSM-V and the stigma of mental illness

Stigma associated with mental illness has been shown to have devastating effects on the lives of people with psychiatric disorders, their families, and those who care for them. In the current article, the relationship between diagnostic labels and stigma is examined in the context of the forthcoming DSM-V. Three types of negative outcomes are reviewed in detail - public stigma, self-stigma, and label avoidance. The article illustrates how a clinical diagnosis may exacerbate these forms of stigma through socio-cognitive processes of groupness, homogeneity, and stability. Initial draft revisions recently proposed by the DSM-V work groups are presented, and their possible future implications for stigma associated with mental illness are discussed.

Public stigma in relation to individuals with depression

OBJECTIVE

To assess public stigma in relation to individuals with depression and possible factors associated with this phenomenon.

METHODS

A cross-sectional study was conducted with a probabilistic sample of 500 individuals who live in the city of São Paulo, Brazil, and are aged between 18 and 65 years. A structured questionnaire was used, and it was applied in person. Questionnaire began with the presentation of a vignette describing an individual with depression (according to DSM-IV and ICD-10). This was followed by a structured questionnaire that assessed perceived negative reactions and discrimination, perceived dangerousness and emotional reactions in relation to the case presented in the vignette.

RESULTS

Individuals with depression were perceived as potentially dangerous by 56% of interviewees. In addition, 49% of the sample perceived them as capable of arousing negative reactions, and 41%, as capable of arousing discrimination in society. However, emotional reactions reported by the interviewees themselves were mainly positive in nature. Those who identified the vignette as a mental illness were the ones who more often perceived dangerousness, stigma and discrimination.

CONCLUSION

This study indicated that individuals with depression face a substantial amount of stigma, pointing to the need to gain in-depth knowledge about its impact on the experiences of these individuals, as well as to implement anti-stigma programs that focus on this disorder in the Brazilian context.

Desire for social distance from people with mental disorders

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to make sense of this confusion, the present review focuses on research on the most commonly measured component: social distance. The review examines measurement of social distance; characteristics of people who desire greater social distance; experiences that affect social distance; characteristics of people that elicit social distance; the effects of psychiatric labelling; the effects of causal explanations for mental disorders; and interventions to reduce social distance. It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.

What factors influence attitudes towards people with current depression and current mania?

BACKGROUND

Previous studies have detected different variables influencing the attitude towards mentally ill individuals but they have never addressed mania. Furthermore, it is not known whether the same factors affect attitudes towards individuals experiencing major depressive or manic episodes.

AIMS

Besides factors such as familiarity with mental illness, we were interested whether vulnerability to psychosis and mood disorders as well as social desirability can affect attitudes towards major depressive episodes and manic episodes.

METHODS

Subjects were presented with a case vignette describing an individual experiencing either a major depressive episode or a manic episode (n = 188, age 16-34 years). Their attitudes towards that person were assessed. Furthermore, factors potentially influencing these attitudes have been assessed such as personal vulnerability factors (i.e. cyclothymia and magical ideation) and social desirability bias.

RESULTS

Familiarity with the phenomenon of mental illness turned out to influence the attitude towards affective episodes, whereas the influence of the other potential predictors such as their own experience of affective or schizotypal symptoms failed to appear to be of significance.

CONCLUSIONS

Whereas ;familiarity' turned out to be a factor positively influencing the attitude towards depression, it turned out to have a rather negative influence on the attitude towards mania. This result could have important implications for anti-stigma campaigns.

Resources for mental health: scarcity, inequity, and inefficiency

Resources for mental health include policy and infrastructure within countries, mental health services, community resources, human resources, and funding. We discuss here the general availability of these resources, especially in low-income and middle-income countries. Government spending on mental health in most of the relevant countries is far lower than is needed, based on the proportionate burden of mental disorders and the availability of cost-effective and affordable interventions. The poorest countries spend the lowest percentages of their overall health budgets on mental health. Most care is now institutionally based, and the transition to community care would require additional funds that have not been made available in most countries. Human resources available for mental health care in most low-income and middle-income countries are very limited, and shortages are likely to persist. Not only are resources for mental health scarce, they are also inequitably distributed-between countries, between regions, and within communities. Populations with high rates of socioeconomic deprivation have the highest need for mental health care, but the lowest access to it. Stigma about mental disorders also constrains use of available resources. People with mental illnesses are also vulnerable to abuse of their human rights. Inefficiencies in the use of available resources for mental health care include allocative and technical inefficiencies in financing mechanisms and interventions, and an overconcentration of resources in large institutions. Scarcity of available resources, inequities in their distribution, and inefficiencies in their use pose the three main obstacles to better mental health, especially in low-income and middle-income countries.

Stigma towards people with mental illness in developing countries in Asia

BACKGROUND

There is a wide range of literature on stigmatization and discrimination of people with mental illness. Most studies, however, derive from Western countries. This review aims at summarizing results from developing countries in Asia published between 1996-2006.

METHOD

Medline search focusing on English-speaking literature.

RESULTS

Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by scepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.

CONCLUSION

This review revealed that the stigmatization of people with mental illness is widespread in Asia. The features of stigmatization-beliefs about causes of and attitudes towards mental illness, consequences for help-seeking-have more commonalities than differences to Western countries.

Public beliefs about and attitudes towards people with mental illness: a review of population studies

OBJECTIVE

To provide a review of population-based attitude research in psychiatry during the past 15 years.

METHOD

An electronic search using PubMed, Medline, and Academic Search Premier plus a hand search of the literature was carried out for studies on public beliefs about mental illness and attitudes towards the mentally ill published between 1990 and 2004.

RESULTS

Thirty-three national studies and 29 local and regional studies were identified, mostly from Europe. Although the majority are of descriptive nature, more recent publications include studies testing theory-based models of the stigmatization of mentally ill people, analyses of time trends and cross-cultural comparisons, and evaluations of antistigma interventions.

CONCLUSION

Attitude research in psychiatry made considerable progress over the past 15 years. However, there is still much to be done to provide an empirical basis for evidence-based interventions to reduce misconceptions about mental illness and improve attitudes towards persons with mental illness.

Public opinions and beliefs about the treatment of depression in urban Turkey

BACKGROUND

Although attitudes towards psychiatric illness influence its presentation, detection, recognition, treatment adherence and rehabilitation, the lay public's opinions and beliefs about the treatment of depression have not been investigated sufficiently.

OBJECTIVE

The aim of this study was to determine public opinions and beliefs about the treatment of depression and the influence of perception and causal attributions on attitudes towards treatment of depression in urban areas.

METHODS

This study was carried out with a representative sample in Istanbul, which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of 32 items rating attitudes towards depression.

RESULTS

The public believes that psychological and social interventions are more effective than pharmacotherapy, and that the medicines used in treatment of depression are harmful and addictive. There was a general reluctance to consult a physician for depression, and psychiatrists were felt to be more helpful than general practitioners. The public viewed depression as treatable. A high educational level and perceiving depression as a disease is associated with positive beliefs and opinions about the treatment of depression; but the perception of depressive patients as aggressive is associated with negative beliefs and opinions about the treatment of depression.

CONCLUSION

The beliefs that "psychological and social interventions are more effective than pharmacotherapy" and "antidepressants are harmful and addictive" must specifically be taken into account in clinical practice and in anti-stigma campaigns. Additional studies are needed to understand the public's tendency to conceptualise depression as a psychosocial problem. In clinical practice, depression should be introduced as a bio-psychosocial disease whatever its cause: biological, psychological or social. In addition, the differences between extreme worry and disease, and the lack of aggressiveness of depressive patients, must be emphasised.