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Amsalem D, Jankowski SE, Markowitz JC, Stroup TS, Dixon LB, Pope LG. Comparing brief video interventions to reduce public and self-stigma: Randomized control trial. Early Interv Psychiatry 2024; 18:839-847. [PMID: 38565326 DOI: 10.1111/eip.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/16/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
AIM Stigma is a major mental healthcare barrier. This study compares the efficacy of two types of brief video interventions, targeting public and self-stigma, in reducing public stigma towards people living with psychosis. We hypothesized both interventions would similarly reduce public stigma and outperform the control group. As a secondary analysis, we explored the effect of familiarity with a person living with serious mental illness (SMI). METHODS Participants (N = 1215) aged 18-35 recruited through crowdsourcing were assessed pre- and post-intervention and at 30-day follow-up regarding five public stigma domains: social distance, stereotyping, separateness, social restriction and perceived recovery. Both videos present individual narratives using different approaches: the self-stigma video was created through focus groups, while the public stigma video portrays a single person's journey. RESULTS A 3 × 3 analysis of variance (ANOVA) revealed a significant group-by-time interaction across all five stigma-related domains (p's < .001). Effect sizes (Cohen's d) ranged from 0.29 to 0.52 (baseline to post-intervention), and 0.18 to 0.45 (baseline to 30-day follow-up). The two video interventions did not significantly differ. Linear mixed modelling showed a significant difference between participants familiar and unfamiliar with people living with SMI for the public stigma video, with greater stigma reductions for unfamiliar participants. CONCLUSIONS This study corroborates previous findings on the positive influence of social contact-based interventions on youth mental health perceptions. Results provide insights into the relationship between public and self-stigma and the impact that familiarity with SMI may have on the efficacy of stigma reduction efforts further validation in diverse groups is needed.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Samantha E Jankowski
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - T Scott Stroup
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Leah G Pope
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
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Amsalem D, Jankowski SE, Pagdon S, Smith S, Yang LH, Valeri L, Markowitz JC, Lewis-Fernández R, Dixon LB. "It's Tough to Be a Black Man with Schizophrenia": Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma. Schizophr Bull 2024; 50:695-704. [PMID: 38372704 PMCID: PMC11059800 DOI: 10.1093/schbul/sbae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND HYPOTHESIS Racial discrimination and public stigma toward Black individuals living with schizophrenia create disparities in treatment-seeking and engagement. Brief, social-contact-based video interventions efficaciously reduce stigma. It remains unclear whether including racial identity experiences in video narrative yields greater stigma reduction. We hypothesized that we would replicate findings showing sustained stigma reduction in video-intervention groups vs control and that Black participants would show greater stigma reduction and emotional engagement than non-Black participants only for a racial-insights video presenting a Black protagonist. STUDY DESIGN Recruiting using a crowdsourcing platform, we randomized 1351 participants ages 18-30 to (a) brief video-based intervention, (b) racial-insights-focused brief video, or (c) non-intervention control, with baseline, post-intervention, and 30-day follow-up assessments. In 2-minute videos, a young Black protagonist described symptoms, personal struggles, and recovery from schizophrenia, with or without mentioning race-related experiences. STUDY RESULTS A 3 × 3 ANOVA showed a significant group-by-time interaction for total scores of each of five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery (all P < .001). Linear mixed modeling showed a greater reduction in stigma from baseline to post-intervention among Black than non-Black participants in the racial insights video group for the social distance and social restriction domains. CONCLUSIONS This randomized controlled trial replicated and expanded previous findings, showing the anti-stigma effects of a brief video tailored to race-related experiences. This underscores the importance of personalized, culturally relevant narratives, especially for marginalized groups who, more attuned to prejudice and discrimination, may particularly value identification and solidarity. Future studies should explore mediators/moderators to improve intervention efficacy.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Samantha E Jankowski
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Shannon Pagdon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Stephen Smith
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Shirvaniyan F, Eissazade N, Shariat SV, Khademoreza N, Daneshvar M, Shalbafan M. Attitude toward patients with mental disorders: what is going on amongst Iranian pharmacies? BMC Psychol 2024; 12:126. [PMID: 38448985 PMCID: PMC10916046 DOI: 10.1186/s40359-024-01604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION As the incidence of mental disorders continues to rise, and pharmacy staff can significantly affect the willingness of patients with mental disorders to seek help; we aimed to evaluate the stigmatizing attitude of the pharmacy staff toward these patients in Iran. METHODS We conducted this cross-sectional study between April 2020 and December 2021 in Tehran, Iran, and included pharmacists, pharmacy technicians and pharmacy students, with the experience of working in a pharmacy for at least three months. The social distance scale (SDS) and dangerousness scale (DS) were used to measure the stigmatizing attitude of the participants. Higher scores indicated more stigmatizing attitudes. RESULTS We included a total of 186 participants with a mean age of 32.97 ± 9.41 years, of which 101 (54.3%) were male, and 75 (40.3%) were pharmacists, 101 (54.3%) were pharmacy technicians, and 8 (4.3%) were pharmacy students. The mean SDS score was 14.2 ± 4.13, and the mean DS score was 33.85 ± 8.92. The greatest tendency for social distance was reported for a patient with a mental disorder, 'being the caretaker of their children for an hour or two' and 'marrying their children.' The most perceived dangerousness was reported for a patient with a mental disorder 'owning a gun.' Positive personal history of psychopharmacological treatment was statistically correlated with lower DS (P = 0.001) and SDS (P = 0.007) scores. Positive family history of psychiatric inpatient admission was significantly correlated with higher DS (P = 0.05) and SDS (P = 0.03) scores. Higher rates of 'received psychiatric prescriptions per month' was associated with lower DS scores (P = 0.04). CONCLUSION Our participants did not have an overall positive attitude toward patients with mental disorders. Although, compared to previous studies, they held a more positive attitude. Positive personal history of psychopharmacological treatment predicted a more positive attitude and positive family history of psychiatric inpatient admission predicted a more negative attitude.
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Affiliation(s)
- Fatemeh Shirvaniyan
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Negin Eissazade
- Brain and Cognition Clinic, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Seved Vahid Shariat
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Noushin Khademoreza
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Daneshvar
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Brain and Cognition Clinic, Institute for Cognitive Sciences Studies, Tehran, Iran.
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Van Alboom M, Baert F, Bernardes SF, Bracke P, Goubert L. Public Chronic Pain Stigma and the Role of Pain Type and Patient Gender: An Experimental Vignette Study. THE JOURNAL OF PAIN 2023; 24:1798-1812. [PMID: 37196927 DOI: 10.1016/j.jpain.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/06/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
Research exploring the specific manifestations of chronic pain (CP) public stigma is scarce. One potential factor influencing public stigma manifestations may be the CP type, that is, the presence (secondary CP) or absence (primary CP) of a clearly identifiable pathophysiology. Furthermore, patient gender may play a key role, whereby pain-related gender stereotypes may evoke distinct gender role expectations towards men and women experiencing CP. The aim of the research was 2-fold. First, by means of an experimental vignette design, the general population's cognitive, affective, and behavioral responses were investigated, both towards primary versus secondary CP and towards men versus women. Second, a potential interaction was examined between CP type and patient gender. The research is divided into 2 separate samples: individuals with CP (N = 729) and individuals without CP (N = 283). Factorial ANOVA models were estimated with CP type, patient gender, and participant gender included as factors, age as control variable. The findings support, partly, the general hypothesis of higher (perceived) public stigma towards individuals with primary (vs secondary) CP. No main effects of patient gender were observed. Gender bias in stigmatizing manifestations only emerged in certain contextual circumstances (ie, pain type and participant gender). Different interaction effects (with a combination of gender, patient gender, or CP type) were significant for the distinctive outcome variables. Interestingly, throughout the findings, different patterns of results are found in both samples. The study contributes to the literature on CP stigma, as well as the psychometric examination of items assessing stigmatizing manifestations. PERSPECTIVE: This study examined the role of contextual factors chronic pain type and patient gender into cognitive, affective, and behavioral stigmatizing manifestations coming from the general population towards individuals with chronic pain through an experimental vignette study. The study contributes to the chronic pain stigma literature, as well as the psychometric examination of items assessing stigmatizing manifestations.
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Affiliation(s)
- Maité Van Alboom
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium.
| | - Fleur Baert
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium
| | - Sónia F Bernardes
- ISCTE, University Institute of Lisbon, School of Social Sciences, Department of Social and Organizational Psychology, Lisboa, Portugal
| | - Piet Bracke
- Ghent University, Faculty of Political and Social Sciences, Department of Sociology, Ghent, Belgium
| | - Liesbet Goubert
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium
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Faruk MO, Khan AH, Chowdhury KUA, Jahan S, Sarker DC, Colucci E, Hasan MT. Mental illness stigma in Bangladesh: Findings from a cross-sectional survey. Glob Ment Health (Camb) 2023; 10:e59. [PMID: 37854431 PMCID: PMC10579681 DOI: 10.1017/gmh.2023.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/12/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
Background Mental illness stigma is universally prevalent and a significant barrier to achieving global mental health goals. Mental illness stigma in Bangladesh has gained little attention despite its widespread impact on seeking mental health care in rural and urban areas. This study aimed to investigate mental illness stigma and the associated factors in rural and urban areas of Bangladesh. Methods The study areas were divided into several clusters from which 325 participants (≥18 years) were recruited with systematic random sampling. The Bangla version of the Days' Mental Illness Stigma Scale was used to collect data. Independent-samples t-test, ANOVA, and multiple regression were performed. Results Results suggest that gender, age, geographical location, socioeconomic status, and occupation significantly differed across subscales of stigma. Age, gender, seeking treatment of mental illness, having knowledge on mental health, and socioeconomic status were predictive factors of mental illness stigma. The results also showed a high treatment gap in both rural and urban areas. Conclusion This study supports that mental illness stigma is prevalent in Bangladesh, requiring coordinated efforts. Results can inform the development of contextually tailored mental health strategies to reduce stigma and contribute to the promotion of mental health of individuals and communities across Bangladesh.
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Affiliation(s)
- Md Omar Faruk
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | - Abid Hasan Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kamal Uddin Ahmed Chowdhury
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
- Nasirullah Psychotherapy Unit, Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | - Sabiha Jahan
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | - Depon Chandra Sarker
- Child Development Center, Department of Pediatrics, Satkhira Medical College and Hospital, Satkhira, Bangladesh
| | | | - M. Tasdik Hasan
- Action Lab, Department of Human Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
- Department of Public Health, State University of Bangladesh, Dhaka, Bangladesh
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Nan D, Chong ESK, Dannuo W, Zewei L, Zexuan M, Shuyu D, Huang YT. Prevalence, risk, and protective factors of self-stigma for people living with depression: A systematic review and meta-analysis. J Affect Disord 2023; 332:327-340. [PMID: 37060952 DOI: 10.1016/j.jad.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND People living with depression are subjected to widespread stigmatization worldwide. Self-stigma may negatively affect patients' treatment, recovery, and psychological well-being. This review aims to summarize and synthesize the evidence on the prevalence, risk, and protective factors of depression self-stigma. METHODS Four online databases, PubMed, PsycINFO, Web of Science, and Embase, were searched to identify eligible studies. Fifty-six studies involving a total of 11,549 samples were included in the final analysis. Four reviewers independently screened the literature, extracted data, and assessed the risk of bias in eligible studies. Pearson's r was chosen as the effect size metric of risk and protective factors. RESULTS The results showed that the global prevalence of depression self-stigma was 29 %. Levels of self-stigma varied across regions, but this difference was not significant. Two demographic factors were identified: ethnicity (r = 0.10, p < 0.05) and having a partner/married (r = -0.22, p < 0.001). Five risk factors were identified: depression severity (r = 0.33, p < 0.01), public stigma (r = 0.44, p < 0.001), treatment stigma (r = 0.46, p < 0.001), perceived stigma (r = 0.37, p < 0.001), and enacted stigma (r = 0.71, p < 0.001). Five protective factors were identified: quality of life (r = -0.38, p < 0.001), social relationship (r = -0.26, p < 0.05), self-esteem (r = -0.46, p < 0.001), extroversion (r = -0.32, p < 0.001), and social functioning (r = -0.49, p < 0.001). LIMITATIONS Heterogeneity was observed in some of the results. Causality cannot be inferred due to the predominance of cross-sectional designs among the included literature. CONCLUSIONS Risk and protective factors of depression self-stigma exist across many dimensions. Future research should examine the inner mechanisms and effectiveness of interventions to reduce stigma.
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Affiliation(s)
- Du Nan
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Eddie S K Chong
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Wei Dannuo
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Liu Zewei
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Mu Zexuan
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Deng Shuyu
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Yu-Te Huang
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China.
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Amsalem D, Jankowski SE, Pagdon S, Valeri L, Yang LH, Markowitz JC, Neria Y, Pescosolido BA, Dixon LB, Martin A. Selfie Videos to Reduce Stigma and Increase Treatment Seeking Among Youths: Two Noninferiority Randomized Controlled Trials. Psychiatr Serv 2023; 74:229-236. [PMID: 36254455 DOI: 10.1176/appi.ps.20220168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Confronting stigma early in life could enhance treatment seeking. In two randomized controlled trials (RCTs), one focused on psychosis and the other on adolescent depression, the efficacy and equivalence of brief social contact-based videos were evaluated and compared with a control condition. The outcomes of interest were changes in illness-related stigma and treatment-seeking intention. The hypotheses were that the intervention videos would show greater efficacy than control conditions and that traditional and selfie videos would demonstrate similar efficacy. METHODS Young adults (study 1, N=895) and adolescents (study 2, N=637) were randomly assigned to view intervention videos (in traditional or selfie styles) or to a control condition. In short videos (58-102 seconds), young presenters humanized their illness by emotionally describing their struggles and discussing themes of recovery and hope. RESULTS Repeated-measures analyses of variance and paired t tests showed significant differences in stigma and treatment seeking between the intervention and control groups and similar efficacy of the traditional and selfie videos. Cohen's d effect sizes ranged from 0.31 to 0.76 for changes in stigma from baseline to 30-day follow-up in study 1 and from 0.13 to 0.47 for changes from baseline to postintervention in study 2. CONCLUSIONS The RCTs demonstrated the efficacy of brief videos, both traditional and selfie, in reducing illness-related stigma among young adults and adolescents and in increasing treatment-seeking intention among adolescents. Future studies should explore the effects of brief videos presented by social media influencers on mental health stigma and treatment engagement.
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Affiliation(s)
- Doron Amsalem
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Samantha E Jankowski
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Shannon Pagdon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Linda Valeri
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Lawrence H Yang
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - John C Markowitz
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Yuval Neria
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Bernice A Pescosolido
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Andrés Martin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
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Schmitt RM, Huynh HP. Stay (Close to) Humble: Intellectual Humility Negatively Predicts Stigma Toward and Social Distance from Individuals with Posttraumatic Stress Disorder. Psychol Rep 2023:332941231157233. [PMID: 36780657 DOI: 10.1177/00332941231157233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Posttraumatic stress disorder (PTSD) remains a highly stigmatized disorder despite its prevalence. Given that the origin of stigmatization is rooted in cognitive representations that people hold, stigma may be differentially exhibited by people with varying degrees of cognitive flexibility. Intellectual humility, the recognition of one's own intellectual shortcomings or flaws, may allow for flexibility in how people navigate knowledge surrounding PTSD, which may reduce stigma and improve interpersonal interactions with individuals with PTSD. The present study investigated whether intellectual humility would negatively predict PTSD stigma and social distance, above and beyond demographic factors and personal or social experience with individuals with PTSD. Participants (N = 421, 67.2% men, mean age = 37.45, SDage = 9.99) completed a multidimensional measure for intellectual humility and the Mental Illness Stigma Scale adapted to assess PTSD stigma. Results confirmed our preregistered predictions. Bivariate correlations demonstrated that overall intellectual humility was negatively correlated with overall PTSD stigma, and overall intellectual humility was negatively correlated with overall social distance. That is, intellectually humble people reported less PTSD stigma and desired closer social distance with individuals with PTSD. Additionally, hierarchical multiple regression revealed that intellectual humility predicted unique variance in PTSD stigma and social distance above and beyond the contribution of demographic factors and personal experience or social relationships with someone with PTSD. These results may provide a useful framework for approaching and minimizing stigma toward PTSD.
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Affiliation(s)
- Randee M Schmitt
- Department of Psychology and Philosophy, 4038Sam Houston State University, Huntsville, TX, USA
| | - Ho Phi Huynh
- Department of Life Sciences, Texas A&M University-San Antonio, San Antonio, TX, USA
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Kolb K, Liu J, Jackman K. Stigma towards patients with mental illness: An online survey of United States nurses. Int J Ment Health Nurs 2023; 32:323-336. [PMID: 36285570 DOI: 10.1111/inm.13084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 01/14/2023]
Abstract
People with mental illness experience significant health disparities, including morbidity and premature mortality. Evidence suggests that stigma is a contributing factor to these observed inequities. The tripartite conceptualization of stigma proposes that three problems underlie stigma: problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). There is limited prior research concerning stigma towards mental illness among nurses in the United States (US). The aims of this study were to assess stigma among US nurses towards patients with mental illness, compare the stigma expressed by nurses working in medical/surgical settings with mental health settings, and identify factors associated with stigma. Participants were recruited online from national professional nursing organizations in the US. We collected demographic data and administered measures of mental health stigma and stigma-related mental health knowledge. Mental health nurses demonstrated comparatively lower levels of stigma and higher levels of knowledge than the medical/surgical nurses. Nursing speciality and personal contact with mental illness were the most significant predictors of stigma and knowledge. Knowledge was found to partially mediate the relationship between nursing speciality and stigma. We found support for the 'contact hypothesis', that is, having a personal experience of mental illness or a friend or family member who has a mental illness is associated with lower stigma towards mental illness. These findings support the development of contact-based and educational anti-stigma interventions for nurses in order to reduce stigma towards mental illness.
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Affiliation(s)
- Kristen Kolb
- New York-Presbyterian Hospital, New York, NY, USA
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | - Kasey Jackman
- New York-Presbyterian Hospital, Columbia University School of Nursing, New York, NY, USA
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10
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Nakanishi M, Tanaka T, Nishida A, Mandai N, Kitamura N, Yoshii H. An online intervention to promote mental health literacy for psychosis amongst parents of adolescents: A pilot randomized controlled trial. Early Interv Psychiatry 2023. [PMID: 36627726 DOI: 10.1111/eip.13390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/02/2022] [Accepted: 01/01/2023] [Indexed: 01/12/2023]
Abstract
AIM This study evaluated an online mental health literacy intervention to improve help-seeking for psychosis amongst parents of adolescents. METHODS A total of 2496 parents of first-grade junior high school students, recruited from a Japan-based survey company, participated in a randomized controlled trial in July 2016; participants were randomly allocated to the intervention (n = 1248) or control group (n = 1248). They were assessed at baseline and one-week post intervention. The intervention group received a 30-minute online educational programme that included a narrative of the mother of an adolescent with psychosis. RESULTS There were no between-group differences in changes in the rate of 'no help-seeking' in any hypothetical situations of a child's psychosis and prodromal symptoms. CONCLUSIONS The intervention might have been suboptimal to improve mental health literacy for psychosis amongst parents of adolescents. A narrative message from a service user may be helpful to encourage parents in help-seeking.
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Affiliation(s)
- Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan.,Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Takahiro Tanaka
- Clinical and Translational Research Center, Niigata University, Niigata-shi, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Nozomu Mandai
- Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga-shi, Japan.,Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ami-machi, Japan
| | - Nobutaka Kitamura
- Clinical and Translational Research Center, Niigata University, Niigata-shi, Japan
| | - Hatsumi Yoshii
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan
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11
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Drent HM, van den Hoofdakker B, Buitelaar JK, Hoekstra PJ, Dietrich A. Factors Related to Perceived Stigma in Parents of Children and Adolescents in Outpatient Mental Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912767. [PMID: 36232067 PMCID: PMC9566109 DOI: 10.3390/ijerph191912767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Halewijn M. Drent
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, 9723 HE Groningen, The Netherlands
- Accare Child Study Center, 9723 HE Groningen, The Netherlands
| | - Barbara van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, 9723 HE Groningen, The Netherlands
- Accare Child Study Center, 9723 HE Groningen, The Netherlands
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, 6525 AJ Nijmegen, The Netherlands
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, 9723 HE Groningen, The Netherlands
- Accare Child Study Center, 9723 HE Groningen, The Netherlands
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, 9723 HE Groningen, The Netherlands
- Accare Child Study Center, 9723 HE Groningen, The Netherlands
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12
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Perry BL, Felix E, Bolton M, Pullen EL, Pescosolido BA. Public Stigma and Personal Networks: Confronting the Limitations of Unidimensional Measures of Social Contact. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:428-445. [PMID: 35220790 DOI: 10.1177/00221465211072311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
One of the most promising directions for reducing mental illness stigma lies in Allport's contact theory, which suggests that intergroup interactions reduce stigma. Here, we argue that stigmatizing attitudes are driven by the nature, magnitude, and valence of community-based ties to people with mental illness (PMI), not simply their presence. Using the 2018 General Social Survey (N = 1,113), we compare network-based measures of contact to traditional survey indicators. We find that knowing someone with mental illness, or even number of people known, explains little about desire for social distance, perceptions of dangerousness, or endorsement of treatment coercion. However, having stronger relationships with more PMI, having more friends and family (but not more peripheral ties) with mental illness, and knowing people in treatment are associated with less stigma endorsement. In contrast, we find that exposure to PMI who are perceived as dangerous is associated with greater levels of stigma.
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13
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Amsalem D, Valeri L, Jankowski SE, Yang LH, Bello I, Nossel I, Malinovsky I, Smith S, Ngo H, Lieff SA, Pagdon S, Lipp A, Markowitz JC, Neria Y, Dixon LB. Reducing public stigma toward individuals with psychosis across race and gender: A randomized controlled trial of young adults. Schizophr Res 2022; 243:195-202. [PMID: 35397250 DOI: 10.1016/j.schres.2022.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Social contact-based interventions effectively reduce stigma toward psychosis. We recently demonstrated the efficacy of a 90-second video intervention in reducing stigma. The current randomized controlled study presents four briefer videos differing in presenter's gender/race, with baseline, postintervention, and 30-day follow-up assessments. The study replicates previous findings and examine whether concordance of presenter's and viewer's race/gender enhanced the anti-stigma effect. METHODS Using a crowdsourcing platform, we recruited 1993 participants ages 18-35 years to one of four brief video-based interventions (Black/White female, Black/White male presenters) or a nonintervention control condition. In the videos, a young presenter with psychosis humanized their illness through an evocative description of living a meaningful and productive life. RESULTS Group-by-time ANOVA showed a significant group-by-time interaction for the total score of all five stigma domains: social distance, stereotyping, separateness, social restriction, and perceived recovery. One-way ANOVA showed greater reductions in video intervention groups than control at post-intervention and 30-day follow-up, but no differences between video groups. Matching race/gender did not further reduce stigma. CONCLUSIONS This randomized controlled study replicated and extended previous research findings, by showing stigma reduction across videos that differ in the presenter's gender and race, thus enhancing generalizability. The videos described the experience of psychosis and reduced stigma, suggesting their potential utility on social media platforms to increase the likelihood of seeking services and ultimately may improve access to care among young individuals with psychosis. Future research should address intersectional stigma experiences by focusing on race/gender and culturally tailoring the narrative.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America.
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, United States of America
| | - Samantha E Jankowski
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, New York, NY, United States of America
| | - Iruma Bello
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Ilana Nossel
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Igor Malinovsky
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Stephen Smith
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Hong Ngo
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Sarah A Lieff
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States of America
| | - Shannon Pagdon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Amanda Lipp
- Department of Human Ecology, University of California, Davis, United States of America
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Yuval Neria
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America; Department of Epidemiology, Columbia University Irving Medical Center, United States of America
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
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14
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Noltemeyer A, Ward RM, Fischbein R, Bonfine N, Ritter C, Zierden C, Seok J. Health professions student helping behaviors and attitudes toward a person experiencing anxiety within the context of COVID-19. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2038984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Rose Marie Ward
- Kinesiology, Nutrition, and Health, Miami University, Oxford, OH, USA
| | - Rebecca Fischbein
- Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Natalie Bonfine
- Psychiatry, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Christian Ritter
- Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Caitie Zierden
- Educational Psychology, Miami University, Oxford, OH, USA
| | - Jonathan Seok
- Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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15
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Amsalem D, Markowitz JC, Jankowski SE, Yang LH, Valeri L, Lieff SA, Neria Y, Dixon LB. Sustained Effect of a Brief Video in Reducing Public Stigma Toward Individuals With Psychosis: A Randomized Controlled Trial of Young Adults. Am J Psychiatry 2021; 178:635-642. [PMID: 33900809 DOI: 10.1176/appi.ajp.2020.20091293] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Public stigma is a barrier to care and increases the duration of untreated psychosis among individuals with first-episode psychosis. The authors recently demonstrated the efficacy of a 90-second social contact-based video intervention in reducing such stigma. That proof-of-concept study was the first to employ so brief an antistigma intervention in a sample of young adults. The authors now present a randomized controlled replication study with baseline, postintervention, and 30-day follow-up assessments. The authors aimed to replicate their previous findings and to show a persisting benefit for the video intervention. METHODS Using a crowdsourcing platform (Amazon Mechanical Turk), the authors recruited and assigned 1,055 participants ages 18-30 years to a brief video-based intervention, to a written vignette intervention containing the same material, or to a nonintervention control condition. In the 90-second video, a 22-year-old African American woman with schizophrenia humanized the illness through her emotional description of living a meaningful and productive life. RESULTS A three-by-three group-by-time multivariate analysis of variance showed a significant group-by-time interaction for the total scores of all five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery. Post hoc pairwise tests showed greater reductions in the video group compared with the vignette and control groups at the postintervention and 30-day follow-up assessments, while the vignette group differed from the control group at the postintervention assessment but not at the 30-day assessment. CONCLUSIONS This randomized controlled study replicated and strengthened the authors' earlier findings, further showing month-long sustained stigma reduction in the social contact-based video intervention arm. A 90-second video sufficed to humanize schizophrenia and reduce stigma. Further research should examine longer-term sustainability, assess changes in behavior, and determine optimal effective video length.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Samantha E Jankowski
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Lawrence H Yang
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Linda Valeri
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Sarah A Lieff
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Yuval Neria
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
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Oudejans SCC, Spits ME, van Weeghel J. A cross-sectional survey of stigma towards people with a mental illness in the general public. The role of employment, domestic noise disturbance and age. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1547-1554. [PMID: 34272574 PMCID: PMC8429159 DOI: 10.1007/s00127-021-02111-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Stigmatization impedes the social integration of persons recovering from mental illnesses. Little is known about characteristics of the stigmatized person that lessen or aggravate public stigma. PURPOSE This study investigates which characteristics of persons with mental illnesses (i.e. with a depression or a psychotic disorder) might increase or decrease the likelihood of public stigma. METHODS Over 2,000 adults read one of sixteen vignettes describing a person with a depressive disorder or a psychotic disorder and answered a set of items measuring social distance. RESULTS The person who was employed (vs. unemployed), or whose neighbors did not experience domestic noise disturbance (vs. disturbance) elicited significantly less social distance. Also persons with a depressive disorder elicited less social distance, vs. persons with a psychotic disorder. CONCLUSION Employment and good housing circumstances may destigmatize persons coping with mental illnesses. Mental health and social services should encourage paid employment, quality housing and other paths to community integration.
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Affiliation(s)
- S. C. C. Oudejans
- Mark Bench, Rhôneweg 16, 1043AH Amsterdam, The Netherlands ,Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam UMC, Amsterdam, The Netherlands
| | - M. E. Spits
- Mark Bench, Rhôneweg 16, 1043AH Amsterdam, The Netherlands ,Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam UMC, Amsterdam, The Netherlands ,Dutch Addiction Association, Amersfoort, The Netherlands
| | - J. van Weeghel
- Phrenos Center of Expertise, Utrecht, The Netherlands ,Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
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17
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Kruis NE, Merlo AV. A Preliminary Assessment of Stigma in Law Enforcement Officers’ Responses to Opioid Overdoses. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620974076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prior work has suggested that provider-based stigma of substance use disorders may be one barrier to fighting the opioid epidemic. However, to date, provider-based stigma has been afforded little attention in the context of the criminal justice system. The goal of the current study was to extend this line of research by examining the impact of provider-based stigma toward opioid using persons to beliefs about help that should be provided to persons experiencing an overdose among a sample of 208 police officers working in departments in the Northeastern Region of the United States. In addition, this study explores the relationship between provider-based stigma and the anticipated on-duty behavioral responses to opioid overdoses. Results from multivariable analyses indicate that certain dimensions of social stigma are significantly related to officers’ perceptions of help in varying directions, along with officers’ experiences with naloxone administration and departmental policy pertaining to the use of naloxone.
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18
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Amsalem D, Yang LH, Jankowski S, Lieff SA, Markowitz JC, Dixon LB. Reducing Stigma Toward Individuals With Schizophrenia Using a Brief Video: A Randomized Controlled Trial of Young Adults. Schizophr Bull 2020; 47:7-14. [PMID: 33484269 PMCID: PMC7825082 DOI: 10.1093/schbul/sbaa114] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Stigma decreases healthcare seeking and treatment adherence and increases the duration of untreated psychosis among people with first-episode psychosis (FEP). This study evaluated the efficacy of a brief video-based intervention in reducing stigma among youth toward individuals with FEP and schizophrenia. We hypothesized that the social-contact-based video intervention group would reduce stigma more than written vignette and control groups, and the vignette more than the control group. METHODS Using Amazon Mechanical Turk, we recruited and assigned 1203 individuals aged 18-30 to either (a) video intervention, (b) written description of the same content ("vignette"), or (c) nonintervention control arm. In the 90-second video intervention, an empowered young woman with schizophrenia described her FEP and the aspects of successful coping with her everyday life difficulties, exposing the viewer to schizophrenia in the context of her personal narrative. Web-based self-report questionnaires assessed stigma domains, including social distance, stereotyping, separateness, social restriction, and perceived recovery. RESULTS A MANOVA showed a significant between-group effects for all 5 stigma-related subscales (P < .001). Post hoc pairwise tests showed significant differences between video and vignette vs control for all 5 stigma domains. Video and vignette groups differed significantly on social distance, stereotyping, and social restriction. Secondary analyses revealed gender differences across stigma domains in the video group only, with women reporting lower stigma. CONCLUSIONS A very brief social contact-based video intervention efficaciously reduced stigma toward individuals with FEP. This is the first study to demonstrate such an effect. Further research should examine its long-term sustainability.
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Affiliation(s)
- Doron Amsalem
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York, NY,To whom correspondence should be addressed; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032; tel: 646-774-8049, fax: 646-774-8105, e-mail:
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY,Department of Epidemiology, Mailman School of Public Health, New York, NY
| | - Samantha Jankowski
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Sarah A Lieff
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY
| | - John C Markowitz
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Lisa B Dixon
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
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19
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Abdisa E, Fekadu G, Girma S, Shibiru T, Tilahun T, Mohamed H, Wakgari A, Takele A, Abebe M, Tsegaye R. Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. Int J Ment Health Syst 2020; 14:56. [PMID: 32760443 PMCID: PMC7391813 DOI: 10.1186/s13033-020-00391-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 02/01/2023] Open
Abstract
Background Self-stigma associated with mental illness has remained a global public health issue affecting social interactions, health care, productivity and acceptance among others. It is one of important factors contributing to non-adherence to medication that leads to increased hospitalization and higher healthcare costs. Hence, the study aimed to assess self-stigma and medication adherence among patients with mental illness treated at the psychiatric clinic of Jimma University Medical Center (JUMC). Methods A cross-sectional, community-level study was conducted at Jimma town. The patient’s data was collected from records between April and June 2017 and the collected data was analyzed using SPSS version 21. The Internalized Stigma of Mental Illness (ISMI) tool was utilized to measure internalized stigma. Linear regression analysis was performed to get the final model. Statistical significance association was considered at p-values less than 0.05 and 95% confidence interval was used. Results Males comprised more than half (61%) of the total sample of 300 respondents and with a mean age of 34.99 (SD ± 11.51) years. About one-third (32%) of patients had a working diagnosis of schizophrenia followed by major depressive disorder (24.3%). More than half of them, 182 (60.7%) were adherent to their psychotropic medication. The overall mean value of self-stigma was 2.16 (SD = 0.867) and 84 (28%) of the respondents had moderate to high self-stigma. Using ISMI the mean score of alienation was 2.26 (SD = 0.95), stereotype endorsement 2.14 (SD = 0.784), perceived discrimination 2.18 (SD = 0.90), social withdrawal 2.10 (SD = 0.857) and stigma resistance 2.11 (SD = 0.844). Increasing age of the patients (std. β = − 0.091, p = 0.009) and living with kids and spouse (std. β = − 0.099, p = 0.038) were negatively associated with self-stigma whereas increased world health organization disability assessment schedule (WHODAS) score (β = 0.501, p < 0.001), number of relapses (std. β = 0.183, p < 0.01) and medication non-adherence (std. β = 0.084, p = 0.021) were positively associated with self-stigma. Conclusion The study revealed that there was high self-stigma among patients with mental illness and a significant association between overall ISMI score and level of medication adherence. These require mental health professionals and policy-makers should give attention to ways to overcome self-stigma and increase medication adherence among patients with mental illness.
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Affiliation(s)
- Eba Abdisa
- Department of Psychiatry, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Clinical Pharmacy Department, School of Pharmacy, Institute of Health Sciences, Wollega University, P.O Box 395, Nekemte, Ethiopia
| | - Shimelis Girma
- Department of Psychiatry, College of Health Science, Jimma University, Jimma, Ethiopia
| | - Tesfaye Shibiru
- Department of Pediatrics and Child Health, Wollega University Referral Hospital, Nekemte, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Habib Mohamed
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Aaga Wakgari
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Amsalu Takele
- Department of Surgery, School of Medicine, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Milkias Abebe
- Medical Microbiology Unit, Department of Medical Laboratory Science, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Reta Tsegaye
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Slewa-Younan S, McKenzie M, Thomson R, Smith M, Mohammad Y, Mond J. Improving the mental wellbeing of Arabic speaking refugees: an evaluation of a mental health promotion program. BMC Psychiatry 2020; 20:314. [PMID: 32552878 PMCID: PMC7301457 DOI: 10.1186/s12888-020-02732-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Refugee populations have particularly high rates of mental health problems, including Posttraumatic Stress Disorder (PTSD) and depression. However, uptake of mental health care may be low even when severe depression and PTSD symptoms are present in individuals following resettlement. This is likely due, at least in part, to cultural influences on refugees' knowledge and beliefs about mental health problems and their treatment. We sought to provide preliminary evidence for the effectiveness of a culturally tailored mental health promotion program for Arabic-speaking refugees. METHODS A total of 33 Arabic-speaking refugees resettled in South Western Sydney were recruited and completed intervention which consisted of weekly three-hour sessions for 4 weeks delivered in Arabic. Key aspects of mental health literacy, help-seeking intentions and levels of general psychological distress were assessed, by means of a self-report survey, pre-intervention, (immediately) post-intervention and 3 months following intervention. RESULTS Of the 33 participants that completed the intervention, 31 completed the immediate post-intervention survey and 29 completed the 3 months follow-up survey. Improvements in most aspects of mental health literacy assessed were found immediately post-intervention and at follow-up, although only changes relating to stigmatising attitudes were statistically significant. Additionally, a statistically significant decrease in participants' levels of general psychological distress was observed immediately following the intervention, and this decrease was sustained at follow-up. CONCLUSION While further research employing a more rigorous study design and larger sample size will be needed, results of this initial trial suggest that a culturally tailored mental health promotion program targeting key aspects of mental health literacy can improve the mental health of Arabic-speaking refugees resettled in a Western nation.
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Affiliation(s)
- Shameran Slewa-Younan
- Mental Health, Translational Health Research Institute, School of Medicine, Humanitarian and Development Research Initiative, Western Sydney University, Campbelltown, Australia. .,Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. .,Mental Health, School of Medicine, Western Sydney University, Campbelltown, Australia.
| | - Molly McKenzie
- grid.1029.a0000 0000 9939 5719Mental Health, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Russell Thomson
- grid.1029.a0000 0000 9939 5719School of Computing, Engineering and Mathematics, Western Sydney University, Sydney, Australia
| | - Mitchell Smith
- grid.410692.80000 0001 2105 7653NSW Refugee Health Service, South Western Sydney Local Health District, Liverpool, NSW Australia
| | - Yaser Mohammad
- grid.1029.a0000 0000 9939 5719Mental Health, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Jonathan Mond
- grid.1029.a0000 0000 9939 5719Mental Health, School of Medicine, Western Sydney University, Campbelltown, Australia ,grid.1009.80000 0004 1936 826XCentre for Rural Health, College of Health and Medicine, University of Tasmania, Hobart, Australia
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Hantzi A, Anagnostopoulos F, Alexiou E. Attitudes Towards Seeking Psychological Help: An Integrative Model Based on Contact, Essentialist Beliefs About Mental Illness, and Stigma. J Clin Psychol Med Settings 2020; 26:142-157. [PMID: 29909480 DOI: 10.1007/s10880-018-9573-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Based on intergroup contact theory, a proposed comprehensive model of attitudes towards seeking professional psychological help was tested, including both potential barriers to mental health help-seeking (i.e., public stigma and self-stigma of seeking help, prejudicial and essentialist beliefs about mental illness, intergroup anxiety) and potential facilitators (i.e., direct and extended contact with persons with mental illness). Relevant measures were completed by 119 community-dwelling participants. Path analysis showed that direct (but not extended) contact with mental illness, by reducing intergroup anxiety, led to less negative beliefs about mental illness and weaker essentialist beliefs about mental illness (the latter being directly and positively associated with negative beliefs about mental illness). Moreover, less negative beliefs about mental illness, by reducing perceptions of self (but not public) stigma of seeking psychological help, were related to more positive attitudes towards help-seeking. Results are discussed in the context of the (unintentional) adverse effects of biogenetic (essentialist) explanations of mental disorders, and the clinical implications regarding interventions that aim at improving help-seeking attitudes.
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Affiliation(s)
- Alexandra Hantzi
- Department of Psychology, Panteion University, 136, Syngrou Avenue, 176 71, Athens, Greece
| | - Fotios Anagnostopoulos
- Department of Psychology, Panteion University, 136, Syngrou Avenue, 176 71, Athens, Greece.
| | - Eva Alexiou
- Department of Psychology, Panteion University, 136, Syngrou Avenue, 176 71, Athens, Greece
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Fox C. Children's attitudes to people with mental illness. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2020. [DOI: 10.1016/j.appdev.2020.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Level of Stigma among Spanish Nursing Students toward Mental Illness and Associated Factors: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234870. [PMID: 31816966 PMCID: PMC6926928 DOI: 10.3390/ijerph16234870] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022]
Abstract
Mental health problems have been identified by the World Health Organization as a global development priority. Negative attitudes toward mental health patients have been documented in multiple health professionals. The aim of this study was to determine the level of stigma and associated factors toward people with mental health problems among students doing their degree in nursing. An explanatory sequential mixed-methods approach. A cross-sectional descriptive observational study was carried out on a sample of 359 students doing their degree in nursing. Students had to be enrolled in any of the four years of study of the degree at the time the questionnaire was done. We explored the perception and experience of students doing their degree in nursing regarding the level of stigma, through in-depth interviews (n = 30). The mean overall Mental Health Stigma Scale (MHSS) score was 30.7 points (SD = 4.52); 29.5% (n = 106) scored low for stigma, 49.9% (n = 179) showed moderate stigma, and 20.6% (n = 74) scored high. The multivariate analysis showed that 4th-year students had an OR of 0.41 (CI95%: 0.20–0.84) for high/moderate stigma and that 3rd-year students had an OR of 0.49 for high/moderate stigma compared with 1st-year students. We also observed that students with family members with mental health problems had an OR of 2.05 (CI95%: 1.19–3.56) for high/moderate stigma compared with students who did not have family members with mental health problems. The following categories emerged: fear and lack of knowledge, breaking the silence, and integration into society. The levels of mental health stigma in our sample of nursing students were moderate. Stigma levels were lower in 3rd- and 4th-year students (i.e., after having received training in mental health), and in students with family members with mental health problems.
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El Morr C, Maule C, Ashfaq I, Ritvo P, Ahmad F. Design of a Mindfulness Virtual Community: A focus-group analysis. Health Informatics J 2019; 26:1560-1576. [PMID: 31709878 DOI: 10.1177/1460458219884840] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mental illnesses are on the rise on campuses worldwide. There is a need for a scalable and economically sound innovation to address these mental health challenges. The aim of this study was to explore university students' needs and concerns in relation to an online mental health virtual community. Eight focus groups (N = 72, 55.6% female) were conducted with university students aged 18-47 (mean = 23.38, SD = 5.82) years. Participants were asked about their views in relation to online mental health platform. Three major themes and subthemes emerged: (1) perceived concerns: potential loss of personal encounter and relationships, fear of cyber bullying, engagement challenge, and privacy and distraction; (2) perceived advantages: anonymity and privacy, convenience and flexibility, filling a gap, and togetherness; and (3) desired features: user-centered design, practical trustworthy support, and online moderation. The analysis informed design features for a mindfulness virtual community.
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Ingram E, Jones R, Schofield P, Henderson C. Small area deprivation and stigmatising attitudes towards mental illness: a multilevel analysis of Health Survey for England (2014) data. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1379-1389. [PMID: 31055630 DOI: 10.1007/s00127-019-01722-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/25/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to explore how small area deprivation is associated with attitudes towards mental illness in a large sample of individuals living in private households in England. METHOD Cross-sectional data from Health Survey for England (2014) were analysed using multilevel models. The exposure of interest was the deprivation level of the small area in which an individual resides as measured by Index of Multiple Deprivation (IMD) score. The primary outcome was an individual's overall attitude towards mental illness, measured using a 12 item version of the Community Attitudes toward the Mentally Ill (CAMI) scale. Further outcomes were the two subscales of the CAMI, reflecting attitudes of (1) prejudice and exclusion and (2) tolerance and support. Individuals were nested within household and small geographical area. RESULTS 5820 participants were included. Results from unadjusted models found strong evidence that individuals residing in the most deprived areas of England have worse attitudes towards mental illness compared to individuals living in the least deprived areas (estimated difference = - 3.5 points; 95% CI - 4.8 to - 2.2; P < 0.001). After adjusting for age, sex, education level, ethnicity and weekly income there was no longer evidence for this association (adjusted difference = - 0.1 points, 95% CI - 1.3 to 1.2; P = 0.931). Similar patterns of results were found for the CAMI subscales. CONCLUSIONS The relationship between small area-level deprivation and attitudes towards mental illness is no longer observed when controlling for certain individual-level characteristics.
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Affiliation(s)
- Elizabeth Ingram
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London, UK.
| | - Rebecca Jones
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London, UK
| | - Peter Schofield
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House, Guy's Campus, London, UK
| | - Claire Henderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
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Self-stigma in patients with schizophrenia: a multicentric study from three Latin-America countries. Soc Psychiatry Psychiatr Epidemiol 2019; 54:905-909. [PMID: 30806726 DOI: 10.1007/s00127-019-01671-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/09/2019] [Indexed: 01/21/2023]
Abstract
The aim of this study was to describe the degree of self-stigma in patients with schizophrenia across three Latin-Americans countries (Bolivia, Chile and Peru). The study included 253 outpatients that were assessed using the Internalized Stigma of Mental Illness Scale (ISMI). The results show that 48.7% of patients from Bolivia report high internalized stigma compared to 38.6% from Chile and 28.6% from Peru. There were no statistically significant differences in ISMI mean total scores for country (p = 0.057), however, there were significant differences on two subscales: alienation and social withdrawal for which Bolivia had the highest scores. In conclusion, even though these countries share several common cultural characteristics, there are also some differences between them on patients' self-stigma.
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La stigmatisation sociale des personnes vivant avec la schizophrénie : une revue systématique de la littérature. EVOLUTION PSYCHIATRIQUE 2019. [DOI: 10.1016/j.evopsy.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Yasuhara K, Formon DL, Phillips S, Yenne EM. Development of a measure of mental health stigma including police behaviors. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2019; 26:520-529. [PMID: 31984093 PMCID: PMC6762149 DOI: 10.1080/13218719.2018.1507845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/01/2018] [Indexed: 06/10/2023]
Abstract
Various stigmatizing notions are associated with mental illness, resulting in negative personal (e.g. employment discrimination) and societal (e.g. public treatment of the mentally ill as 'dangerous' and/or 'criminal') outcomes. This study develops and validates a new multi-scale assessment tool to assess several dimensions of mental illness stigma, including perceived dangerousness, self-care, social distance, treatment amenability and predicted police behavior. A total of 641 undergraduate students from various American universities completed the new stigma measure along with two other existing measures. The results indicate that the new stigma measure has an acceptable three-factor solution consisting of self-care, dangerousness and police behavior. The self-care and dangerousness factors were found to have concurrent validity with the corresponding scales of the existing measures. Future research involving different populations, as well as the policy implications of the new police behavior factor, are discussed.
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Affiliation(s)
- Kento Yasuhara
- College of Arts and Sciences, University of New Haven, West Haven, CT, USA
| | - Dana L. Formon
- College of Humanities and Social Sciences, Sam Houston State University, Huntsville, AL, USA
| | - Sarah Phillips
- College of Arts and Sciences, Drexel University, Philadelphia, PA, USA
| | - Elise M. Yenne
- College of Humanities and Social Sciences, Sam Houston State University, Huntsville, AL, USA
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Regional differences in mental health stigma-Analysis of nationally representative data from the Health Survey for England, 2014. PLoS One 2019; 14:e0210834. [PMID: 30668597 PMCID: PMC6342445 DOI: 10.1371/journal.pone.0210834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/02/2019] [Indexed: 12/18/2022] Open
Abstract
Background Mental health stigma persists despite coordinated and widely-evaluated interventions. Socioeconomic, structural, and regional context may be important in shaping attitudes to mental illness, and response to stigma interventions. Regional differences in attitudes towards mental illness could be relevant for intervention, but have not been systematically explored. We evaluated regional variation in mental health stigma using nationally representative data from England, the Health Survey for England (HSE), from 2014. Methods A previously derived scale for mental health-related attitudes with 2 factors (i. tolerance and support, ii. prejudice and exclusion), and overall attitudes, were outcomes. Weighted linear regressions estimated contribution of individual characteristics and region of residence to inter-individual variability in mental health-related attitudes. Results London and southern regions tended to have more negative mental health-related attitudes. These differences were not fully or consistently explained by individual sociodemographic characteristics, or personal familiarity with mental illness. Conclusions Stigma policies could require refinements based on geographic setting. Regions may be in particular need of stigma interventions, or be more resistant to them. Regional differences might be related to media coverage of mental illness, funding differences, service availability, or accessibility of educational opportunities. Greater geographic detail is necessary to examine reasons for regional variation in stigmatizing attitudes towards people with mental illness, for example through multilevel analysis.
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Fox AB, Earnshaw VA, Taverna EC, Vogt D. Conceptualizing and Measuring Mental Illness Stigma: The Mental Illness Stigma Framework and Critical Review of Measures. STIGMA AND HEALTH 2018; 3:348-376. [PMID: 30505939 PMCID: PMC6261312 DOI: 10.1037/sah0000104] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the last decade has seen a proliferation of research on mental illness stigma, lack of consistency and clarity in both the conceptualization and measurement of mental illness stigma has limited the accumulation of scientific knowledge about mental illness stigma and its consequences. In the present article, we bring together the different foci of mental illness stigma research with the Mental Illness Stigma Framework (MISF). The MISF provides a common framework and set of terminology for understanding mechanisms of mental illness stigma that are relevant to the study of both the stigmatized and the stigmatizer. We then apply this framework to systematically review and classify stigma measures used in the past decade according to their corresponding stigma mechanisms. We identified more than 400 measures of mental illness stigma, two thirds of which had not undergone any systematic psychometric evaluation. Stereotypes and discrimination received the most research attention, while mechanisms that focus on the perspective of individuals with mental illness (e.g., experienced, anticipated, or internalized stigma) have been the least studied. Finally, we use the MISF to discuss the strengths and weaknesses of mental illness stigma measurement, identify gaps in the literature, and provide recommendations for future research.
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Affiliation(s)
- Annie B Fox
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System
| | - Valerie A Earnshaw
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
| | - Emily C Taverna
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
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Caldwell H, Lauderdale SA. Public stigma for men and women veterans with combat-related posttraumatic stress disorder. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-9940-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bass B, Lake E, Elvy C, Fodemesi S, Iacoe M, Mazik E, Brooks D, Lee A. Smoking-Related Stigma Expressed by Physiotherapists toward Individuals with Lung Disease. Physiother Can 2018; 70:65-71. [PMID: 29434420 DOI: 10.3138/ptc.2016-98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: We determined the extent and nature of stigma exhibited by a sample of Canadian cardiorespiratory physiotherapists toward people with lung disease who had a smoking history. Method: A quantitative online survey was distributed to Canadian cardiorespiratory physiotherapists, and an anti-smoking attitudes questionnaire was used to measure explicit stigma. We used two case studies with questions to measure implicit stigma. The first involved a patient with chronic obstructive pulmonary disease (COPD) and a smoking history, and the second described a patient with COPD with no smoking history. Results: Of the respondents (n=50), 56% demonstrated mild explicit stigma and 44% demonstrated moderate to severe explicit stigma. The extent of explicit stigma was not associated with respondents' age, area of practice, personal smoking history, or family history of lung disease resulting from smoking. The results indicated no evidence of implicit stigma, and no significant differences were found between the participants' prospective treatments and their professional attitudes toward patient cases. Conclusions: Canadian cardiorespiratory physiotherapists demonstrated explicit stigma toward people with lung disease with a significant smoking history, but there was no evidence of implicit stigma. These findings suggest that further research is needed to investigate how stigma held by cardiorespiratory physiotherapists may affect the quality of care provided for patients with a smoking history.
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Affiliation(s)
- Bethany Bass
- Department of Physical Therapy, University of Toronto
| | | | - Chelsea Elvy
- Department of Physical Therapy, University of Toronto
| | | | - Mara Iacoe
- Department of Physical Therapy, University of Toronto
| | - Emilie Mazik
- Department of Physical Therapy, University of Toronto
| | - Dina Brooks
- Department of Physical Therapy, University of Toronto.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto
| | - Annemarie Lee
- Department of Physical Therapy, University of Toronto.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto
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Abramenko L, Lovisi GM, Fonseca DDL, Abelha L. Atitudes dos trabalhadores de saúde mental em relação aos pacientes psiquiátricos em uma cidade do interior do Estado do Rio de Janeiro. ACTA ACUST UNITED AC 2017. [DOI: 10.1590/1414-462x2017000200019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Resumo Introdução Existem poucos estudos acerca da avaliação das atitudes dos trabalhadores em saúde mental em relação aos indivíduos com transtornos mentais no Brasil, principalmente em cidades de médio e pequeno porte. Portanto, foi conduzido um estudo seccional para avaliar as atitudes dos profissionais de saúde mental que trabalham em uma pequena cidade do interior do Estado do Rio de Janeiro. Método Foram avaliados 155 trabalhadores em saúde mental do município de Carmo, em novembro de 2015, utilizando a escala Community Attitudes Toward Mentally Ill (CAMI-BR). A CAMI tem quatro subescalas: Autoritarismo, Benevolência, Restrição Social e Ideologia de Saúde Mental Comunitária. Resultados Os trabalhadores, na sua maioria, apresentaram atitudes positivas para com os pacientes psiquiátricos. A subescala que teve pontuação mais alta foi Benevolência, seguida por Ideologia Comunitária, enquanto Restrição Social e Autoritarismo obtiveram as pontuações mais baixas. As variáveis que tiveram associação significativa com as atitudes positivas foram: faixa etária, categoria profissional e nível educacional. As pessoas mais jovens e com mais anos de estudo foram as que mostraram atitudes mais positivas. Os Cuidadores apresentaram atitudes mais negativas quando comparados às outras categorias. Conclusão Embora ainda persistam algumas atitudes autoritárias no cuidado dos pacientes psiquiátricos, os trabalhadores de Carmo têm atitudes positivas relacionadas às pessoas com transtorno mental e sua inclusão na comunidade, o que fortalece a implementação das reformas da assistência psiquiátrica no município.
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Granados-Gámez G, López Rodríguez MDM, Corral Granados A, Márquez-Hernández VV. Attitudes and Beliefs of Nursing Students Toward Mental Disorder: The Significance of Direct Experience With Patients. Perspect Psychiatr Care 2017; 53:135-143. [PMID: 26813481 DOI: 10.1111/ppc.12147] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/14/2015] [Accepted: 11/18/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The objective of this study was to analyze nursing students' beliefs and attitudes toward mental disorder before and after clinical placements. DESIGN AND METHODS A cross-sectional design was chosen. One hundred ninety-four first- and third-year students in a three-year nursing degree course completed the Attribution Questionnaire AQ-27 regarding Mental Health, the Questionnaire of Beliefs, and a Socio-Demographic Questionnaire. FINDINGS Significant differences were found between students who had experienced mental illness and those who had not. Differences were also found between students with friends who suffered from mental health problems and those who did not. PRACTICE IMPLICATIONS These results emphasize the need for nursing students to have direct interaction with people with a mental illness.
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Affiliation(s)
- Genoveva Granados-Gámez
- Genoveva Granados-Gámez, PhD, is Professor of the Faculty of Health Sciences, University of Almeria, Almeria, Spain
| | - Maria Del Mar López Rodríguez
- Maria del Mar López Rodríguez, PhD, is a Researcher in the Faculty of Health Sciences, University of Almeria, Almeria, Spain
| | - Ana Corral Granados
- Ana Corral Granados, MD, is in the Department of Psychology, University of Anglia Ruskin, Chelmsford, UK
| | - Verónica V Márquez-Hernández
- Verónica V. Márquez-Hernández, PhD, is a Researcher in the Faculty of Health Sciences, University of Almeria, Almeria, Spain
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Winkler P, Mladá K, Janoušková M, Weissová A, Tušková E, Csémy L, Evans-Lacko S. Attitudes towards the people with mental illness: comparison between Czech medical doctors and general population. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1265-73. [PMID: 27357820 DOI: 10.1007/s00127-016-1263-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/22/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Stigma among health care professionals is detrimental to the life of those with mental health problems. In the region of post-communist Europe, the level of stigma among health care providers remains understudied. We aimed to compare attitudes towards people with mental illness between Czech medical doctors and the general population. METHODS The Community Attitudes towards Mentally Ill (CAMI) scale was used to measure stigmatizing attitudes among a nationally representative sample of (1) adults residing in the Czech Republic (n = 1810) and (2) Czech medical doctors (n = 1200). Descriptive statistics and multivariable linear regression were used to assess differences between both samples. RESULTS Compared to the general adult population in the Czech Republic, Czech medical doctors demonstrated less stigmatizing attitudes toward people with mental illness in 26 of the 27 CAMI items as well as in the total CAMI score. Medical doctors, however, were more likely to consider mental hospitals as an up-to-date method of treating people with mental illness. CONCLUSIONS Our findings demonstrate more favourable attitudes towards people with mental illness among Czech medical doctors when compared to the Czech general population. Stigma, however, is high among both these groups.
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Affiliation(s)
- Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.
- Personal Social Services Research Unit London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Karolína Mladá
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Miroslava Janoušková
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Aneta Weissová
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Eva Tušková
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Ladislav Csémy
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Sara Evans-Lacko
- Personal Social Services Research Unit London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Validation of the Malayalam version of the Internalized Stigma of Mental Illness (ISMI) scale. Asian J Psychiatr 2016; 20:22-9. [PMID: 27025467 DOI: 10.1016/j.ajp.2016.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 12/16/2015] [Accepted: 01/01/2016] [Indexed: 11/20/2022]
Abstract
Little is known about internalized stigma of mental illness in India. A reason for this could be the lack of valid assessment instruments adapted for the diverse cultures and languages of the country. One of the most widely used and accepted questionnaires to assess internalized stigma is the 29-item Internalized Stigma of Mental Illness (ISMI) scale. The aim of the present study was to translate and adapt the ISMI to the Malayalam-speaking population of Kerala, India and to assess its content and factorial validity. The content validity of the Malayalam-language ISMI was studied through interviews with 7 experts on stigma in India. Factorial validity was examined by means of a confirmatory factor analysis (CFA) based on a cross-sectional survey among 290 patients with mental illness attending follow-up outpatient and primary care clinics in Kerala, India. The expert panel concluded that the items of the translated questionnaire adequately represent internalized stigma in the Malayalam-speaking population of Kerala. The theorized factor structure of the ISMI consisting of five factors showed a suboptimal model fit (WRMR=0.940; TLI=0.971, CFI=0.948; RMSEA=0.059) which improved considerably after removal of the stigma resistance factor and three items with poor factor loadings (WRMR=0.819; TLI=0.982, CFI=0.966; RMSEA=0.051). Although our study identifies some sources of model ill-fit, it shows that a reduced version of the Malayalam-language ISMI can be a valuable tool for the study of internalized stigma in this cultural setting.
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Wiesjahn M, Jung E, Kremser JD, Rief W, Lincoln TM. The potential of continuum versus biogenetic beliefs in reducing stigmatization against persons with schizophrenia: An experimental study. J Behav Ther Exp Psychiatry 2016; 50:231-7. [PMID: 26412294 DOI: 10.1016/j.jbtep.2015.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/07/2015] [Accepted: 09/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A central aspect of previous anti-stigma campaigns was the promotion of biogenetic causes of schizophrenia. Although biogenetic beliefs have been shown to reduce the blame given to persons with schizophrenia, they tend to increase discrimination and stereotypes such as dangerousness and unpredictability. A novel anti-stigma approach is to incorporate continuum beliefs in order to oppose the perceived separation, which is a main component of the stigma process. The aim of the study was to compare the effects of a continuum, a biogenetic, and a control intervention on stereotypes, fear, and social distance towards persons with schizophrenia. Furthermore, it was intended to replicate earlier findings on the associations between continuum beliefs, biogenetic beliefs, and different facets of stigmatization. METHOD In an online-experiment, 1189 participants from the general population randomly received either a continuum, a biogenetic, or a control intervention, which consisted of written information texts. RESULTS The continuum group showed less endorsement of the stereotype incompetence/unpredictability than the biogenetic group. The biogenetic group ascribed less blame to persons with schizophrenia than the other groups. The correlation analyses indicated continuum beliefs to be consistently associated with lower stereotype scores, less fear, and less preferred social distance. LIMITATIONS The sample was not fully representative and the experimental manipulations in our study consisted of relatively short information texts. CONCLUSION It is concluded that continuum beliefs have the potential to reduce stigmatization against persons with schizophrenia. However, future studies need to investigate the effects of more powerful interventions to promote them.
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Affiliation(s)
- Martin Wiesjahn
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Germany.
| | - Esther Jung
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Germany
| | - Julian D Kremser
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Germany
| | - Winfried Rief
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Germany
| | - Tania M Lincoln
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Universität Hamburg, Germany
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Hootz T, Mykota DB, Fauchoux L. Strength-based crisis programming: Evaluating the process of care. EVALUATION AND PROGRAM PLANNING 2016; 54:50-62. [PMID: 26512431 DOI: 10.1016/j.evalprogplan.2015.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 06/05/2023]
Abstract
In this study, a utilization-focused process evaluation framework was used to explore client and service providers' experiences of Crisis Management Services (CMS), their perceptions of the services provided, and the process of client engagement CMS offers. CMS is a strength-based program that targets individuals who experience crises every day. The Community-University Institute for Social Research facilitated the evaluation by engaging academic expertise in a coordinated collaborative approach to community-university partnerships. Semi-structured interviews were conducted with the clients and service providers. The general inductive approach was used for transcript analysis with seven themes emerging. A conceptual model of service delivery is presented, which integrates the interviews conducted with clients and service providers. Results affirm that the establishment of a close personal strength-based relationship is key to client engagement. Collaborative goal setting with informal and formal community resources viewed as potential assets, characterizes the process that enables clients to live at their optimal level of independence. This study is unique as it provides valuable insight on the perspectives of vulnerable individuals in crisis situations. Through the establishment of community-university partnerships the gap between scholarly research and its applicability to community organizations is narrowed with opportunities for improving the quality of life enhanced.
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Affiliation(s)
- Terra Hootz
- Department of Educational Psychology and Special Education, College of Education, University of Saskatchewan, 28 Campus Drive, Saskatoon, SK S7N 0X1, Canada.
| | - David B Mykota
- Department of Educational Psychology and Special Education, College of Education, University of Saskatchewan, 28 Campus Drive, Saskatoon, SK S7N 0X1, Canada.
| | - Laurissa Fauchoux
- Department of Educational Psychology and Special Education, College of Education, University of Saskatchewan, 28 Campus Drive, Saskatoon, SK S7N 0X1, Canada.
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Chidrawi HC, Greeff M, Temane QM. Health behaviour change of people living with HIV after a comprehensive community-based HIV stigma reduction intervention in North-West Province in South Africa. SAHARA J 2015; 11:222-32. [PMID: 25495580 PMCID: PMC4272095 DOI: 10.1080/17290376.2014.985700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
All over the world, health behaviour is considered a complex, far reaching and powerful phenomenon. People's lives are influenced by their own or others' health behaviour on a daily basis. Whether it has to do with smoking, drinking, pollution, global warming or HIV management, it touches lives and it challenges personal and community responses. Health behaviour, and health behaviour change, probably holds the key to many a person's immediate or prolonged life or death outcomes. The same can be said about communities, culture groups and nations. This SANPAD-funded study focused on research questions relating to health behaviour change for people living with HIV (PLWH) in the North-West Province in South Africa. It investigated whether a comprehensive community-based HIV stigma reduction intervention caused health behaviour change in PLWH. An quantitative single system research design with one pre- and four repetitive post-tests utilizing purposive sampling was used to test change-over-time in the health behaviour of 18 PLWH. The results of the study indicated statistical and/or practical significant change-over-time. The intervention not only addressed the health behaviour of PLWH, but also their HIV stigma experiences, HIV signs and symptoms and their quality of life in the context of being HIV positive. The recommendations include popularization of the comprehensive community-based HIV stigma reduction intervention and extending it to include a second intervention to strengthen health behaviour and quality of life for PLWH in the community at large.
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Affiliation(s)
- H Christa Chidrawi
- a PhD (Psychiatric Nursing), is a candidate in the Africa Unit for Transdisciplinary Health Research , North-West University, Potchefstroom Campus , Private Bag x6001, Potchefstroom 2520 , South Africa
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Kim WJ, Song YJ, Ryu HS, Ryu V, Kim JM, Ha RY, Lee SJ, Namkoong K, Ha K, Cho HS. Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness. Psychiatry Res 2015; 225:433-9. [PMID: 25554354 DOI: 10.1016/j.psychres.2014.11.071] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 11/25/2014] [Accepted: 11/28/2014] [Indexed: 11/29/2022]
Abstract
We aimed to examine internalized stigma of patients with mental illness in Korea and identify the contributing factors to internalized stigma among socio-demographic, clinical, and psychosocial variables using a cross-sectional study design. A total of 160 patients were recruited from a university mental hospital. We collected socio-demographic data, clinical variables and administered self-report scales to measure internalized stigma and levels of self-esteem, hopelessness, social support, and social conflict. Internalized stigma was identified in 8.1% of patients in our sample. High internalized stigma was independently predicted by low self-esteem, high hopelessness, and high social conflict among the psychosocial variables. Our finding suggests that simple psychoeducation only for insight gaining cannot improve internalized stigma. To manage internalized stigma in mentally ill patients, it is needed to promote hope and self-esteem. We also suggest that a relevant psychosocial intervention, such as developing coping skills for social conflict with family, can help patients overcome their internalized stigma.
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Affiliation(s)
- Woo Jung Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youn Joo Song
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Sook Ryu
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Vin Ryu
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Jae Min Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ra Yeon Ha
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kee Namkoong
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hyun-Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Rubio-Valera M, Chen TF, O'Reilly CL. New roles for pharmacists in community mental health care: a narrative review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10967-90. [PMID: 25337943 PMCID: PMC4211017 DOI: 10.3390/ijerph111010967] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/30/2014] [Accepted: 10/07/2014] [Indexed: 02/05/2023]
Abstract
Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This narrative review aims to describe the evidence for pharmacist-delivered services in mental health care and address the barriers and facilitators to increasing the uptake of pharmacist services as part of the broader mental health care team. This narrative review is divided into three main sections: (1) the role of the pharmacist in mental health care in multidisciplinary teams and in supporting early detection of mental illness; (2) the pharmacists' role in supporting quality use of medicines in medication review, strategies to improve medication adherence and antipsychotic polypharmacy, and shared decision making; and (3) barriers and facilitators to the implementation of mental health pharmacy services with a focus on organizational culture and mental health stigma. In the first section, the review presents new roles for pharmacists within multidisciplinary teams, such as in case conferencing or collaborative drug therapy management; and new roles that would benefit from increased pharmacist involvement, such as the early detection of mental health conditions, development of care plans and follow up of people with mental health problems. The second section describes the impact of medication review services and other pharmacist-led interventions designed to reduce inappropriate use of psychotropic medicines and improve medication adherence. Other new potential roles discussed include the management of antipsychotic polypharmacy and involvement in patient-centered care. Finally, barriers related to pharmacists' attitudes, stigma and skills in the care of patients with mental health problems and barriers affecting pharmacist-physician collaboration are described, along with strategies to reduce mental health stigma.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Department of Pharmacology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona 08830, Spain.
| | - Timothy F Chen
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
| | - Claire L O'Reilly
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
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Determinants of mental illness stigma for adolescents discharged from psychiatric hospitalization. Soc Sci Med 2014; 109:26-34. [DOI: 10.1016/j.socscimed.2013.12.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 11/21/2013] [Accepted: 12/31/2013] [Indexed: 11/20/2022]
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Parcesepe AM, Cabassa LJ. Public stigma of mental illness in the United States: a systematic literature review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 40:384-99. [PMID: 22833051 DOI: 10.1007/s10488-012-0430-z] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Public stigma is a pervasive barrier that prevents many individuals in the U.S. from engaging in mental health care. This systematic literature review aims to: (1) evaluate methods used to study the public's stigma toward mental disorders, (2) summarize stigma findings focused on the public's stigmatizing beliefs and actions and attitudes toward mental health treatment for children and adults with mental illness, and (3) draw recommendations for reducing stigma towards individuals with mental disorders and advance research in this area. Public stigma of mental illness in the U.S. was widespread. Findings can inform interventions to reduce the public's stigma of mental illness.
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Affiliation(s)
- Angela M Parcesepe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Richards M, Hori H, Sartorius N, Kunugi H. Cross-cultural comparisons of attitudes toward schizophrenia amongst the general population and physicians: a series of web-based surveys in Japan and the United States. Psychiatry Res 2014; 215:300-7. [PMID: 24374117 DOI: 10.1016/j.psychres.2013.12.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/19/2013] [Accepted: 12/04/2013] [Indexed: 12/23/2022]
Abstract
Cross-cultural differences in attitudes toward schizophrenia are suggested, while no studies have compared such attitudes between the United States and Japan. In our previous study in Japan (Hori et al., 2011), 197 subjects in the general population and 112 physicians (excluding psychiatrists) enrolled in a web-based survey using an Internet-based questionnaire format. Utilizing the identical web-based survey method in the United States, the present study enrolled 172 subjects in the general population and 45 physicians. Participants' attitudes toward schizophrenia were assessed with the English version of the 18-item questionnaire used in our previous Japanese survey. Using exploratory factor analysis, we identified four factors labeled "social distance," "belief of dangerousness," "underestimation of patients' abilities," and "skepticism regarding treatment." The two-way multivariate analysis of covariance on the four factors, with country and occupation as the between-subject factors and with potentially confounding demographic variables as the covariates, revealed that the general population in the US scored significantly lower than the Japanese counterparts on the factors "social distance" and "skepticism regarding treatment" and higher on "underestimation of patients' abilities." Our results suggest that culture may have an important role in shaping attitudes toward mental illness. Anti-stigma campaigns that target culture-specific biases are considered important.
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Affiliation(s)
- Misty Richards
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan; Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles (UCLA), Los Angeles, CA 90024, USA; Fulbright Foundation, New York, NY 10025, USA
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan.
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
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Girma E, Möller-Leimkühler AM, Müller N, Dehning S, Froeschl G, Tesfaye M. Public stigma against family members of people with mental illness: findings from the Gilgel Gibe Field Research Center (GGFRC), Southwest Ethiopia. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2014; 14:2. [PMID: 24555444 PMCID: PMC3933511 DOI: 10.1186/1472-698x-14-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/14/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Public stigma against family members of people with mental illness is a negative attitude by the public which blame family members for the mental illness of their relatives. Family stigma can result in self social restrictions, delay in treatment seeking and poor quality of life. This study aimed at investigating the degree and correlates of family stigma. METHODS A quantitative cross-sectional house to house survey was conducted among 845 randomly selected urban and rural community members in the Gilgel Gibe Field Research Center, Southwest Ethiopia. An interviewer administered and pre-tested questionnaire adapted from other studies was used to measure the degree of family stigma and to determine its correlates. Data entry was done by using EPI-DATA and the analysis was performed using STATA software. Unadjusted and adjusted linear regression analysis was done to identify the correlates of family stigma. RESULTS Among the total 845 respondents, 81.18% were female. On a range of 1 to 5 score, the mean family stigma score was 2.16 (± 0.49). In a multivariate analysis, rural residents had significantly higher stigma scores (std. β = 0.43, P < 0.001) than urban residents. As the number of perceived signs (std. β = -0.07, P < 0.05), perceived supernatural (std. β = -0.12, P < 0.01) and psychosocial and biological (std. β = -0.11, P < 0.01) explanations of mental illness increased, the stigma scores decreased significantly. High supernatural explanation of mental illness was significantly correlated with lower stigma among individuals with lower level of exposure to people with mental illness (PWMI). On the other hand, high exposure to PWMI was significantly associated with lower stigma among respondents who had high education. Stigma scores increased with increasing income among respondents who had lower educational status. CONCLUSIONS Our findings revealed moderate level of family stigma. Place of residence, perceived signs and explanations of mental illness were independent correlates of public stigma against family members of people with mental illness. Therefore, mental health communication programs to inform explanations and signs of mental illness need to be implemented.
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Affiliation(s)
- Eshetu Girma
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
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van Boekel LC, Brouwers EPM, van Weeghel J, Garretsen HFL. Public opinion on imposing restrictions to people with an alcohol- or drug addiction: a cross-sectional survey. Soc Psychiatry Psychiatr Epidemiol 2013; 48:2007-16. [PMID: 23657876 DOI: 10.1007/s00127-013-0704-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/29/2013] [Indexed: 01/16/2023]
Abstract
PURPOSE Alcohol- and drug addiction tends to evoke disapproval and rejection among people. This study provides insight into the origin of people's negative attitudes towards these people. Corrigan's attribution model is used to examine intentions of the Dutch public to impose restrictions to people who are addicted to alcohol or illicit drugs. METHODS Data were derived from a cross-sectional survey among a representative panel of the Dutch population (N = 2,793). Path analyses were conducted to test the influence of attribution beliefs, emotional responses and familiarity with addictions on people's intentions to impose restrictions to these people. RESULTS More than half of the respondents agreed with imposing restrictions to someone with an addiction such as excluding from taking public office or forbid to care for children. Corrigan's attribution model was partially applicable to explain people's intentions to impose restrictions, since only a rather small percentage of the variance in people's intentions was explained by the model. The perception of personal responsibility for an addiction and high expectancy of aggressiveness have a positive influence on intentions to impose restrictions. Feelings of anger and fear were also predictors of intentions to impose restrictions. CONCLUSIONS The Dutch public showed high intentions to restrict people with an alcohol- or drug addiction which has an extensive impact on their life opportunities. Perceived aggressiveness, feeling of anger and fear, and perceived responsibility were associated with higher intentions to impose restrictions.
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Affiliation(s)
- Leonieke C van Boekel
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, The Netherlands,
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Cigarette smoking as a stigma: evidence from France. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:282-90. [PMID: 24315503 DOI: 10.1016/j.drugpo.2013.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/13/2013] [Accepted: 08/30/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is growing evidence that cigarette smoking has become a stigmatized behaviour, at least in western countries, and there is ongoing debate among experts about whether or not such stigma should be an instrument of anti-tobacco policy. METHODS We investigated French non-smokers attitudes toward cigarette smokers, using data from a telephone survey carried out in 2010 among a representative random sample of non-smokers aged 15-75 (N=3091). We carried out a cluster analysis to build contrasted attitudinal profiles and we also computed a score of stigmatization. RESULTS We found evidence for the existence of stigma associated with cigarette smoking in France: a majority of French non-smokers would not date a smoker, nor hire one to take care of their children. The cluster analysis identified four contrasting profiles, corresponding to different levels of stigmatization, including one cluster whose respondents demonstrated strong levels of moral condemnation and social rejection of smokers. Older people, those with a lower educational level and those reporting financial difficulties were more prone to stigmatize smokers, while those who reported that somebody smoked in their home were less likely to do so. Those who had never smoked and those who abstained from alcohol were more prone to stigmatize smokers. Obese people were also more likely to do so (in bivariate analysis only). CONCLUSION The process of tobacco stigmatization seems well-advanced in France, despite a cultural context that may be less permeable to this process. Further research is needed as our results raise some questions regarding its efficiency as a policy tool. First, people who are familiar with smokers are less prone to stigmatize them. More generally, simultaneously stigmatizing several categories of people may provide each of these same categories with stereotyped 'others' onto whom they can deflect their stigma.
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Perkins R, Repper J. Prejudice, discrimination and social exclusion: reducing the barriers to recovery for people diagnosed with mental health problems in the UK. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roberts SH, Bailey JE. An ethnographic study of the incentives and barriers to lifestyle interventions for people with severe mental illness. J Adv Nurs 2013; 69:2514-24. [DOI: 10.1111/jan.12136] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Seren Haf Roberts
- Institute of Medical and Social Care Research (IMSCaR); Bangor University; Wrexham UK
| | - Jois Elisabeth Bailey
- Recovery Service and Assertive Outreach Team; Betsi Cadwaladr University Health Board; Wrexham UK
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Tanioka T, Chiba S, Onishi Y, Kataoka M, Kawamura A, Tomotake M, Williams CL, Yasuhara Y, Mifune K. Factors associated with discharge of long-term inpatients with schizophrenia in Japan: a retrospective study. Issues Ment Health Nurs 2013; 34:256-64. [PMID: 23566188 DOI: 10.3109/01612840.2012.742602] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Deinstitutionalization for people with mental disorders has only begun to be implemented in Japan. The purpose of this retrospective study was to examine factors associated with discharge for long-term patients with schizophrenia. Seventy patients were judged capable of discharge with psychiatric rehabilitation (special staff service). As a result of rehabilitation efforts, 37 patients were discharged and 33 patients remained in the hospital. Significant differences were found in age, level of family agreement about patient's disability, and length of the special staff service. These factors might be important to predict patients' potential for discharge.
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Affiliation(s)
- Tetsuya Tanioka
- The University of Tokushima, Institute of Health Biosciences, Tokushima, Japan.
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