Assessing knowledge of schizophrenia: development and psychometric properties of a brief, multiple-choice knowledge test for use across various samples

Putting a label on someone: impact of schizophrenia stigma on emotional mimicry, liking, and interpersonal closeness

Affiliation is both an antecedent and a consequence of emotional mimicry (i.e. imitating a counterpart's emotional expression). Thus, interacting with a disliked partner can decrease emotional mimicry, which in turn can further decrease liking. This perpetuating circle has not been investigated in the context of mental health stigma yet. The present study tested the influence of the label "schizophrenia" on liking, interpersonal closeness, and emotional mimicry. In an online experiment (n = 201), participants recruited from the general population saw several videos of actors displaying emotional expressions. Actors were described with one of four labels: "schizophrenia", "healthy", "diabetes", and a negative adjective (e.g. "hot-tempered"). Emotional mimicry was measured using OpenFace 2.2. Liking and interpersonal closeness were assessed with questionnaires. Overall, compared to other labels, participants reported less liking and interpersonal closeness to the actor with the schizophrenia label. However, no effect on emotional mimicry was found. The decreased liking of the schizophrenia actors was explained by a lack of knowledge about schizophrenia and the explicit stigma of schizophrenia. Our study contributes to the literature by highlighting the need to reduce the stigma of schizophrenia.

Causal beliefs about mental illness: A scoping review

Research on causal beliefs about mental illness-the beliefs people hold about what causes a particular mental illness, or mental illnesses in general-is split across a number of theories and disciplines. Although research on this subject has provided a number of insights and practical applications, the diversity of theories, terminology, and keywords makes it challenging for a new reader to gain a comprehensive understanding. We sought to address this by conducting a systematic scoping review of research on causal beliefs. This review included English-language articles from any year that mentioned causal beliefs for mental illness in their title or abstract. We identified articles in two stages. In the first stage, we used a narrow set of search terms referring specifically to causal beliefs (1227 records identified, 417 included). In the second stage, we used a comprehensive set of terms relevant to research on causal beliefs (10,418 records identified, 3838 included). We analyzed articles qualitatively, organizing them into one of five theories or categories: the common-sense model of self-regulation, explanatory models, mental health literacy, biogenetic causal beliefs, and other research on causal beliefs. We provide a comprehensive summary of these literatures in terms of their history, typical research questions and study design, findings, and practical applications. These theories differ in their theoretical orientation towards causal beliefs, research methods, findings, and applications. However, they broadly share a view of causal beliefs as multifaceted, culturally determined, and relevant for additional psychosocial variables such as mental illness stigma and help-seeking. We conclude by making recommendations for researchers, clinicians, public health messaging, and for individuals with mental illness.

Healthcare professionals' knowledge, confidence and attitudes in relation to psychosis care: A systematic review

BACKGROUND

Psychosis is a mental disorder that, despite its low prevalence, causes high disease and economic burden. Inadequate knowledge, lack of confidence and stigmatising attitudes of healthcare professionals (HCPs) may lead to suboptimal care.

AIM

To review the literature exploring HCPs' knowledge, confidence and attitudes in relation to psychosis care.

METHOD

A systematic search was undertaken across three databases (MEDLINE, Embase, PsycINFO) using a search strategy encompassing the concepts: 'healthcare professionals', 'knowledge, attitude, and confidence in care' and 'psychotic illnesses and symptoms' to identify relevant records published from 1st January 2002 to 18th March 2022. Results were screened against predetermined inclusion and exclusion criteria by title and abstract, followed by full text. Data were extracted into tables and synthesised narratively.

RESULTS

Initially, 7,397 studies were identified. Following two-stage screening, 24 studies were eligible for inclusion. Of these studies, 16 explored attitudes, four explored knowledge and attitudes, one explored knowledge, one explored confidence, one explored attitudes and confidence in care and one explored all three constructs. Most HCPs in the included studies demonstrated stigmatising attitudes towards people with psychosis. Furthermore, certain HCPs, including nurses and general practitioners, demonstrated low levels of knowledge, while psychiatrists, occupational therapists, psychologists and nurses had low levels of confidence in caring for people with psychosis. Conversely, positive attitudes were also observed in some HCPs resulting from having acquaintances with lived experience of psychosis. The need for additional education and training to improve HCPs' knowledge and confidence in relation to caring for people living with psychosis was identified.

CONCLUSIONS

Most attitudes identified were negative and stemmed from stigma, while some were positive due to HCPs' compassion and familiarity with psychosis. The level of knowledge and confidence identified were mostly suboptimal, and so further research is required to develop and evaluate tailored interventions to address this gap.

User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial

BACKGROUND

Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population.

OBJECTIVE

The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers.

METHODS

We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication.

RESULTS

In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52).

CONCLUSIONS

To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis.

Changes in knowledge, behavioural expectations, self-efficacy, and stigma after an educational campaign about early psychosis for jail correction officers

AIM

Given a lack of interventions to identify and engage individuals with early psychosis in jail and connect them to specialty care in the community upon release, we designed a Targeted Educational Campaign (TEC) for correction officers working in jails. We report on impacts of the TEC on officers' cognitive and attitudinal outcomes.

METHODS

Three different cohorts of officers-totaling n = 451-took part in a survey: 200 at baseline before the TEC began, 123 at 6-months into the TEC, and 128 at 12-months into the TEC. Among each cohort of officers, four constructs were measured: (1) knowledge about early psychosis; (2) self-efficacy around detecting early psychosis and referring to mental health services within the jail; (3) expectations about the benefits of detection and referral to specialty care; and (4) social distance stigma toward detainees with early psychosis.

RESULTS

While exposure to TEC elements was as-planned in the first 6-months, exposure diminished substantially at 12-months, coinciding with increasing fatigue among correction officers due to the COVID-19 pandemic as well as serious staffing shortages. Knowledge, behavioural expectations, and self-efficacy scores improved from baseline to 6-months, with greater exposure to roll-call messages driving scores. Knowledge and behavioural expectations at 12-months were associated with having received an information post card. Social distance stigma worsened across timepoints.

CONCLUSIONS

An educational campaign for jail staff can enhance knowledge, self-efficacy, and behavioural expectations regarding early psychosis, though only while the campaign elements are active. Further research should investigate whether or not social distance stigma or other types of stigma increase alongside improvements.

Knowledge about schizophrenia test: the Chinese Mandarin version and its sociodemographic and clinical factors

BACKGROUND

Schizophrenia is a chronic, complex, and severe mental disorder and caregivers having knowledge about it can help improve patient adherence to treatment. This study aims to translate the Knowledge About Schizophrenia Test (KAST) into a Chinese Mandarin version and test it among caregivers to validate its reliability and reproducibility, as well as to determine its associated sociodemographic factors and clinical factors.

METHODS

The project surveyed 160 patients with schizophrenia and their caregivers at four community health facilities in Beijing, China, from January 2022 to February 2022. All patients and caregivers completed the sociodemographic questionnaire, and caregivers also completed the Chinese-version KAST, and 143 of these caregivers completed the Chinese-version KAST again 2-4 weeks later.

RESULTS

The mean (SD) of the caregiver score was 11.49 (± 3.13). After item analysis, there was acceptable internal consistency among the 17 items in the Chinese version (KR-20 coefficient 0.702). The intraclass correlation coefficient in the retest (0.686) was statistically significant. Gender, educational attainment, marital status, relationship with the patient, and occupational status were associated with the KAST score.

CONCLUSION

The findings demonstrate that the Chinese-version KAST is a reliable and reproducible instrument that can measure knowledge about schizophrenia and is valid to be applied in schizophrenia research.

Family psychoeducation to improve outcome in caregivers and patients with schizophrenia: a randomized clinical trial

Introduction

Schizophrenia is recognized for its severe impact on both patients and caregivers. In a 12-month follow-up randomized clinical trial, we aimed to measure the efficacy of a brief family psychoeducation program in terms of reducing relapse risk and improving medication adherence in patients, as well as reducing caregiver burden, depression and increasing knowledge of the illness.

Methods

A total of 25 days of patients with schizophrenia (DSM-IV-TR) and family primary caregivers were recruited in a single regional psychiatric outpatient facility located in Bordeaux. In the active group, caregivers received a psychoeducational intervention consisting of six sessions spread over 1.5 months, while the control group was placed on a waiting list. Sociodemographic, symptom severity (PANSS) and medication adherence (MARS) from patients were assessed at baseline and relapse rates was recorded during the 12 months follow-up period. Caregivers' burden (ZBI), depression (CES-D), quality of life (S-CGQoL), knowledge of the disease (KAST) and therapeutic alliance (4PAS-C) were assessed at baseline, three and 6 months.

Results

On the 25 patients included, the mean age was 33.3 years (SD = 9.7) with a mean duration of disease of 7.48 years (SD = 7.1). On the 25 caregivers included, the mean age was 50.6 years (SD = 14.0). Twenty-one were female (84.0%), 12 were married (48.0%) and 11 lived alone (44.0%). For patients, the family psychoeducation intervention significantly reduced the risk of relapse with a significant effect found at 12 months follow-up (p = 0.014). No change was observed on medication adherence. For caregivers, the intervention reduced the burden (p = 0.031), decreased the depression (p = 0.019), and increased the knowledge on schizophrenia (p = 0.024). Analyzes for repeated measures showed a statistically significant difference in therapeutic alliance (p = 0.035).

Conclusion

As confirmed by previous studies, the brief multifamily program (consisting of six sessions over a period of 1.5 months) was found to be effective in improving outcomes for caregivers (e.g., burden, depression, knowledge) and patients (e.g., preventing relapse) in the context of routine care. Given its short duration, this program is expected to be easily implementable within the community.

Clinical trial registration

https://clinicaltrials.gov/, NCT03000985.

Community-based rehabilitation interventions on quality of care for people with schizophrenia in China (CRISC): study protocol for a cluster-randomized controlled trial

BACKGROUND

International consensus shows that community-based rehabilitation (CBR) service is an effective way to improve functioning and negative symptoms and address the treatment gap for schizophrenia. Rigorous trials are needed in China to demonstrate effective and scalable CBR interventions to significantly improve outcomes for people with schizophrenia and to provide evidence of the economic benefits. The objectives of this trial are to examine the effectiveness of CBR as an adjunct to test the usual facility-cased care (FBC) in comparison to FBC alone in improving a range of outcomes in people with schizophrenia and their caregivers.

METHODS

This trial is a cluster randomized controlled trial design in China. The trial will be conducted at three districts of Weifang city, Shandong province. Eligible participants will be identified from the psychiatric management system where community-dwelling patients with schizophrenia have been registered. Participants will be recruited after providing informed consent. 18 sub-districts will be randomly allocated in a 1:1 ratio to facility-based care (FBC) plus CBR (intervention arm) or FBC alone (control arm). The structured CBR intervention will be delivered by trained psychiatric nurses or community health workers. We aim to recruit 264 participants. The primary outcomes include symptoms of schizophrenia, personal and social function, quality of life, family burden of caring, etc. The study will be conducted according to good ethical practice, data analysis and reporting guidelines.

DISCUSSION

If the hypothesized clinical benefit and cost-effectiveness of CBR intervention are confirmed, this trial will provide significant implications for policy makers and practitioners to scale up rehabilitation services, as well as for people with schizophrenia and their family to promote recovery and social inclusion, and to alleviate the burden of care.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2200066945). Registered December 22, 2022.

Culturally adapted family intervention for people with schizophrenia in Indonesia (FUSION): a development and feasibility study protocol

Background

Mental illnesses comprise the single largest source of health-related economic burden globally, and low- and middle-income countries are disproportionately affected. The majority of people with schizophrenia who need treatment do not receive it and are often wholly reliant on family caregivers for daily care and support. Family interventions have an exceptionally robust evidence base for their efficacy in high-resource settings, but it is unknown whether they can produce equivalent effects in some low-resource settings where cultural beliefs, explanatory models of illness and contextual socio-economic issues differ.

Methods

This protocol describes the methods for a randomised controlled trial to determine the feasibility of testing culturally adapt and refine an evidence-based, family intervention for relatives and caregivers of people with schizophrenia in Indonesia. The feasibility and acceptability of implementing our adapted, co-produced intervention via task shifting in primary care settings will be evaluated using the Medical Research Council framework for complex interventions. We will recruit 60 carer-service-user dyads and randomise them in a 1:1 ratio either to receive our manualised intervention or continue to receive treatment as usual. Healthcare workers in primary care settings will be trained to deliver family interventions using our manualised intervention by a family intervention specialist. Participants will complete the ECI, IEQ, KAST and GHQ. Service-user symptom level and relapse status will be measured using the PANSS at baseline, post-intervention and 3 months later by trained researchers. Fidelity to the intervention model will be measured using the FIPAS. Qualitative evaluation will further assist with refining the intervention, evaluating trial processes and evaluating acceptability.

Discussion

National healthcare policy in Indonesia supports the delivery of mental health services in a complex network of primary care centres. This study will provide important information on the feasibility of delivering family interventions for people with schizophrenia via task shifting in primary care settings in Indonesia and allow further refinement of the intervention and trial processes.

A multifaceted approach in promoting positive mental health culture in Hong Kong secondary schools: The Mindshift educational networking programme

AIM

Many young people with mental health problems refuse to seek help because of stigma and leave the problem untreated. Previous research suggests that contact interventions with education could improve the stigma of mental illness in young people, thereby encouraging help-seeking in distress. The current study examined the effectiveness of a multifaceted programme, the Mindshift educational networking programme (MENP), in promoting a positive mental health culture in Hong Kong secondary schools.

METHODS

The MENP provided activities at school, teacher and student levels to 14 Hong Kong secondary schools. School activities included visits, mental health talks and support for capstone projects. While teachers participated in workshops and regional seminars, students received ambassador training workshops, contact opportunities with people with psychosis and attachment programmes. The impact of MENP was evaluated by changes in students' knowledge, attitudes and behaviours toward people with psychosis and mental illness before and after the programme, as well as by teachers' feedback on the programme.

RESULTS

This study analysed data from 55 students and 20 teachers. It was found that the MENP improved students' knowledge of mood symptoms (p = .03), acceptance of people with psychosis (p = .04) and intended behaviour toward people with mental illness (p = .02). The feedback of the teachers on the programme was positive.

CONCLUSIONS

The results support the application of the multifaceted approach to promote a positive mental health culture in schools. The findings call on the government to implement the programme in schools in Hong Kong by providing financial support to relevant organizations.

Developing an assessment tool for geropsychiatric mental healthcare knowledge and attitude evaluations in clinical practice for nursing students

AIM

To develop an instrument to investigate geropsychiatric psychological symptoms, health problem nursing knowledge (GPN-K), geropsychiatric psychological symptoms and health problem nursing attitude scale (GPN-A) in clinical practice for nursing students.

DESIGN

Instrument development and cross-sectional study for psychometric testing.

METHODS

Construct validity was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA), and internal consistency was calculated using Cronbach's α.

RESULTS

A total of 300 students have completed the questionnaires (85.71% response rate). The CFA of GPN-K showed good fitness and validity. The Kuder-Richardson 20 (KR-20) value of the internal consistency reliability is 0.64. The GPN-A overall content validity index is 0.95. A three-factor structure was shown by exploratory factor analysis. The three factors are communication and care, helping others improve and problem evaluation tendency. The total variance explained is 59.01%. Cronbach's alpha of GPN-A equals 0.84, which represents good internal consistency.

Assessing mental health literacy among Danish adolescents - development and validation of a multifaceted assessment tool (the Danish MeHLA questionnaire)

It is recognized that mental health literacy is vital in both the prevention of mental health problems and in mental health promotion and empowerment of adolescents. In spite of this, only a limited number of tools assessing mental health literacy among adolescents have been developed and most of these have not been adequately tested. In this study, a questionnaire assessing mental health literacy was developed and tested using a three-step approach: 1) item generation in which the principles of public patient involvement were essential, 2) item testing and 3) exploration of psychometric properties. Internal consistency of the questionnaire was determined through Cronbach's alpha and confirmatory factor analysis was conducted in order to determine the construct validity of the questionnaire. The results demonstrated partly skewed data, good internal consistency, good Kaiser-Meyer-Olkin and acceptable results in the goodness of fit index. The initial results suggest that the questionnaire developed and validated in this study is valuable in assessing mental health literacy and could provide useful, essential information on the topic. It thus appears to be a promising tool in the promotion and improvement of mental health and early intervention of mental health problems among adolescents.

Psychometric evaluation of the illness perception questionnaire for schizophrenia in a Chinese population

BACKGROUND

Illness perceptions have been associated with patients' reactions to health threats and further health outcomes. The Illness Perception Questionnaire for Schizophrenia (IPQS)¹ has been applied in different contexts. However, the validity and reliability of IPQS remain unknown in mainland China.

AIMS AND OBJECTIVES

To test the psychometric properties of the Chinese version of IPQS in mainland China.

DESIGN

A cross-sectional survey.

METHODS

A total of 200 community-dwelling patients with schizophrenia were surveyed in Beijing, China. The validity and reliability of the instrument were tested. As well as demographic data, the IPQS and the Knowledge About Schizophrenia Test (KAST)² were also administered.

RESULTS

Factor analysis was utilised to refine the factor structure of the IPQS. The difference between IPQS and KAST denoted the discriminant validity. The subscale scores among patients of different illness duration, educational attainment, and medication adherence in the past two years were significantly different (P＜0.05), indicating the known-group validity of the IPQS. Except for 'personal control' and 'burdensome effect', other subscales were internally consistent. Most of the subscales proved stable over a four-week period.

CONCLUSION

The Chinese version of IPQS can be used, with some refinements, to assess illness perceptions about schizophrenia for patients in future studies. This will provide empirical evidence for its generalizability and clinical utility and provide deeper insight into Chinese patients' illness perceptions about schizophrenia.

Destigmatizing psychosis: Investigating the effectiveness of a school-based programme in Hong Kong secondary school students

AIM

Although the reasons behind the stigmatization of psychosis are manifold, poor mental health literacy among the general public is likely to be a major factor. In Hong Kong, the Early Psychosis Foundation (EPISO) was established in 2007 to tackle this issue by providing educational and mental health promotional activities, among other aims and services. The current study evaluated the effectiveness of a school-based interventional programme, the School Tour, developed by EPISO.

METHODS

The School Tour differentiates itself from other interventional programmes by supplementing a traditional psychoeducational talk with 2 additional elements: an engaging drama performance and exercise demonstrations. Twelve secondary schools, with a total of 4520 students, participated in the study. Knowledge and attitudes towards psychosis were evaluated before and after the school programme.

RESULTS

The School Tour was found to improve both students' knowledge of psychosis (P < .001) and their attitude (P < .001) towards the illness.

CONCLUSIONS

Its effectiveness in reducing the stigma towards psychosis validates the use of novel strategies like drama performances to engage adolescent students, and urges the government to support increased student participation in the programme by providing funding to the relevant organizations.

Brief interactive psychoeducation for caregivers of patients with early phase psychosis in Yogyakarta, Indonesia

AIM

Brief psychoeducation for families of psychotic patients has been shown to significantly increase family members' knowledge of the disorder. This increase is associated with reductions in relapse and rehospitalization. The aim of this study was to assess the effectiveness of brief psychoeducation about schizophrenia to caregivers of patients in early phases of psychotic disorders in Yogyakarta, Indonesia.

METHODS

This study was a prospective, randomized trial with 2 parallel groups. Subjects were patients in the early phase of psychotic disorders and their respective caregivers. Inclusion criteria included a diagnosis of acute and transient psychotic disorders, schizophrenia, schizoaffective disorder or delusional disorder. Participants were randomly assigned to either control or intervention groups by means of paired simple randomization. A brief psychoeducation was conducted for both the patients and caregivers. The interventions were conducted in 4 interactive sessions, once per week. Effectiveness was measured using standardized instruments before the intervention, and at 1 and 6 months post-intervention. Assessment instruments included the Knowledge of Psychosis (KOP), the Compliance and Relapse Assessment, the Brief Psychiatric Rating Scale and the Positive and Negative Symptoms of Schizophrenia scale.

RESULTS

Interventions improved KOP scores significantly in the intervention group. The intervention group had increased regularity of follow-up with health providers and improved compliance. No statistically significant difference in relapses/rehospitalization was observed.

CONCLUSIONS

This study demonstrated that brief psychoeducation with caregivers of patients with early phase psychosis was feasible in our setting, significantly improved caregivers' knowledge, and resulted in improved regularity of contact with health providers and compliance with pharmacotherapy.

The effect of media reporting of a homicide committed by a patient with schizophrenia on the public stigma and knowledge of psychosis among the general population of Hong Kong

PURPOSE

This study aimed to investigate the effects of media reporting of a homicide committed by a patient with schizophrenia on the knowledge about and stigma regarding psychosis among the general Hong Kong population. The effects of using the term 'schizophrenia (jing-shen-fen-lei)' in the news on the perceptions of the new Chinese term 'psychosis (si-jue-shi-tiao)' were explored.

METHODS

Random telephone surveys of the general Hong Kong population were conducted in April 2009 (1 month before the incident) and June 2009 (1 week after the incident). Stigma was measured with the Link's Perceived Discrimination-Devaluation Scale (LPDDS). Knowledge about the symptoms, treatment and belief of dangerousness of psychosis were assessed. The emotional reaction of the public to the news was explored, and its effects on knowledge and stigma were studied.

RESULTS

Overall, 1016 and 506 participants completed the two surveys. More participants in the post-incident survey agreed that people with psychosis are dangerous to the public (χ² = 4.934, p = 0.026). However, no significant differences were observed in the LPDDS scores. Participants who reported a high level of distress related to the news were more likely to perceive people with psychosis as dangerous to the public (χ² = 6.738, p = 0.009). Women and older people reported greater distress.

CONCLUSIONS

These findings suggest that media reporting of violent incidents involving people with schizophrenia increases the public belief in the dangerousness of people with psychosis but not the overall stigma. Further studies of the differential effects of violence reporting on public perceptions about people with psychosis and schizophrenia are warranted.

Managing information gaps on caregivers of psychotic patients in primary health settings of Yogyakarta, Indonesia

Background: Information gaps hinder the management of psychotic patients. Incorporating mental health services into primary care might solve the problem. Health workers can be trained to provide psycho-education for caregivers of psychotic patients.

Methods: This study was a two stage experimental study. In the first stage, 43 health workers were trained to provide a psycho-education for caregivers of psychotic patients. Next, 10 health workers were selected to provide the psycho-education. Participants were family caregivers of psychotic patients (n = 113) randomly assigned to control and intervention groups. Pre- and post-tests were conducted to assess the results. Statistical analyses were conducted using paired t tests and analysis of covariance (ANCOVA).

Results: The intervention group scored higher for Knowledge of Psychosis at post-test. Both groups showed significant increase of knowledge (paired t tests: P<0.001; P<0.001; respectively) and the increases were not significantly different between the groups (ANCOVA: P=0.057).

Conclusion: Psycho-education was applicable in primary care settings. Training primary care health workers is a feasible method to address information gaps in the management of mental health problems.

Evaluating Mental Health Literacy in the Workplace: Development and Psychometric Properties of a Vignette-Based Tool

Purpose Early intervention and support for workers with mental health problems may be influenced by the mental health literacy of the worker, their colleagues and their supervisor. There are gaps, however, in our understanding of how to develop and evaluate mental health literacy within the context of the workplace. The purpose of this study was to evaluate the psychometric properties of a new Mental Health Literacy tool for the Workplace (MHL-W). Methods The MHL-W is a 16-question, vignette-based tool specifically tailored for the workplace context. It includes four vignettes featuring different manifestations of mental ill-health in the workplace, with parallel questions that explore each of the four dimensions of mental health literacy. In order to establish reliability and construct validity, data were collected from 192 healthcare workers who were participating in a mental health training project. Baseline data was used to examine the scale's internal consistency, factor structure and correlations with general knowledge ratings, confidence ratings, attitudes towards people with mental illness, and attitudes towards seeking help. Paired t-tests were used to examine pre and post intervention scores in order to establish responsiveness of the scale. Results There was strong support for internal consistency of the tool and a one-factor solution. As predicted, the scores correlated highly with an overall rating of knowledge and confidence in addressing mental health issues, and moderately with attitudes towards seeking professional help and (decreased) stigmatized beliefs. It also appears to be responsive to change. Conclusions The MHL-W scale is promising tool to track the need for and impact of mental health education in the workplace.

Is there a link between biological parents' insight into their offspring's schizophrenia and their cognitive functioning, expressed emotion and knowledge about disorder?

BACKGROUND

Recent studies suggest that parents' awareness of their offspring's schizophrenia could influence their offspring's insight. Low patient insight is linked to impairment of specific cognitive abilities, and biological parents of schizophrenia patients have impaired capacities in these same domains. However, little is known about what specific socio-demographic, affective or cognitive factors may influence biological parents' awareness of their offspring's disease.

METHOD

Data were drawn from 41 patient-parent dyads. Insight was assessed with a modified version of Amador's Scale to assess Unawareness of Mental Disorders, exploring dimensions of parents' awareness and attribution of their offspring's illness and symptoms.

RESULTS

Higher educational levels, better working memory and executive functioning of parents were associated with better attribution of their offspring's symptoms to schizophrenia.

CONCLUSIONS

Parents' insight into their offspring's schizophrenia is associated with cognitive abilities. This must be taken into account when developing family interventions.

Gender effect on public stigma changes towards psychosis in the Hong Kong Chinese population: a comparison between population surveys of 2009 and 2014

PURPOSE

Public stigma is an important barrier to the recovery of patients with psychosis. The current study aimed to investigate the change in stigma towards psychosis and knowledge about psychosis between 2009 and 2014 among the Chinese population in Hong Kong, with a specific focus on gender role.

METHODS

Random telephone survey of general population in Hong Kong was conducted in 2009 and 2014. Stigma was measured with the revised Link's Perceived Discrimination-Devaluation Scale (LPDDS). Logistic regression was used to explore the effect of time on the change of knowledge of psychosis, and linear regression was used to explore the effect of time on the change of stigma. Change of knowledge and stigma based on gender was specifically explored.

RESULTS

In total, 1016 and 1018 subjects completed the survey in 2009 and 2014, respectively. Significantly, more people agreed with medication treatment for psychosis and fewer people had misunderstanding about psychosis. However, there was no significant change in stigma levels. Males were found to have a significant deterioration of stigma (B = 0.099, SE = 0.033, β = 0.100, p = 0.003) but not females. Significantly, more males endorsed medication treatment for psychosis (χ ² = 5.850, df = 1, p = 0.016) but no change for females (χ ² = 1.401, df = 1, p = 0.238).

CONCLUSIONS

Results of this study suggested that there was an improvement in the biological understanding of psychosis but no change of public stigma within the Hong Kong Chinese population. The specific role of gender in relation to stigma and level of knowledge about psychosis indicates that this should be a consideration in designing future anti-stigma campaigns.

Expanding a measure of mental health literacy: Development and validation of a multicomponent mental health literacy measure

Mental health literacy (MHL) is an important factor in mental health care. However, few measures are available that assess multiple components of MHL and that are applicable to lay community people. A valid, comprehensive measure is needed to adequately identify the level of MHL and need for mental health education. This study presents the development of a multicomponent MHL measure and its psychometric properties. Participants (n=211) were recruited from a local public housing authority in Texas. A series of an exploratory factor analysis, a confirmatory factor analysis, an independent sample t-test, and a correlation analysis were used to assess construct, known-groups, and concurrent validity. Internal consistency reliability was examined by Kuder-Richardson Formula 20. The result suggested a second-order factor model by three first-order factors: knowledge-oriented MHL; beliefs-oriented MHL; resource-oriented MHL. This measure was a valid tool to assess MHL among public housing staff. This measure can be useful in examining lay community members' levels of MHL.

Measurement properties of tools measuring mental health knowledge: a systematic review

BACKGROUND

Mental health literacy has received great attention recently to improve mental health knowledge, decrease stigma and enhance help-seeking behaviors. We conducted a systematic review to critically appraise the qualities of studies evaluating the measurement properties of mental health knowledge tools and the quality of included measurement properties.

METHODS

We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library, and ERIC for studies addressing psychometrics of mental health knowledge tools and published in English. We applied the COSMIN checklist to assess the methodological quality of each study as "excellent", "good", "fair", or "indeterminate". We ranked the level of evidence of the overall quality of each measurement property across studies as "strong", "moderate", "limited", "conflicting", or "unknown".

RESULTS

We identified 16 mental health knowledge tools in 17 studies, addressing reliability, validity, responsiveness or measurement errors. The methodological quality of included studies ranged from "poor" to "excellent" including 6 studies addressing the content validity, internal consistency or structural validity demonstrating "excellent" quality. We found strong evidence of the content validity or internal consistency of 6 tools; moderate evidence of the internal consistency, the content validity or the reliability of 8 tools; and limited evidence of the reliability, the structural validity, the criterion validity, or the construct validity of 12 tools.

CONCLUSIONS

Both the methodological qualities of included studies and the overall evidence of measurement properties are mixed. Based on the current evidence, we recommend that researchers consider using tools with measurement properties of strong or moderate evidence that also reached the threshold for positive ratings according to COSMIN checklist.

A population study of public stigma about psychosis and its contributing factors among Chinese population in Hong Kong

PURPOSE

Public stigma is an important barrier to the recovery of patients with psychosis. This study aimed to explore public stigma associated with a newly adopted Chinese name for psychosis 'si-jue-shi-tiao' in a representative Chinese population in Hong Kong, focusing on factors contributing to public stigma. Exposure to mass media and its relationship with the stigma were explored in detail.

METHODS

Random telephone survey of general population in Hong Kong was conducted. Information including basic demographics, psychosis literacy, recent news recall about psychosis and stigma, measured with the revised Link's Perceived Discrimination-Devaluation Scale (LPDDS) were obtained. Univariate analysis of LPDDS score and demographic variables, news exposure, previous contacts with people with psychosis and knowledge about psychosis were conducted. Further hierarchical regression analysis was performed.

RESULTS

A total of 1,016 subjects were interviewed. The sample was comparable with the whole Hong Kong population aged 18 years and above. Those of female gender, with higher educational level and better knowledge about symptoms and treatment of psychosis had higher score of LPDDS. The model significantly explained 8.3% of variance of LPDDS score (F(7, 895) = 12.606, p < .0001, p < .0001). The negative news recall had trend significance in the model.

CONCLUSION

The finding suggested that discrimination among the general public against people with psychosis was still common. Specific strategies will need to be established in targeting media news reporting about psychosis, knowledge disseminating and needs of specific population. Further researches should be conducted to understand the mechanisms of the stigma development in relation to these factors so that more focused and effective strategies could be developed.

Adaptation of a peer based online emotional support program as an adjunct to treatment for people with schizophrenia-spectrum disorders

The aim of this study was to describe the adaptation of a program designed to leverage 7 Cups of Tea (7Cups), an available online platform that provides volunteer (i.e., listener) based emotional support, to complement ongoing treatment for people with schizophrenia-spectrum disorders. The adaptation of the program was based on two stages: First, following platform demonstration, six clinicians specializing in the treatment of schizophrenia completed a survey examining attitudes towards the program and suggested modifications. In response to clinicians' feedback, a computerized training program that provides information for listeners supporting people with schizophrenia was developed, and one hundred and sixty eight listeners completed an online knowledge test. In the second stage, 10 outpatients with schizophrenia-spectrum disorders were recruited to chat with listeners, provided post-session open-ended comments as well as usability and usefulness ratings assessed on a five point Likert scale. The additional training significantly increased listeners' knowledge and confidence (0.38 < = Cohen's d < = 1.14, p < = .024). Patients' attitudes towards the listeners were positive and they expected the platform will be usable and helpful. Most patients expected a positive gain by having the opportunity to receive an outlet for emotions and socialize. The authors conclude that the use of an available digital platform resulted in a feasible intervention in terms of cost and availability, which is now ready for evaluation in real-world settings.

Impact of co-facilitated information programmes on outcomes for service users and family members: the EOLAS programmes (paper 2)

Objective

The present study evaluated the impact on psychosocial outcome of parallel clinician and peer-led information programmes for people with a diagnosis of schizophrenia and bipolar disorder and for family members within an Irish context.

Methods

A sequential mixed method design was used. Quantitative data were collected using pre- and post-programme questionnaires followed by an integrated qualitative component involving semi-structured interviews after the programme. The questionnaires assessed knowledge, attitudes towards recovery, hope, support, advocacy and well-being. Interviews with participants, facilitators and project workers explored their experiences and views of the programme.

Findings

While a number of the questionnaires did not show a statistically significant change, findings from the interviews suggest that the1 programmes had a number of positive outcomes, including increases in perceived knowledge, empowerment and support. Participants in both programmes valued the opportunity to meet people in similar circumstances, share their experiences, learn from each other and provide mutual support.

Conclusion

The EOLAS programmes offer a novel template for communication and information sharing in a way that embodies the principles of collaboration and offers users and families a meaningful opportunity to become involved in service design, delivery and evaluation.

Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review

BACKGROUND

Mental health literacy has received increasing attention as a useful strategy to promote early identification of mental disorders, reduce stigma and enhance help-seeking behaviors. However, despite the abundance of research on mental health literacy interventions, there is the absence of evaluations of current available mental health literacy measures and related psychometrics. We conducted a scoping review to bridge the gap.

METHODS

We searched PubMed, PsycINFO, Embase, CINAHL, Cochrane Library, and ERIC for relevant studies. We only focused on quantitative studies and English publications, however, we didn't limit study participants, locations, or publication dates. We excluded non-English studies, and did not check the grey literature (non peer-reviewed publications or documents of any type) and therefore may have missed some eligible measures.

RESULTS

We located 401 studies that include 69 knowledge measures (14 validated), 111 stigma measures (65 validated), and 35 help-seeking related measures (10 validated). Knowledge measures mainly investigated the ability of illness identification, and factual knowledge of mental disorders such as terminology, etiology, diagnosis, prognosis, and consequences. Stigma measures include those focused on stigma against mental illness or the mentally ill; self-stigma ; experienced stigma; and stigma against mental health treatment and help-seeking. Help-seeking measures included those of help-seeking attitudes, intentions to seek help, and actual help-seeking behaviors.

CONCLUSIONS

Our review provides a compendium of available mental health literacy measures to facilitate applying existing measures or developing new measures. It also provides a solid database for future research on systematically assessing the quality of the included measures.

Knowledge in schizophrenia: The Portuguese version of KAST (Knowledge About Schizophrenia Test) and analysis of social-demographic and clinical factors' influence

Schizophrenia is a complex disorder, and the knowledge about it can have a positive impact. The purpose of this study was to make the translation and cultural adaptation of the Knowledge About Schizophrenia Test (KAST) into Portuguese and determine the influence of clinical and socio-demographic factors on knowledge. The test was applied to 189 caregivers of patients enrolled in Schizophrenia Program of the Federal University of São Paulo, 30 caregivers of clinical patients of the General Outpatient Clinic of the same University, and 30 health professionals. The face and content validity of the test was established. The mean value (SD) obtained with the application of the final version to caregivers of schizophrenic patients was 12.96 (2.45) - maximum 17. Level of knowledge increased considering the following order: caregivers of clinical patients, caregivers of patients with schizophrenia and mental health professionals. The intraclass correlation coefficient (0.592) obtained in the test-retest was statistically significant. An influence of social class, race, gender and education of the caregiver on the test was observed, and the last two factors were more relevant. The KAST translated and adapted into Portuguese is a valid instrument and can be used as an evaluation tool on psychoeducational interventions.

Insight of patients and their parents into schizophrenia: Exploring agreement and the influence of parental factors

Poor insight is found in up to 80% of schizophrenia patients and has been associated with multiple factors of which cognitive functioning, social and environmental factors. Few studies have explored associations between patient insight and that of their biological parents', and the influence of parental factors. Insight was assessed in 41 patients and their biological parents with Amador's Scale for the assessment of Unawareness of Mental Disorder (SUMD). Parents' knowledge about schizophrenia and critical attitudes were assessed with validated self-report questionnaires. Both groups underwent cognitive assessments for working memory and executive functioning. Insight in patients and their parents was not associated for any of the SUMD dimensions but a significant correlation was found between patient and parent awareness of treatment effect for patient-parent dyads with frequent daily contact. Low parental critical attitude was associated with higher patient awareness of symptoms and a high parental memory task score with high patient insight. Our study is the first to suggest a possible influence of parental factors such as critical attitudes and cognitive performance on patient insight.

Perceived risk of relapse and role of medication: comparison between patients with psychosis and their caregivers

PURPOSE

Studies have suggested that appraisal of relapse risk and knowledge of medications in relapse prevention may shape one's reactions towards an illness and treatment, and influence the illness outcome. The aim of this study is to explore patients' and caregivers' knowledge of medications, perceived chances of relapse and its predictors, as well as their relations with medication adherence.

METHODS

Eighty patient-caregiver dyads participated in the study. Their knowledge about psychosis, specific knowledge about medications and course of illness of their own and their relatives, medication adherence and symptomatology of patients were assessed. Differences in knowledge between patients and caregivers were compared. The link between adherence with perceived relapse risk and consequences of stopping medication were explored. Multinomial regression analyses were performed to examine predictors of perceived relapse risk.

RESULTS

More patients underestimated their chance of relapse and were unaware that stopping medication may lead to relapse. The lack of understanding about the effect of stopping medication of both caregivers and patients was related to poor medication adherence of patients. Patients perceived of having higher chance of relapse had more severe positive symptoms. Positive symptoms of patients and greater knowledge about psychosis of caregivers were related to higher caregivers' perceived relapse risk of their relative.

CONCLUSIONS

This study explored the views of patients and their caregivers on the perceived risk of relapse and role of medication in preventing relapse, and the potential significance. Specific interventions addressing these areas should be considered in developing relapse prevention programs.

Comparing accuracy of knowledge of functional effects of schizophrenia and brain injury

This study developed and validated the Brain Injury and Schizophrenia Awareness Scale (BISAS) to compare accuracy of knowledge of functional effects of schizophrenia and TBI. The BISAS displayed good internal consistency and evidence of construct validity. Overall, general community participants (n=143) lacked understanding of the shared effects of these conditions, and attributed emotional and behavioural deficits to schizophrenia and cognitive deficits to TBI.

Medication adherence, knowledge about psychosis, and insight among patients with a schizophrenia-spectrum disorder

This study aimed to explore the relationship between knowledge about psychosis, insight, and medication adherence among patients at an early stage of a schizophrenia-spectrum disorder. Eighty patients were recruited from a specialized outpatient clinic. Knowledge was assessed with the modified Knowledge About Schizophrenia Test (KAST). Medication adherence was determined with the Chinese abridged Medication Adherence Ratings Scale. Insight was measured with the abridged Scale to Assess Unawareness of Mental Disorder (SUMD). The KAST total score was correlated with the SUMD. A trend correlation between KAST subscores of cause and SUMD was found. The nonadherence rate was 43.8%. The medication-adherent patients had lower SUMD (z = -4.338, p < 0.0001) and higher KAST subscore of cause (z = -2.767, p = 0.006). These two variables explained 38.9% of the variance in adherence behavior, with SUMD being the mediator. This study highlights the importance of patients' understanding of etiology of the illness and its relationship with insight and medication adherence.

Development, item analysis, and initial reliability and validity of a multiple-choice knowledge of mental illnesses test for lay samples

The public's level of mental health literacy remains low, despite growing access to information regarding mental illnesses. Because few measures exist to assess the level of knowledge of mental illnesses in lay samples, the Multiple-Choice Knowledge of Mental Illnesses Test (MC-KOMIT) was developed, initially for use in a study involving police officers, some of whom received 40 h of training focused on recognizing mental illnesses, using verbal de-escalation techniques, and making mental health referrals when appropriate. This report details the initial development of the 100 questions in the item bank and the eventual selection of the final 33 items that were retained. For these 33 items, internal consistency was demonstrated, and test-retest reliability was examined among officers not in the mental health-related training who completed the test on Monday morning and again on Friday afternoon. Construct validity was examined by three hypothesis tests: the MC-KOMIT was sensitive to change related to the educational intervention, scores were significantly correlated with years of educational attainment, and officers reporting past or current treatment for a mental health problem scored higher than those without such a history. This initial report suggests that the MC-KOMIT may be useful in quantifying knowledge of mental illnesses in police officers and other diverse lay samples.

Family-level predictors and correlates of the duration of untreated psychosis in African American first-episode patients

BACKGROUND

Little is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain.

METHODS

From a sample of 109 patients, 42 African American patients with family-level data were included. Cox proportional hazard models quantified associations between family-level predictors and DUP, and analyses controlled for effects of three previously determined patient-level predictors of DUP - mode of onset of psychosis, living with family members versus alone or with others, and living above versus below the federal poverty level.

RESULTS

The median DUP was 24.5 weeks. Greater family strengths and a better family coping capacity were associated with a shorter DUP, whereas higher insight among informants and greater level of perceived caregiver strain were associated with a longer DUP.

CONCLUSIONS

Whereas family strengths and coping likely account for a significant portion of variability in DUP, both insight and caregiver strain probably evolve as a consequence of DUP. Efforts to strengthen families and tap into existing strengths of families in specific cultural groups would likely enhance early treatment-seeking for psychotic disorders.