Mental illness stigma and willingness to seek mental health care in the European Union

The Association Between Emotion Recognition and Internalizing Problems in Children and Adolescents: A Three-Level Meta-Analysis

Numerous studies have explored the link between how well youth recognize emotions and their internalizing problems, but a consensus remains elusive. This study used a three-level meta-analysis model to quantitatively synthesize the findings of existing studies to assess the relationship. A moderation analysis was also conducted to explore the sources of research heterogeneity. Through a systematic literature search, a total of 42 studies with 201 effect sizes were retrieved for the current meta-analysis, and 7579 participants were included. Emotion recognition was negatively correlated with internalizing problems. Children and adolescents with weaker emotion recognition skills were more likely to have internalizing problems. In addition, this meta-analysis found that publication year had a significant moderating effect. The correlation between emotion recognition and internalizing problems decreased over time. The degree of internalizing problems was also found to be a significant moderator. The correlation between emotion recognition and internalizing disorders was higher than the correlation between emotion recognition and internalizing symptoms. Deficits in emotion recognition might be relevant for the development and/or maintenance of internalizing problems in children and adolescents. The overall effect was small and future research should explore the clinical relevance of the association.

Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross-cultural network analysis

Comorbidity between depression and anxiety is well-established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self-reports on the Depression Anxiety and Stress Scales-21 (DASS-21) in three cross-cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.

Ethnic identity and barriers for using mental health services among Arab-Bedouin women coping with emotional distresses

The study aimed to explore barriers to mental health service attainment among Bedouin women living in different residential environments in southern Israel. We hypothesized that emotional distress and the utilization of mental health services would be influenced by the living environment and ethnic identity factors. The sample included 376 Arab-Bedouin women, 126 Arab-Bedouin women from the recognized and unrecognized villages, and 250 Arab-Bedouin women from the central localities. Quantitative methods were used, including emotional distress (GHQ12), ethnic identity scale (EIS), mental health literacy (MHLS), and barriers to mental health services attainment (BACE). Results indicated that participants from the central localities demonstrated a greater inclination to seek and utilize mental health services. Furthermore, higher rates of affirmation of ethnic identity were also found to be a predictive factor for the willingness to attain mental health services. These findings further support the role of residential environment and ethnic identity in shaping mental health service utilization patterns. Current research explored barriers to mental health services seek and attainment for Arab-Bedouin women in different residential environments in southern Israel. Ethnic identity factors and barriers such as stigma and access to resources predicted the tendency to seek help. Findings emphasize the need to address barriers to seeking help and the role of ethnic identity in mental health service attainment for Arab-Bedouin women.

Understanding experiences of mental health help-seeking in Arab populations around the world: a systematic review and narrative synthesis

BACKGROUND

Racial and ethnic disparities in mental health service utilisation and access is well established. Mental illness is common among Arab populations globally, but most individuals display negative attitudes towards mental health and do not seek professional help. The aim of this systematic review was to determine 1) help-seeking behaviours 2) help-seeking attitudes and 3) help-seeking barriers and facilitators, related to mental health services among Arab adults.

METHOD

A pre-defined search strategy and eligibility criteria allowed for database searching using terms related to: mental health, Arabs, help-seeking, as well as experiences and behaviours. Seventy-four articles were included and analysed through narrative synthesis. Results were reported using the PRISMA guidelines. The review protocol was registered prospectively on PROSPERO (CRD42022319889).

RESULTS

Arabs across the world have negative attitudes towards formal help-seeking and are reluctant to seek help, despite the presence of psychological distress. There is little information on factors that influence help-seeking behaviours and rates of service use. Preference for informal help sources such as family and friends were expressed and considered more acceptable. Low mental health literacy, stigma, gender, age, education, religion, acculturation, and immigrant status were the most common factors influencing help-seeking attitudes. Barriers to help-seeking included stigma, privacy and confidentiality, trust, mental health literacy, language, logistics, and culture related barriers. Increasing societal and family awareness, external support and encouragement, shared culture between the client and therapist, quality of doctor patient relationship, and feelings of connectedness with the host country among refugees were mentioned facilitators. Mixed findings for the role of religion, and family and community, in relation to facilitating or hindering help-seeking were reported.

CONCLUSIONS

There is an increased likelihood and preference to seek informal sources of psychological support among Arabs. Contextual and cultural factors impeding help-seeking for Arabs are common across the world. Future research should address actual utilisation rates of services to better understand factors that influence help-seeking behaviours and facilitators to help-seeking. Increasing mental health literacy and developing anti stigma campaigns is necessary. Developing culturally informed interventions should inform future efforts to promote help-seeking among this population.

The effectiveness of mental illness stigma-reduction interventions: A systematic meta-review of meta-analyses

The high prevalence of stigma toward mental illnesses contributes to the worsened health and quality of life for people with mental illnesses. Different stigmas (e.g., public, self) lead to social discrimination, social isolation, and reduce the likelihood that people with mental illnesses receive adequate treatment for their conditions. In response to this, numerous social interventions have been developed to help combat the spread of stigma. Subsequently, researchers have conducted meta-analyses to determine the effectiveness of different interventions for reducing stigma toward mental illness. To date, no efforts have been made to synthesize these meta-analyses to identify gaps in the stigma-reduction literature, assess the quality of extant literature, and to identify trends in programming efforts. The present study conducted a systematic meta-review of 19 meta-analyses, drawing from the Health Stigma and Discrimination Framework, to address these gaps. Results showed that the included meta-analyses were of relatively poor quality and that interventions primarily addressed either public or self-stigma, while overlooking other stigmas. Further, meta-analyses primarily assessed the effects of contact-promotion or educational intervention strategies. There was little evidence to suggest that interventions were effective longitudinally. Implications for future research and intervention development are discussed.

Factors Related to Perceived Stigma in Parents of Children and Adolescents in Outpatient Mental Healthcare

Little is known about factors contributing to perceived stigma in parents of children and adolescents with behavioral and emotional problems in outpatient mental healthcare. We aimed to identify the most relevant factors related to perceived parental stigma using least absolute shrinkage and selection operator (LASSO) regression including a broad range of factors across six domains: (1) child characteristics, (2) characteristics of the primary parent, (3) parenting and family characteristics, (4) treatment-related characteristics, (5) sociodemographic characteristics, and (6) social-environmental characteristics. We adapted the Parents' Perceived Stigma of Service Seeking scale to measure perceived public stigma and affiliate stigma in 312 parents (87.8% mothers) during the first treatment year after referral to an outpatient child and adolescent clinic. We found that the six domains, including 45 individual factors, explained 34.0% of perceived public stigma and 19.7% of affiliate stigma. Child and social-environmental characteristics (social relations) explained the most deviance in public stigma, followed by parental factors. The strongest factors were more severe problems of the child (especially callous-unemotional traits and internalizing problems), mental healthcare use of the parent, and lower perceived parenting competence. The only relevant factor for affiliate stigma was lower perceived parenting competence. Our study points to the multifactorial nature of perceived stigma and supports that parents' perceived public stigma is susceptible to social influences, while affiliate stigma relates to parents' self-evaluation. Increasing parents' perceived parenting competence may help mitigate perceived stigma. Future studies should explore how stigma relates to treatment outcomes.

Psychiatrization in mental health care: The emergency department

BACKGROUND

In the light of high incidences of diagnosed mental disorders and the growing utilization of mental healthcare services, a progressing psychiatrization of society has been hypothesized as the underlying dynamic of these developments. Mental healthcare institutions, such as psychiatric hospitals, may play a decisive role in this. However, there is a scarcity of research into how psychiatrization emerges in hospital settings. This paper explores whether the emergency department (ED) can be considered as a site where psychiatrization happens, becomes observable, and which factors in the context of the ED may be its potential drivers.

METHODS

Two cases as encountered in an interdisciplinary ED will be presented in the following in an anonymized way. Although the cases originate from individual consultations, they can be considered as prototypical. The cases were collected and discussed using the method of interactive interviewing. The results will be analyzed against the backdrop of current theoretic concepts of psychiatrization.

FINDINGS

The ED can be seen as an important area of contact between society and psychiatry. Decisions whether to label a certain condition as a "mental disorder" and to therefore initiate psychiatric treatment, or not, can be highly difficult, especially in cases where the (health) concerns are rather moderate, and clearly associated with common life problems. Psychiatrists' decisions may be largely influenced in favor of psychiatrization by a wide array of disciplinary, institutional, interpersonal, personal, cultural, and social factors.

CONCLUSIONS

The ED appears to be a promising field for research into the mechanisms and motives through which psychiatrization may emerge in mental healthcare settings. Psychiatrists in the ED work within a complex sphere of top-down and bottom-up drivers of psychiatrization. Encounters in the ED can be an important step toward adequate support for many individuals, but they also risk becoming the starting point of psychiatrization by interpreting certain problems through the psychiatric gaze, which may induce diagnoses of questionable validity and treatment of little use.

Is it time to change the approach of mental health stigma campaigns? An experimental investigation of the effect of campaign wording on stigma and help-seeking intentions

Introduction

Mental health stigma causes a range of diverse and serious negative sequelae. Anti-stigma campaigns have largely aligned with medical theories and categorical approaches. Such campaigns have produced some improvements, but mental health stigma is still prevalent. The effect of alternative theoretical perspectives on mental health within anti-stigma campaigns has not been tested. Moreover, we do not know their effect on help-seeking intentions.

Methods

We conducted an online experimental pre-post study comparing the effects of two anti-stigma campaign posters on mental health stigma and help-seeking intentions. One poster adhered to the medical, categorical approach to mental health, whereas the other poster portrayed mental health problems in line with a non-categorical, continuous perspective.

Results

After controlling for familiarity with the campaign poster, country of residence and pre-test scores, we found no significant between-group differences in terms of help-seeking intentions and all stigma attitudes except for danger-related beliefs. That is, those who viewed the non-categorical poster reported an increased perception that people with mental health problems are dangerous.

Discussion

Our largely null findings may suggest the equivalence of these posters on stigma and help-seeking intentions but may also reflect the brevity of the intervention. Our findings concerning danger beliefs may reflect a Type I error, the complexities of stigma models, or the adverse effects of increased perceived contact. Further research is needed to test the effects of differing mental health paradigms on stigma and help-seeking intentions over a longer duration.

Change in suicidal ideation and associated factors among young adults in Hong Kong from 2018 to 2019: a latent transition analysis

PURPOSE

Suicide in young adulthood is a vital public health concern. There have been few systematic studies that examined the prevalence and transition of suicidal ideation classes in young adults and the factors associated with the transition.

METHODS

This two-wave survey recruited 1269 young adults (Mean age = 24.0 years, 70.1% males) in Hong Kong. The participants completed the Suicidal Ideation Attributes Scale, Chinese Health Questionnaire, and help-seeking behaviors in 2018 and 2019. Latent profile analysis was used to classify the participants into latent classes of suicidal ideation with substantive checking under the 3-step approach. Latent transition analysis with measurement invariance examined the transition among the latent classes from 2018 to 2019 and the associations with help-seeking behaviors and change in psychological distress.

RESULTS

Three latent classes of suicidal ideation were identified and over two-thirds of the participants belonged to the Low-risk class with minimal suicidal ideation. The prevalence of the High-risk class dropped from 10.2 to 7.2%, while that of the Moderate-risk class remained stable from 2018 to 2019. Increases in psychological distress predicted higher probabilities to remain at or transit into more risky classes. Engagement in help-seeking behaviors showed differential transitions in suicidal ideation across time.

CONCLUSION

The findings suggest three latent classes of suicidal ideation with distinct profiles among the young adults. Deterioration in psychological distress showed a temporal effect on worsening of suicidal ideation over a 1-year period. Future studies should elucidate the comparative effectiveness of help-seeking behaviors via online and offline channels.

Psychiatrization of Society: A Conceptual Framework and Call for Transdisciplinary Research

Purpose: Worldwide, there have been consistently high or even rising incidences of diagnosed mental disorders and increasing mental healthcare service utilization over the last decades, causing a growing burden for healthcare systems and societies. While more individuals than ever are being diagnosed and treated as mentally ill, psychiatric knowledge, and practices affect the lives of a rising number of people, gain importance in society as a whole and shape more and more areas of life. This process can be described as the progressing psychiatrization of society. Methods: This article is a conceptual paper, focusing on theoretical considerations and theory development. As a starting point for further research, we suggest a basic model of psychiatrization, taking into account its main sub-processes as well as its major top-down and bottom-up drivers. Results: Psychiatrization is highly complex, diverse, and global. It involves various protagonists and its effects are potentially harmful to individuals, to societies and to public healthcare. To better understand, prevent or manage its negative aspects, there is a need for transdisciplinary research, that empirically assesses causes, mechanisms, and effects of psychiatrization. Conclusion: Although psychiatrization has highly ambivalent effects, its relevance mainly derives from its risks: While individuals with minor disturbances of well-being might be subjected to overdiagnosis and overtreatment, psychiatrization could also result in undermining mental healthcare provision for the most severely ill by promoting the adaption of services to the needs and desires of the rather mild cases. On a societal level, psychiatrization might boost medical interventions which incite individual coping with social problems, instead of encouraging long-term political solutions.

Socioeconomic status and mental illness stigma: the impact of mental illness controllability attributions and personal responsibility judgments

BACKGROUND

Prior research has suggested that higher levels of socioeconomic status (SES) may be linked with heightened mental illness stigma (MIS). It has been posited that this link is due to the resource-rich environment high-SES individuals live in, which predisposes them to seeing the certain phenomena as being more controllable in nature than low-SES individuals.

AIMS

The current study intended to address the attributional mechanisms behind the SES-MIS link.

METHODS

In a sample of 932 participants, we collected self-reported SES along with the controllability attributions and personal responsibility judgments participants make for individuals with mental illnesses.

RESULTS

Analyses indicated that SES was significantly associated with greater MIS levels, and that this link was significantly mediated by controllability attributions and personal responsibility judgments.

CONCLUSIONS

Findings suggest that high-SES individuals are more likely to see mental illness as due to internal, controllable factors, which leads to blaming the individual for mental illness onset and, ultimately, greater mental illness stigma. These results provide support for more socioeconomically diverse committees and panels where mental health funding decisions are made due to inherent attributional biases which may be present along the SES spectrum.

EXPLICIT-IMPLICIT DISCREPANCY IN MACRO-LEVEL MENTAL ILLNESS STIGMA IS LINKED TO PREVALENCE AND CARE

Introduction: This study explores the associations in the United States between each state's stereotypes about the dangerousness of people with mental illness and important outcomes for people with mental illness.

Methods: Implicit association test and questionnaire data from 17,312 online participants were aggregated within states and years. Each state's annual average implicit and explicit stereotypes were used to predict state differences in prevalence, and treatment, unemployment, and homelessness among people with mental illness.

Results: Implicit and explicit perceived dangerousness interact such that in states with low explicit perceived dangerousness, implicit perceived dangerousness is positively associated with all outcomes. In states with high explicit perceived dangerousness, implicit perceived dangerousness is negatively associated with homelessness.

Discussion: Explicit-implicit discrepancy in macro-level perceived dangerousness is generally associated with worse outcomes for people with mental illness, but the effects are small. Macro-level stereotypes might have larger effects in smaller regions, like counties, than in states.

The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys

Background: Research on social distancing from patients with depression has primarily focused on individual-level factors rather than context-level factors. This study aimed to investigate the relationship between individual-level and context-level factors and social distancing from depressive patients. Methods: Sample data were collected via computer-assisted telephone interviews with 800 Taiwanese adults aged 20 to 65 years in 2016. All effects were tested using multilevel analysis. Results: With regard to individual-level variables, male sex, older age, people with more perceived dangerousness and those with more emotional reaction of fear were associated with greater social distancing from depressive patients. After controlling for individual-level variables, a positive association was found between the degree of urbanization and social distancing. We also found the interaction between the density of psychiatric rehabilitation services and perceived dangerousness to be associated with social distance. This finding revealed that persons with more perceived dangerousness and living in a region with higher density of psychiatric rehabilitation services were associated with greater social distance. Conclusions: We found that social distancing from depressive patients is not only determined by individual-level factors but influenced by the surroundings. This study provides useful directions for the implementation of optimal anti-stigma interventions for patients with depression.

Mental Health Literacy of Maternal and Paternal Postnatal Depression in a Community Sample of Romanian Adults

Postnatal depression affects a large proportion of Romanian parents, but no existing research has examined knowledge of postnatal depression in Romanian adults. To rectify this, we examined the ability of Romanian adults to correctly identify cases of maternal and paternal postnatal depression, as well as attitudes toward cases of postnatal depression. A total of 1,248 Romanian adults were presented with vignettes describing cases of maternal or paternal postnatal depression. Based on the vignettes, participants were asked to report if they thought anything was wrong with the targets and, if so, to describe what they thought was wrong. Participants also rated the targets on several attitudinal dimensions. Participants were more likely to indicate that something was wrong when the target was female (67.9%) compared with male (46.4%). Of those who believed something was wrong, 57.7% of participants correctly described the female target as experiencing postnatal depression, but only 37.1% did so for the male target. Women held significantly more positive attitudes toward the targets than men, particularly when the target was female. Mental health literacy of postnatal depression appears to be poor in Romanian adults compared with other national groups, especially in the case of paternal postnatal depression.

Self-labeling as having a mental or physical illness: the effects of stigma and implications for help-seeking

PURPOSE

Personal and perceived stigma can hinder persons in appraising their symptoms as constituting part of a mental illness (self-labeling), an important early step in the help-seeking process. This study examines the impact of personal and perceived stigma on self-labeling and provides prospective data on the possible connections between self-labeling and help-seeking behavior.

METHODS

Personal stigmatizing attitudes, perceived stigma and self-labeling behavior as well as their statistical connections were cross-sectionally investigated in a community sample of 207 participants with a present untreated mental health problem. We further conducted prospective analyses to investigate possible associations between self-labeling and help-seeking behavior at 3 and 6 month follow-ups. Socio-demographics, previous treatment and depression symptoms were also measured as potential confounders.

RESULTS

Personal stigmatizing attitudes were significantly more pronounced in respondents who self-labeled as physically compared to mentally ill, while group differences in levels of perceived stigma were not. Self-labeling as physically or mentally ill increased the likelihood of seeking help from the health service provider deemed most suitable for that label (physical: GP, p <0.05; mental: MHP, p < 0.1) compared to persons who applied no self-label.

CONCLUSIONS

The findings suggest that personal stigmatizing attitudes-rather than perceived stigma-impact on self-labeling, and highlight the need for interventions that assist persons with mental illness in overcoming those attitudes. They also underscore the possible impact of self-labeling in the help-seeking process and underline the important role of GPs in mental health care. Further, preferably epidemiological research into the matter would be desirable.

Impact of the mass media OBERTAMENT campaign on the levels of stigma among the population of Catalonia, Spain

Reducing public stigma could improve patients’ access to care, recovery and social integration. The aim of the study was to evaluate a mass media intervention, which aimed to reduce the mental health, related stigma among the general population in Catalonia (Spain). We conducted a cross-sectional population-based survey of a representative sample of the Catalan non-institutionalized adult population (n = 1019). We assessed campaign awareness, attitudes to people with mental illness (CAMI) and intended behaviour (RIBS). To evaluate the association between campaign awareness and stigma, multivariable regression models were used. Over 20% of respondents recognized the campaign when prompted, and 11% when unprompted. Campaign aware individuals had better attitudes on the benevolence subscale of the CAMI than unaware individuals (P = 0.009). No significant differences in authoritarianism and support for community mental health care attitudes subscales were observed. The campaign aware group had better intended behaviour than the unaware group (P < 0.01). The OBERTAMENT anti-stigma campaign had a positive impact to improve the attitudes and intended behaviour towards people with mental illness of the Catalan population. The impact on stigma was limited to attitudes related to benevolence. A wider range of anti-stigma messages could produce a stronger impact on attitudes and intended behaviour.

Barriers to mental health services utilisation in Portugal - results from the National Mental Health Survey

Background: The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap.Aims: To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal.Method: Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal).Results: The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72-6.46), and disability (OR = 2.43; 95% CI: 1.33-4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20-0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24-0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42-5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01-2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10-0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01-3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28-0.90) and mood disorders (OR = 0.16; 95% CI: 0.09-0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29-10.92).Conclusions: This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.

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.

Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness

It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need predicted intention (GP: beta 0.45, p < 0.001; MHP: beta 0.38, p < 0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p < 0.01; GP: beta 0.17, p = 0.093). More knowledge was associated with more self-identification (beta 0.21, p < 0.01), while support for discrimination was associated with lower self-identification (beta - 0.14, p < 0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta - 0.16, p < 0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Recognizing one's own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.

Mental Health Stigma and Veterinary Medical Students' Attitudes Toward Seeking Professional Psychological Help

Veterinary medical students may be at increased risk for a variety of mental health problems. However, research with student samples suggests that students in distress may not seek professional help, even when mental health services are available. The purpose of this study was to explore veterinary students' willingness to seek mental health services for several common presenting concerns, as well as their perceptions of their peers' willingness to seek help for the same concerns. We also sought to explore the roles of public stigma, self-stigma, and attitudes toward seeking professional psychological help in explaining students' willingness to seek services using a serial mediation analysis. Study participants were 573 veterinary medical students currently enrolled in accredited programs in the United States. Participants reported being most willing to seek mental health services for issues regarding substance abuse, traumatic experiences, and anxiety. They also tended to perceive other students were less willing to seek mental health services for most presenting issues than they actually were. As expected, self-stigma and attitudes toward seeking professional psychological help serially mediated the relationship between public stigma and willingness to seek mental health services. Public stigma was positively related to self-stigma, self-stigma was negatively related to attitudes toward seeking professional psychological help, and attitudes toward seeking help were positively related to willingness to seek mental health services. Implications for outreach, research, and education are discussed.

Psychometric validation of the self-identification of having a mental illness (SELF-I) scale and the relationship with stigma and help-seeking among young people

PURPOSE

Self-identification of having a mental illness has been shown to be an important factor underpinning help-seeking behaviour and may mediate the relationship between personal stigma and mental health service use. This study validates a new scale for the self-identification of having a mental illness among a non-clinical, community cohort of young people in the UK.

METHODS

Following consultation with a group of young person experts with experience of mental health problems, we evaluated the psychometric properties of the self-identification of mental illness scale (SELF-I) among 423 young people aged 13-24 years who are part of an ongoing prospective community cohort. We performed test retest reliability among a subset of 53 participants. Psychometric validation for the scale used measures of Cronbach's alpha and Pearson's correlation coefficient. Item performance was assessed along and in relation with each covariate.

RESULTS

The SELF-I demonstrated robust psychometric properties including high test-retest reliability (0.95) and good internal consistency (0.87 as determined by the Cronbach's alpha). The inter-total correlations for each item, which ranged from 0.62 to 0.74, supported keeping all items in the scale. Reporting greater psychiatric symptomatology via the SDQ (β: 0.82 95% confidence interval 0.40, 1.23), psychotic-like experiences (β: 0.37 95% confidence interval 0.14, 0.59), and use of mental health services (β: 0.92 95% confidence interval 0.71, 1.13) were associated with a greater self-perception as having a mental illness (p < 0.05), providing evidence of convergent validity. As expected, we found that less intended stigmatising behaviour was associated with greater self-perceptions of having a mental illness (B: 0.18, 95% CI 0.07, 0.28).

CONCLUSIONS

The SELF-I scale provides a method to gather insight into how young people, who may not identify as service users, perceive their own mental state and potential risk for developing a mental illness. This can be important for understanding perceived need for help and likelihood of using services among those with mental health problems.

Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison

Purpose: The detrimental impact of stigma on the utilization of mental health services is a well-established finding. Nevertheless, most studies consider only the personal or interactional dimensions of stigma. This contribution makes a distinction between the dominant beliefs about stigma within a culture and the personal beliefs of individuals with regard to stigma. We hypothesize that both have an impact on professional-care seeking within the field of mental health. Methods: A multi-level research design is used to estimate the effects of both types of stigma beliefs on the likelihood of consulting general and specialized health professionals about mental health problems in 28 European countries (N of individuals = 24,881, Eurobarometer 248, 2005-2006). Results: In countries where stigmatizing beliefs are dominant, the likelihood of seeking help from specialized mental health professionals is constrained, and individuals refrain from contacting general practitioners when in need of formal support, regardless of their own personal stigma beliefs. Conclusion: The present study signals the importance of stigma beliefs as shared cultural phenomena, and of personal stigma beliefs to the likelihood of seeking professional care for mental health problems. We therefore propose that most studies on stigma and formal-care seeking underestimate the pervasive effects of stigma beliefs, due to methodological individualism.

Impact of economic crises on mental health care: a systematic review

AIMS

Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care.

METHODS

Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate.

RESULTS

Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders.

CONCLUSIONS

Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis.

Patterns of chronic physical multimorbidity in psychiatric and general population

OBJECTIVE

A growing body of evidence has demonstrated the high prevalence and complexity of chronic physical multimorbidity defined as ≥2 chronic physical illness in people with psychiatric disorders. The present study aimed to assess differences in the prevalence and patterns of self-reported chronic physical illness and multimorbidity in the general and psychiatric populations.

METHODS

We performed a latent class analysis of 15 self-reported chronic physical illnesses on a sample of 1060 psychiatric patients and 837 participants from the general population.

RESULTS

Self-reported chronic physical illness and multimorbidity were significantly more prevalent in the population of psychiatric patients than in the general population (P < .001). Psychiatric patients had 27% (CI_95% 24% - 30%) higher age-standardized relative risk for chronic physical illness and a 31% (CI_95% 28% - 34%) higher for multimorbidity (P < .001). The number of chronic physical illnesses combinations was 52% higher in the psychiatric than in general population (255 vs 161 combinations respectively; P < .001). We identified four distinct latent classes: "Relatively healthy", "Musculoskeletal", "Hypertension and obesity", and "Complex multimorbidity" with no significant differences in the nature of multimorbidity latent classes patterns. The class "Relatively healthy" was significantly less (ARI = -25% (CI_95% -30% -21%), and the class "Hypertension and obesity" was significantly more prevalent in the population of psychiatric patients (ARI = 20% (CI_95% 17% - 23%).

CONCLUSIONS

These findings indicate that mental disorders are associated with an increased risk of a wide range of chronic physical illnesses and multimorbidity. There is an urgent need for the development of the guidelines regarding the physical healthcare of all individuals with mental disorders with multimorbidity in focus.

Stigma among international students is associated with knowledge of mental illness

Increasing numbers of international students require Japanese universities to provide mental health support as one of their primary responsibilities. The problem with the provision of such support is that the stigma of mental disorder causes many individuals to avoid seeking help. We aim to clarify the association between stigma and mental illness to develop anti-stigma education. We performed a cross-sectional observational study. The target population comprised international students enrolled in a Japanese university. Online questionnaires were used to assess self-stigma, perceived stigma, recognized knowledge of schizophrenia and depression, gender, country and region, general mental health status, parents' income, non-clinical and clinical help-seeking attitudes, and Japanese and English language ability. Logistic regression model was used to estimate odds ratios (ORs) for self-stigma and perceived stigma after adjusting for the above factors. A total of 119 students were invited to participate, 61 (51.3%) of whom were enrolled. Students with good knowledge of depression/schizophrenia did not indicate more severe self-stigma compared with those without such knowledge. Students with good knowledge of schizophrenia indicated more severe perceived stigma compared with those without such knowledge (OR 3.78 [95% confidence intervals; CI, 1.21-11.78]). Students with good knowledge of depression indicated less severe perceived stigma compared with those without such knowledge (OR 0.31 [95% CI, 0.10-0.94]). In this study, among international students, higher perceived stigma was associated with knowledge of schizophrenia and lower knowledge of depression.

Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys

BACKGROUND

The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data.

METHODS

Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).

RESULTS

Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes).

CONCLUSIONS

The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.

Factors Influencing on Mental Health Help-seeking Behavior Among Korean Women: A Path Analysis

PURPOSE

The purpose of the study was to identify factors influencing mental health help-seeking behavior among women in the community.

METHODS

A cross-sectional design was used. Participants were 402 women in South Korea. Data were analyzed using descriptive statistics, Pearson's correlation coefficient, and a path analysis by IBM SPSS 21.0 and AMOS 21.0.

RESULTS

There was a significant, but weak positive correlation between perceived need and help-seeking intentions for formal mental health help (r=0.09, p<0.05). In the path analysis, significant the factors influencing help-seeking intentions were perceived need, attitude, and belief toward mental illness, and the attitude of them had the greatest effect. These factors accounted for 12.2% of the total variance, and the model fit was acceptable.

CONCLUSION

The findings of the study reveal that positive mental illness interpretation and consequence can predict mental health help-seeking behavior of women as well as the perceived need for mental health help.

The Stigma of Mental Illness as a Barrier to Self Labeling as Having a Mental Illness

The aim of this study was to investigate whether personal stigma decreases self-identification as having a mental illness in individuals with untreated mental health problems. We interviewed 207 persons with a currently untreated mental health problem as confirmed by a structured diagnostic interview. Measures included symptom appraisal, self-identification as having a mental illness (SELFI), self-labeling (open-ended question on the nature of their problem) stigma-related variables (explicit and implicit), as well as sociodemographics, current symptom severity, and previous treatment. Support for discrimination and implicit stigmatizing attitude were both associated with lower likelihood of self-identification. More social distance and support for discrimination were associated with less self-labeling. Previous treatment was the strongest predictor of symptom appraisal, SELFI, and self-labeling. Destigmatizing mental illness could increase awareness of personal mental health problems, potentially leading to lower rates of untreated mental illness.

Stigma: The relevance of social contact in mental disorder

INTRODUCTION

The stigma associated with mental illness is a health problem, discriminating and limiting the opportunities for sufferers. Social contact with people suffering a mental disorder is a strategy used to produce changes in population stereotypes. The aim of the study was to examine differences in the level of stigma in samples with social contact and the general population.

METHOD

The study included two experiments. The first (n=42) included players in an open football league who played in a team with players with schizophrenia. In the second included, a sample without known contact (n=62) and a sample with contact (n=100) were compared. The evaluation tool used was AQ-27, Spanish version (AQ-27-E). The mean difference between the two samples of each of the 9 subscales was analyzed.

RESULTS

In the first experiment, all the subscales had lower scores in post-contact than in pre-contact, except for responsibility. The two subscales that showed significant differences were duress (t=6.057, p=.000) and Pity (t=3.661, p=.001). In the second experiment, seven subscales showed a significance level (p=<.05). Segregation and responsibility and did not.

CONCLUSIONS

It is observed that the social contact made in daily situations can have a positive impact on the reduction of stigma. This can help to promote equality of opportunity.

Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey

In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n = 3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p < 0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p < 0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p < 0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p < 0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.

State of the art of population-based attitude research on mental health: a systematic review

AIMS

Population surveys have become a frequently used method to explore stigma, help-seeking and illness beliefs related to mental illness. Methodological quality however differs greatly between studies, and our current knowledge seems heavily biased towards high-income countries. A critical appraisal of advances and shortcomings of psychiatric attitude research is missing. This review summarises and appraises the state of the art in population-based attitude research on mental health.

METHODS

Systematic review of all peer-reviewed papers reporting representative population studies on beliefs and attitudes about mental disorders published between January 2005 and December 2014 (n = 478).

RESULTS

Over the decade covered by this review considerably more papers on psychiatric attitude research have been published than over the whole time period before. Most papers originated in Europe (36.3%), North America (23.2%) and Australia (22.6%), only 14.6% of all papers included data from low- or middle income countries. The vast majority of papers (80.1%) used correlational cross-sectional analyses, only 4% used experimental or quasi-experimental designs. Data in 45.9% of all papers were obtained with face-to-face interviews, followed by telephone (34.5%), mail (7.3%) and online surveys (4.0%). In almost half of papers (44.6%) case-vignettes served as stimulus for eliciting responses from interviewees. In 20.7% instruments meeting established psychometric criteria were used. The most frequently studied disorder was depression (44.6% of all paper), followed by schizophrenia (33%). 11.7% of papers reported time trend analyses of attitudes and beliefs, 7.5% cross-cultural comparisons. The most common focus of research was on mental health literacy (in total 63.4% of all papers, followed by various forms of stigma (48.3%).There was a scarcity of papers (12.1%) based on established theoretical frameworks.

CONCLUSIONS

In the current boom of attitude research, an avant-garde of studies uses profound and innovative methodology, but there are still blind spots and a large proportion of conventional studies. We discuss current and future methodological challenges that psychiatric attitude research needs to embrace. More innovative and methodologically sound studies are needed to provide an empirical basis for evidence-based interventions aimed at reducing misconceptions about mental disorders and improve attitudes towards those afflicted.

Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys

Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.

Childhood bullying victimization is associated with use of mental health services over five decades: a longitudinal nationally representative cohort study

BACKGROUND

Research supports robust associations between childhood bullying victimization and mental health problems in childhood/adolescence and emerging evidence shows that the impact can persist into adulthood. We examined the impact of bullying victimization on mental health service use from childhood to midlife.

METHOD

We performed secondary analysis using the National Child Development Study, the 1958 British Birth Cohort Study. We conducted analyses on 9242 participants with complete data on childhood bullying victimization and service use at midlife. We used multivariable logistic regression models to examine associations between childhood bullying victimization and mental health service use at the ages of 16, 23, 33, 42 and 50 years. We estimated incidence and persistence of mental health service use over time to the age of 50 years.

RESULTS

Compared with participants who were not bullied in childhood, those who were frequently bullied were more likely to use mental health services in childhood and adolescence [odds ratio (OR) 2.53, 95% confidence interval (CI) 1.88-3.40] and also in midlife (OR 1.30, 95% CI 1.10-1.55). Disparity in service use associated with childhood bullying victimization was accounted for by both incident service use through to age 33 years by a subgroup of participants, and by persistent use up to midlife.

CONCLUSIONS

Childhood bullying victimization adds to the pressure on an already stretched health care system. Policy and practice efforts providing support for victims of bullying could help contain public sector costs. Given constrained budgets and the long-term mental health impact on victims of bullying, early prevention strategies could be effective at limiting both individual distress and later costs.

Responding to maternal distress: from needs assessment to effective intervention

OBJECTIVES

To perform a needs assessment of maternal distress to plan the development of an intervention for the prevention and reduction of antenatal maternal distress.

METHODS

We searched PubMed, OVID and EBSCO and applied the PRECEDE logic model to select the data. Experts in the field validated the findings.

RESULTS

We identified 45 studies. Maternal distress was associated with diminished maternal and child's quality of life. Aetiological factors of maternal distress included past and present circumstances related to obstetric factors and to a woman's context of living, coping behaviour, and support mechanisms. Lacking knowledge of coping with (maternal) distress was identified as a predisposing factor. Reinforcing factors were relaxation, partner support, counselling experiences and positive interaction with the midwife. Enabling factors were the availability of a support network.

CONCLUSIONS

When planning the development of an antenatal intervention for maternal distress, it is advisable to focus on assessment of antenatal emotional wellbeing, the context of the woman's past and present circumstances, her coping behaviour and her environment. The identified predisposing factors, enabling and reinforcing factors should also be taken into consideration.

Public perception of the lifetime morbid risk of mental disorders in the United States and associations with public stigma

PURPOSE

This study examined the relationship between estimates of the prevalence of mental disorders and mental health stigma. It also examined whether stigma might be more greatly associated with the terms "mental illness," "mental disorder," or "mental health condition."

METHODS

Respondents (N = 302) on Amazon's Mechanical Turk completed an online survey designed to measure social distance, which is one variant of stigma. Half of the respondents were informed at the beginning of the survey that the lifetime morbid risk (LMR) of meeting criteria for at least one mental disorder at some point in life was 70-80 %, while the others were asked to provide their own LMR estimates. All respondents were also randomly assigned to view the survey with either the term "mental illness," "mental disorder," or "mental health condition."

RESULTS

Higher LMR estimates (B = -0.030; β = -0.154), having a mental disorder (B = -2.002; β = -0.200), and a history of contact with an individual with a mental disorder (B = -2.812; β = -0.298), each significantly predicted lower desire for social distance. Respondents in the "mental disorder" group endorsed greater desire for social distance. Participants who were informed about LMR at the start of the survey did not score lower on social distance.

CONCLUSIONS

Estimates for LMR were more than half as predictive of social distance scores as contact with individuals with mental disorders. But anti-stigma interventions may need to do more than inform individuals about the high prevalence of mental disorders in order to be effective.

Changes in attitudes, intended behaviour, and mental health literacy in the Swedish population 2009-2014: an evaluation of a national antistigma programme

OBJECTIVE

Public stigma of mental illness is still a major problem where numerous population studies during the last decade have mainly shown no improvements. A Swedish national antistigma campaign has been running 2010-2014. The aim of this study was to investigate changes in public stigma during this period as compared to baseline in 2009.

METHODS

Yearly population surveys were made between 2009 and 2014 including assessments of mental health literacy, attitudes, and intended future behaviour. Two surveys were made, one including a nationally representative sample and one including a representative sample from three original campaign regions. Multiple regression analyses, also including age, gender, education, and familiarity with mental illness were made to investigate yearly changes in public stigma compared to baseline.

RESULTS

Mental health literacy improved significantly in the campaign regions between 2009 and 2014, as did intended future behaviour. Attitudes toward mental illness also improved significantly. Improvements were also shown in the national population surveys, but the time pattern of these compared to that of the original campaign regions indicated that these changes took place mainly after the campaign had been extended to a further five Swedish regions.

CONCLUSION

The results of our surveys suggest that a campaign primarily based on social contact theory and involving people with lived experience of mental illness may, even in a rather short-term perspective, have a significant positive impact on mental health literacy, attitudes, and intentions of social contact with people with mental illness.

Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area

BACKGROUND

The financial crisis has yielded adverse effects on the population worldwide, as evidenced by elevated rates of major depression. International recommendations for offsetting the mental health impact of the recession highlight the need for effective treatment, including reduction in the stigma attached to the disorder.

AIMS

This study endeavoured to explore lay attitudes to depression and psychiatric medication during a period of financial crisis and to identify their correlates. Furthermore, it investigated their link to help-seeking intentions.

METHOD

A random and representative sample of 621 respondents from Athens area participated in the study (Response Rate = 81.7%). The telephone interview schedule consisted of the Personal Stigma Scale, a self-constructed scale tapping attitudes to psychiatric medication and one question addressing help-seeking intentions.

RESULTS

The preponderant stigmatising belief about depression pertains to perceiving the disorder as a sign of personal weakness. In addition, stereotypes of unpredictability and dangerousness were popular among the sample. Nonetheless, stigmatising beliefs are much stronger with regard to psychiatric medication; perceived as addictive, capable of altering one's personality, less effective than homeopathic remedies and doing more harm than good. Help-seeking intentions were predicted by education, unemployment and attitudes to psychiatric medication solely.

CONCLUSION

Research on the mental health effects of the global recession should encompass studies investigating the stigma attached to mental disorders and its implications.

Psychiatric referral and glycemic control of Egyptian type 2 diabetes mellitus patients with depression

OBJECTIVE

To evaluate the relationship between psychiatric referral acceptance for fluoxetine treatment and glycemic control in type 2 diabetes mellitus (T2DM) Egyptian patients with depression.

METHODS

Patients with T2DM who attended the diabetes outpatients clinic at Zagazig University Hospital, Egypt, between May 2013 and April 2015 and who scored ≥20 on screening with the Major Depression Inventory (MDI) (n=196) were offered a psychiatric referral for fluoxetine treatment and monitoring. Decliners (56.1%) received time/attention matched care via diabetologist visits (attentional controls). Fluoxetine patients and controls were compared at the time of the offer (T1) and 8weeks later (T2). Factors that significantly correlated with glycemic control were used in a linear regression analysis as the independent variables.

RESULTS

Eighty-six patients (43.9%) accepted psychiatric referral. Most of them (97.7%) remained throughout the study adherent to fluoxetine (mean daily dose=31.9mg). At T2, these patients, in comparison to controls, showed a reduction from baseline in MDI, fasting plasma glucose and glycosylated hemoglobin (HbA1c) levels (P for all comparisons <.001). In the final model of a regression analysis, 65.9% of the variation in percentage change in HbA1c was explained by adherence to antidiabetics, psychiatric referral acceptance and Internalized Stigma of Mental Illness (ISMI) and MDI scores.

CONCLUSION

In T2DM patients with depression, psychiatric referral acceptance for fluoxetine treatment is a significant predictor of both depression and glycemic control improvements.

Help-seeking intentions for early signs of mental illness and their associated factors: comparison across four kinds of health problems

Background

Failure and delay in initial treatment contact for mental disorders has been recognized as an important public health problem. According to the concept of mental health literacy, recognition of symptoms is crucial to making decisions to seek or not seek professional help. The aims of this study were to investigate the types of health problems for which Japanese adults intend to seek help, their preferred sources of help, and the factors associated with help-seeking intentions.

Methods

A cross-sectional web-based survey was conducted in June 2014 among Japanese adults aged 20–59 years. A total of 3308 eligible respondents were included in this study. Help-seeking intentions were measured by listing potential sources of help (including ‘would not receive help’) and asking which ones would be chosen in four health conditions indicated by irritability, dizziness, insomnia, and depressed mood, respectively.

Results

In the case of dizziness, 85.9 % of the participants reported a positive help-seeking intention and 42.7 % gave first priority to seeking help from formal sources. These percentages were smaller in the cases of insomnia (75.4 and 25.0 %), depressed mood (74.9 and 18.7 %), and irritability (72.9 and 0.9 %). Multiple logistic regression analysis revealed that the factors significantly associated with help-seeking intentions were almost identical across the four health problems. In particular, perception of family and friends regarding help-seeking, psychiatric history, contact with people with mental illness, better health literacy, and neighborhood communicativeness were significantly associated with the overall help-seeking intention and also the help-seeking intention from formal sources for all the problems of dizziness, insomnia, and depressed mood.

Conclusions

The majority of participants indicated their intentions to seek help, but psychological problems (insomnia and depressed mood) were less likely to induce help-seeking intentions than a physical problem (dizziness). Besides developing health literacy skills, community-based interventions for creating a friendly approachable atmosphere and facilitating daily interactions with family, friends, and neighbors may be worth considering as a possible public health strategy for encouraging help-seeking whether for psychological or physical problems.

The Importance of Considering Clinical Utility in the Construction of a Diagnostic Manual

The development of major diagnostic manuals primarily has been guided by construct validity rather than clinical utility. The purpose of this article is to summarize recent research and theory examining the importance of clinical utility when constructing and evaluating a diagnostic manual. We suggest that construct validity is a necessary but not sufficient criterion for diagnostic constructs. This article discusses components of clinical utility and how these have applied to the current and forthcoming diagnostic manuals. Implications and suggestions for future research are provided.

Stigma, Attitudes, and Help-Seeking Intentions for Psychological Problems in Relation to Regional Suicide Rates

In this ecological study, we investigated whether help-seeking related to stigma, intentions, and attitudes toward suicide are associated with the suicide rates of 20 regions within the Netherlands and Belgium. Significant associations were found between regional suicide rates and the intention to seek informal help (β = -1.47, p = .001), self-stigma (β = 1.33, p = .038), and shame (β = .71, p = .030). The association between self-stigma and suicide rate was mediated by intentions to seek informal help. These results suggest that to promote suicide prevention at the level of the regional population, stigma, shame, and intentions to seek help should be targeted in the public domain.

Recruiting for research studies using online public advertisements: examples from research in affective disorders

Successful recruitment is vital for any research study. Difficulties in recruitment are not uncommon and can have important implications. This is particularly relevant to research conducted in affective disorders due to the nature of the conditions and the clinical services that serve these patients. Recently, online public advertisements have become more generally accessible and may provide an effective way to recruit patient populations. However, there is paucity of evidence on their viability as a method of recruiting patients into studies of disease mechanisms in these disorders. Public advertisement methods can be useful when researchers require specific populations, such as those not receiving pharmacological treatment. This work describes our experience in successfully recruiting participants into neuroimaging research studies in affective disorders using online public advertisements. Results suggest that these online public advertisements are an effective method for successfully recruiting participants with affective disorders into research studies, particularly for research focusing on disease mechanisms in specific populations.