How does direct to consumer advertising affect the stigma of mental illness?

Opening Access but Concealing Contact: A First Study of Over-The-Counter Hearing Aid Consumer-Facing Communications

Hearing loss is a prevalent chronic health condition with approximately 40 million Americans living with mild to moderate hearing loss. Yet, only about 20% will ever pursue hearing interventions. To broaden uptake the FDA approved over the counter (OTC) hearing aid (HA) options in October 2022. A stigmatized health topic, it is both necessary and well-timed to explore how HAs are depicted in consumer-facing communications, which has not been formally studied to date. The present study examines social media posts across a one-year time frame (six months prior and six months following the FDA announcement) from the three most-followed OTC HA brands. With the shift to OTC, HA companies are responsible for communicating directly with consumers. Through the lens of Contact Theory, we explore three mechanisms by which these messages enact stigma, through contact with (1) people, (2) HA products, and (3) a larger brand community. Overall, only 22% of posts discussed OTC in any capacity. Contact was similarly limited, with only 9% of posts showing a person wearing an HA. However, following the FDA announcement, the number of posts depicting people or social relationships doubled (23% to 58% and 13% to 36%, respectively). To overcome stigma and increase uptake of these essential health products, it is important to promote contact with hearing aids and those who wear them. Timely implications for health communication research and practice are discussed.

Prospective Patient Preferences for Humor in Urologists Treating Erectile Dysfunction: A Survey Study

INTRODUCTION

Men seeking treatment for sexual dysfunction can experience embarrassment as a result of stigma. This research manuscript presents the findings of a survey conducted to investigate the influence of humor on prospective patients' preferences when selecting a specialist to address erectile dysfunction (ED).

METHODS

The respondents were presented with five pairs of mock urology business cards: one professional and one humorous. A questionnaire was designed and distributed via an online survey platform. Descriptive statistics and Fisher's exact test were performed using the Statistical Package for Social Sciences (SPSS) software version 29 (IBM SPSS Statistics, Armonk, NY) to evaluate age and race associations with card preference.

RESULTS

Among the 997 participants, an average of 66.1% (a median of 71.2%) preferred professional cards. Humorous card selection rates ranged from 5.2% to 38.4% compared to 54.0% to 78.1% for professional cards. A statistically significant relationship between age and professional card choice existed in all except the fifth set of cards (p = 0.001, 0.001, 0.001, 0.001, and 0.054). The relationship between race or ethnicity and business card preference was not reported due to an imbalance in demographics, with most participants identifying as Caucasian.

DISCUSSION

A humor-centric approach may not resonate with all individuals seeking treatment for sensitive conditions such as ED. Limitations include the subjectivity of humor, the use of an online survey platform, and the hypothetical nature of this study. Real patients experiencing ED may face stigma and respond to humor differently.

CONCLUSION

This study provides insights into patient preference for professionalism over humor from their urologist but leaves room for the exploration of humor in medical contexts. Future studies could examine the impacts of humor on patient choices in real-world healthcare settings.

A scoping review of empirical research on prescription drug promotion

BACKGROUND

Pharmaceutical spending on prescription drug promotion is considerable, and exposure to advertising can influence demand and behavior. The U.S. Food and Drug Administration (FDA) provides industry guidance to help ensure that communications to consumers and health care providers about prescription drug promotion are truthful, balanced, and accurately communicated. As empirical research has accelerated on this topic in the past decade, an understanding of the current landscape of the science will help inform future research.

OBJECTIVES

Using systematic methods, this rigorous scoping review of the literature over the past decade (2012-2021) (1) examined the extent to which prescription drug promotion has been empirically investigated with consumers, patients, and health care providers; (2) examined the extent to which content and features of prescription drug promotion have been empirically investigated; and (3) identified themes across the literature to better understand the current landscape of prescription drug promotion.

METHODS

Databases searched include PubMed, Web of Science, CINAHL, APA PsycInfo, Business Source Corporate, Communication Source, Cochrane Library, and ClinicalTrials.gov for original research published in English from January 1, 2012, through November 10, 2021, using terms related to direct-to-consumer advertising, prescription drugs, and outcomes of interest (e.g., attitudes, perceptions, intentions, behaviors).

RESULTS

Of 804 screened references, 151 studies addressed the first research question, and 40 studies addressed the second. The most common theme across the body of evidence focused on testing of features and content in prescription drug promotional materials (84), followed by studies examining attitudes, perceptions, and behaviors toward prescription drug promotion more generally (43). Some (27) studies focused on targeted populations, such as patients, the elderly, non-English speaking people or individuals of a non-white race/ethnicity. Twenty-four studies assessed influence of exposure to prescription drug promotion on actual clinical outcomes, while 11 studies examined emerging technologies around prescription drug promotion. Seven studies evaluated the extent to which prescription drug promotion complied with existing guidelines and requirements.

CONCLUSIONS

Findings from this scoping review suggest there has been an increase in the number of empirical studies conducted on prescription drug promotion over the past decade. Potential areas that warrant further study include examination of emerging technologies, an expanded focus on targeted populations, and construct measurement.

Resisting stigma and evaluating realism in a direct-to-consumer advertisement for psychiatric drugs

Purpose

This study aims to examine how experience with mental illness influences perceptions of stigma and realism in a specific direct-to-consumer advertisement (DTCA) for bipolar depression.

Design/methodology/approach

An online survey had participants watch a 90 s advertisement for a prescription bipolar depression drug and then answer 24 questions about stigma, mental illness experience and the realism of the portrayals in the advertisement.

Findings

Findings show that people who identify as having experience with mental illness tend to see the ad as more stigmatizing and less realistic. Additionally, people who expressed more stigmatizing beliefs also tended to see more stigma present in the ad. Finally, the study reconfirms conclusions of previous research that people who have experience with mental health conditions possess fewer stigmatizing beliefs overall regarding mental illness.

Research limitations/implications

The sample population, while diverse in age and somewhat diverse in location, were highly educated, suggesting that they were not representative of the general population. Future studies may want to use more representative samples. A more nuanced approach to understanding experience is needed. While the sample in this study was purposively derived from communities with a higher rate of mental illness, a comprehensive experience scale to measure degrees of experience with mental illness would enhance understanding of this construct. Researchers may also want to look more deeply into the emotional responses of consumers who view these ads. To develop a greater understanding of the trajectory of DTCA, studies of online advertising for psychiatric drugs are needed.

Practical implications

The results of the study suggest that respondents with experience with mental illness may find ads that sell psychiatric medications unrealistic. This study presents the topic of realism in DTCA as an important construct for determining how consumers may perceive portrayals of disorders.

Social implications

The fact that people who have experience with mental illness found the Latuda ad to be generally unrealistic suggests that DTCA may be failing to represent mental illness in a way that demonstrates care for patients. Additionally, this research confirms that people who have had exposure to and experience with mental illness tend to hold less stigmatizing beliefs, (Link and Cullen, 1986; Corrigan et al., 2001; Angermeyer et al., 2004) a finding which supports the continuing project of increasing mental health literacy and awareness in the general population.

Originality/value

This study investigates the reactions of people who identify as having some experience with mental illness to see if they accept the portrayals of mental illness in DTCA or resist them by challenging their realism or identifying stigmatizing elements.

Comparison of maximal isometric forearm supination torque in two elbow positions between subjects with and without limited forearm supination range of motion

Study Design: Cross-sectional comparison. Introduction: Forearm supination range of motion is often limited by short or stiff pronators. Many studies have examined maximal isometric forearm supination torque (MIFST). However, there is little research comparing MIFST in two elbow positions between subjects with and without limited forearm supination range of motion (LSR). Purpose of the Study: The purpose of this study was to compare MIFST in two elbow positions (90º flexed elbow, extended elbow) between subjects with and without LSR. Methods: Thirteen right-handed subjects (seven men, six women) with LSR and 13 age- and gender-matched healthy controls participated in this study. The forearm supination range of motion and MIFST were measured using a Smart KEMA system. Two-way repeated-measures analysis of variance was used to compare MIFST in two elbow positions between subjects with and without LSR. Results: No significant difference between groups (p > .05) was found. However, there was an interaction effect between elbow position and group on MIFST (p < .05). Independent t-tests were used to confirm the simple effects. In the LSR group, the value of MIFST was significantly lower in the elbow-extended position than in the group without LSR (p < .05). Conclusions: These findings indicate that elbow position should be considered when assessing the strength or increasing the strength of the supinator muscle, especially in patients with LSR.

The (Surprising) Impact of Televised Antidepressant Direct-to-Consumer Advertising on the Stigmatization of Mental Illness

This study tests the effect of pharmaceutical Direct-to-Consumer Advertising (DTCA) for antidepressants on perceived stigma surrounding mental disorders. We randomly assigned participants into one of three experimental conditions: antidepressant DTCA with portrayals of discrimination, cognitive separation, and stereotyping (DCSS), antidepressant DTCA without these representations, or a no-exposure control. Contrary to study hypotheses, participants who viewed ads containing portrayals of DCSS were significantly less likely to want to socially distance themselves from those with mental illnesses than those assigned to the no-exposure control condition, even when controlling for demographics and personal experience with mental illness. We discuss plausible explanations for the unexpected pattern of effects and resulting implications for future research on the topic.

Educational intervention to decrease stigmatizing attitudes of undergraduate nurses towards people with mental illness

Health professionals can hold stigmatizing views about people with mental illness. In addition to being discriminatory, these beliefs cause anxiety that can affect learning in the clinical environment. A review of an undergraduate nursing curriculum introduced the Modern Apprenticeship curriculum model and provided an opportunity for an educational intervention designed to address stigmatizing beliefs about people with mental health and addiction problems. The aim of the present study was to measure the extent to which an educational intervention - guided clinical experience in an acute mental health unit during the first year of the curriculum - decreased stigmatizing beliefs of undergraduate nurses towards those with mental health and addiction issues. In a before-and-after design, Corrigan's Attribution Questionnaire was used to collect data pre- and post-guided clinical experience in an acute mental health unit. The intervention resulted in a significant positive change in stigmatizing attitudes for four of the nine factors tested. There was a non-significant positive change in three factors, while two factors showed a non-significant negative change. Using guided clinical experience as an educational intervention in the first year of an undergraduate nursing curriculum can contribute to positive change in undergraduate nurses' stigmatizing beliefs. The findings have implications for teaching of mental health content in undergraduate nursing programmes.

The Effects of Direct-To-Consumer-Advertising on Mental Illness Beliefs and Stigma

Despite widespread use, little is known about how video direct-to-consumer-advertising (DTCA) influences beliefs about or stigma towards mental illness. The purpose of this study was to examine the effects of a medication advertisement on beliefs and stigma towards one mental disorder-bipolar disorder. A total of 424 participants were randomly assigned to view a medication or automobile advertisement and completed measures of beliefs and stigma towards bipolar disorder before and immediately after the advertisement. The medication advertisement did not lead to changes in perception of biological etiology, but did lead to increases in perception of prevalence, treatability, and controllability. No substantive changes were noted in stigma. In contrast to previous research and speculation, DTCA did not have an immediate, substantial impact on stigma or contribute to the "medicalization" of mental disorders.

The effects of pity on self- and other-perceptions of mental illness

Previous research has demonstrated that pity may have a positive influence on public perceptions of individuals with a mental illness but has not adequately addressed the potential negative impacts of pity perceptions. Seventy-five research participants with serious mental illness completed measures of pity, public stigma, shame, hopelessness, personal empowerment, self-esteem, depression, and quality of life at baseline. Measures of hopelessness, personal empowerment, self-esteem, and depression were repeated six months later. Bivariate correlations found significant associations between pity and "other" effects of stigma including dangerousness, fear, segregation, avoidance and perceived stigma. Baseline pity was significantly correlated with self-effects of stigma such as shame, hopelessness, lower empowerment, lower self-esteem, depression, and decreased quality of life. At six-month follow-up, baseline pity was still associated with increased hopelessness and depression along with decreased empowerment and self-esteem. Anger, avoidance, perceived stigma, shame, and self-esteem were significantly related to pity in multiple linear regressions. Outcomes of path analyses suggest that the significant positive relationship between pity at baseline and depression at six-month follow-up was mediated by self-esteem and hopelessness. Individuals who view mental illness with pity experience negative self- and other-effects of stigma. These effects persist 6-months later. These findings have important implications for stigma-reducing advertising programs.