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Prior E, Papathomas A, Rhind D. Navigating athlete mental health: Perspectives from performance directors within elite sport. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 73:102661. [PMID: 38735507 DOI: 10.1016/j.psychsport.2024.102661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
Performance directors lead high-performance programmes within elite sport and where they opt to invest resources has implications for athletes. This study explores performance directors' perspectives on mental health and illness and their experiences of managing these within elite sport. We conducted semi-structured interviews with 11 performance directors, resulting in 18 h of data. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We constructed three themes: 1) making sense of mental health: legitimacy vs. scepticism; 2) mental health as athlete responsibility; and 3) simplifying and sanitising mental health. Performance directors used physical health analogies to make sense of mental health, sometimes describing unrealistic expectations regarding mental health management. They also positioned athletes as responsible for finding solutions to their mental health concerns, at times overlooking the impact of the elite sport environment. Some performance directors shared over-simplified perceptions of mental health, often focusing on 'the positive' and neglecting to talk about the more challenging aspects of mental health and illness. Educating performance directors, as well as others in leadership positions, on the complexities of mental health and illness is recommended. This should include how mental illness differs from physical illness and injury, how to respond when athletes disclose mental health concerns, and how mental illness recovery is often nonlinear and subjectively defined.
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Affiliation(s)
- Erin Prior
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK.
| | - Anthony Papathomas
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Daniel Rhind
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
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Ward L. Worry-YING and Worry-YANG: A Critical Feminist Study with Women Who Worry. Issues Ment Health Nurs 2024; 45:715-723. [PMID: 38901022 DOI: 10.1080/01612840.2024.2346591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Gender is a critical determinant of mental health and well-being. Women are at greater risk of mental illness due to gender-based violence, economic disadvantage, and low social status. Women experience higher levels of acute and chronic stress and are twice as likely to be diagnosed with anxiety disorder. Anxiety disorder is a serious public health problem affecting 1:3 people worldwide, and according to WHO's International Classification of Diseases (ICD-10), a key symptom of anxiety is excessive worry. Few studies, however, have explored worry as a precursor to anxiety, and fewer have explored worry in relation to gender. This critical feminist study aimed to explore this phenomenon and identify the impact of worry on women and their mental health and well-being. Methods: Forty-five women living in Melbourne, Australia, participated in this qualitative study. They attended a 1-h semi-structured interview with the researcher to define and discuss worry and identify any impact or effect worry or worrying has had on their life as women. Results: The findings revealed that women worry about children, money, work, study, and violence against women. Conclusions: This study builds on the existing knowledge of the mental health and well-being of women, supports early intervention strategies to prevent anxiety disorder and long-term health risks; and meets the core objectives of the National Women's Health Strategy 2020-2030 to 'Improve the health and wellbeing of all women and girls in Australia'.
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Affiliation(s)
- Louise Ward
- Nursing, Southern Cross University, Lismore, New South Wales, Australia
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Shi J, Chen Y, Jiang Y, Li Y, Wang W, Zhao H, Guo L, Liao Y, Zhang H, Gao C, McIntyre RS, Zhang WH, Han X, Lu C. Stigma and its associations with medication adherence in major depressive disorder. Psychiatry Res 2024; 331:115664. [PMID: 38070363 DOI: 10.1016/j.psychres.2023.115664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/02/2024]
Abstract
This study sought to evaluate internalized stigma (IS) and perceived stigma (PS), in persons (n = 522) living with major depressive disorder (MDD), with a view to analyzing the association of IS and PS with medication adherence in a cohort of participants with MDD in China. Perceived stigma is the awareness of societal negative views and attitudes towards depression, and IS is applying others' attitudes to oneself, both measured by the Depression Stigma Scale (DSS). Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). We observed that 76.0 % of participants reported IS and 84.5 % reported PS. Factors associated with increased IS included older age, marital status, disease history, and a higher baseline Patient Health Questionnaire-9 (PHQ-9). Higher education level, family income, and scores on the Connor-Davidson Resilience Scale (CD-RISC) were associated with lower levels of IS. Higher education levels, Childhood Trauma Questionnaire (CTQ) scores, and living with others were also associated with higher PS, while engagement in exercise and higher number of prior episodes were associated with lower PS. IS had a negative association with medication adherence, whereas PS did not significantly associate with adherence. In conclusion, a testable hypothesis is derived from our data that strategies targeting IS amongst persons with MDD may improve overall rates of adherence to antidepressant treatment, a necessary prelude to improving recovery.
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Affiliation(s)
- Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Yingchen Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Hao Zhao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Caihong Gao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China.
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Loveridge S, Skidmore M, Shupp R, Miller PK, Cuthbertson C, Goetz S. Rural US residents recognize anxiety better than urbanites and suburbanites but hold similar stigma. J Rural Health 2023; 39:860-869. [PMID: 36988517 DOI: 10.1111/jrh.12757] [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] [Indexed: 03/30/2023]
Abstract
PURPOSE Recognizing signs of psychological distress is a critical first step in assisting people who are struggling with poor mental health to access help. However, community-level factors that impact recognition and stigma are underexplored. The purpose of this study is to investigate the relationship between rurality, other community-level variables, and individual variables with regard to the recognition and stigma of anxiety. METHODS We use a survey of US adults (N = 627), including a rural oversample, and a cloaked vignette approach. We assess the ability to identify anxiety and measure associated stigma. The analysis applies an ecological model in multinomial logistic regressions. FINDINGS About half of the respondents recognize anxiety from a list of possibilities when provided with a vignette detailing common anxiety symptoms. Respondents living in rural areas are nearly twice as likely to correctly identify anxiety than nonrural respondents. About one-fifth of respondents agree with a statement designed to measure stigma: that exhibiting the symptoms is a sign of personal weakness. Respondents able to identify anxiety show less stigma. Respondents from counties with high mental health provider access were less likely to endorse the stigma statement. CONCLUSIONS Rural areas seem poised to reduce the stigma associated with anxiety, because residents are more adept at identifying anxiety than people living elsewhere. Future work could focus on effective mechanisms for reducing stigma associated with anxiety in rural areas, and whether anxiety recognition and stigma are changing.
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Affiliation(s)
- Scott Loveridge
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, Michigan, USA
| | - Mark Skidmore
- Department of Agricultural, Food, and Resource Economics and Department of Economics, Michigan State University, East Lansing, Michigan, USA
| | - Robert Shupp
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, Michigan, USA
| | - Paula K Miller
- Department of Sociology and Anthropology, Ohio University, Athens, Ohio, USA
| | - Courtney Cuthbertson
- Human Development and Family Studies, University of Illinois, Urbana-Champaign, Urbana, Illinois, USA
| | - Stephan Goetz
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, State College, Philadelphia, Pennsylvania, USA
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ÇİLEK NZ, AKKAYA C. A Review on Mental Illness and Stigma. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1069845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The concept of stigma is a universal problem that has been the subject of many studies. The phenomenon of stigmatization in psychiatric disorders is also an issue that should be particularly emphasized. Studies have reported that the diagnostic groups most exposed to stigmatization are psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, and substance use disorders. The stigma process is shaped especially by the clinical features of psychiatric disorders and the society’s attributions to the causes of psychiatric disorders. IIn order for interventions to be developed to prevent stigmatization to be effective, the causes of stigmatization must first be understood.. Therefore, in this study, it is aimed to review the stigmatization processes separately according to the types of psychiatric disorders.
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Davidson MC, Lu S, Barrie MB, Freeman A, Mbayoh M, Kamara M, Tsai AC, Crea T, Rutherford GW, Weiser SD, Kelly JD. A post-outbreak assessment of exposure proximity and Ebola virus disease-related stigma among community members in Kono District, Sierra Leone: A cross-sectional study. SSM - MENTAL HEALTH 2022; 2:100064. [PMID: 35449727 PMCID: PMC9017820 DOI: 10.1016/j.ssmmh.2022.100064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Based on findings from other contexts, informed by intergroup contact theory, that more contact is associated with less stigma, we hypothesized that community members with greater exposure to cases of Ebola virus disease (EVD) were less likely to report EVD-related stigma towards EVD survivors. We assessed personal stigmatizing attitudes towards Ebola survivors, which reflects personal fear and judgement, as well as perceived stigma towards EVD survivors, which reflects an individual's perception of the attitudes of the community towards a stigmatized group. Methods From September 2016 to July 2017, we conducted a cross-sectional, community-based study of EVD-related stigma among individuals who did not contract Ebola in four EVD-affected rural communities of Kono District, Sierra Leone. We identified individuals from all quarantined households and obtained a random sample of those who were unexposed. Exposed individuals either lived in a quarantined household or were reported to have been in contact with an EVD case. Our explanatory variable was proximity to an EVD case during the outbreak. Our primary outcome was stigma towards EVD survivors, measured by a 6-item adapted HIV-related stigma index validated in Zambia and South Africa, with 1 item reflecting personal stigmatizing attitudes and 5 items reflecting perceived community stigma. The 6-item EVD stigma index had good internal consistency (Cronbach's alpha=0.82). We used modified Poisson and negative binomial regression models, adjusting for potential confounders, to estimate the association between exposure proximity and EVD stigma. Results We interviewed 538 participants aged 12 to 85 years. Most (57%) had been quarantined. Over one-third (39%) reported personal stigmatizing attitudes or perceived community stigma; the most frequently endorsed item was fear and judgment towards EVD survivors. Having contact with someone with EVD was significantly associated with a lower likelihood of perceived community stigma (prevalence ratio [PR], 0.26; 95% CI, 0.13-0.54) and personal stigmatizing attitudes (PR, 0.44; 95% CI, 0.29-0.65). In contrast, being quarantined was significantly associated with a higher likelihood of perceived community stigma (PR, 3.9; 95% CI, 1.5-10.1). Conclusions In this cross-sectional study, we found evidence of an inverse relationship between EVD-related stigma and contact with an EVD case. This finding substantiates intergroup contact theory and may form the basis for anti-stigma interventions.
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Affiliation(s)
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - M. Bailor Barrie
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
- Partners In Health, Freetown, Sierra Leone
| | | | | | | | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Crea
- School of Social Work, Boston College, Boston, MA, USA
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - J. Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
- F.I. Proctor Foundation, University of California, San Francisco, CA, USA
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Li XY, Liu Q, Chen P, Ruan J, Gong X, Luo D, Zhou Y, Yin C, Wang XQ, Liu L, Yang BX. Predictors of Professional Help-Seeking Intention Toward Depression Among Community-Dwelling Populations: A Structural Equation Modeling Analysis. Front Psychiatry 2022; 13:801231. [PMID: 35280177 PMCID: PMC8907597 DOI: 10.3389/fpsyt.2022.801231] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background A low intention of professional help seeking hinders the effective treatment of depression. The factors are from the perspectives of the social, family, and individual; however, an understanding of how they interact to predict professional help-seeking intention (PHSI) is not clear. Objectives The objectives of the study was to investigate PHSI toward depression in a Chinese community-dwelling population and construct a predictive model of the PHSI to explore the various factors involved. Methods Stratified random sampling and Kish table methods were used to identify 2,000 community residents. Participants completed a series of questionnaires to measure general characteristics, PHSI, professional help-seeking attitude, depression stigma, depression knowledge, family function, and depression symptoms. Analyses included descriptive statistics and Pearson correlation analysis using SPSS 26.0 and a Structural Equation Model using Amos 22.0. Results The score of the PHSI was 14.92 ± 9.574. Professional help-seeking attitude (r = 0.291, p < 0.001) and depression knowledge (r = 0.077, p = 0.002) were positively related to PHSI, while a negative correlation was found between stigma (r = -0.149, p < 0.001) and PHSI. The model of the PHSI indicated a good fit with a CMIN/DF = 2.740 and RESEA = 0.032. The total effect of the influencing factors on the PHSI was listed in the following order: professional help-seeking attitude (0.676) > stigma (-0.143) > depression knowledge (0.088) > depression symptoms (-0.009) > family function (0.005). The total effect of depression knowledge on PHSI included a direct negative effect (Beta = -0.266, p < 0.001) and an indirect positive effect (0.354) through professional help-seeking attitude and stigma. Also, depression knowledge was negatively associated with stigma (Beta = -0.153, p < 0.001). Depression symptoms were negatively associated with family function (Beta = -0.282, p < 0.001), depression knowledge (Beta = -0.252, p < 0.001), and stigma (Beta = -0.102, p < 0.001), indicating that people with less severe depression symptoms had good family function, depression knowledge, and higher stigma. Family function contributed a positive effect on depression knowledge directly (Beta = 0.145, p < 0.001) and a totally positive effect (0.033) on stigma. Conclusion The PHSI toward depression is low among Chinese community residents. Professional help-seeking attitude, depression knowledge, and family functioning were facilitators of PHSI, and stigma and the severity of depression symptoms were barriers to PHSI. This study provides reference for the development of policies and guidelines to promote community residents to actively seek professional mental health help. Future policies can focus on multicollaboration among the government, mental health services, and families to increase the mental health resources, improve family functioning, enhance mental health literacy (MHL) of the public, and reduce depression stigma to ease the burden of this mental health issue.
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Affiliation(s)
- Xin Yi Li
- School of Nursing, Wuhan University, Wuhan, China
| | - Qian Liu
- School of Nursing, Wuhan University, Wuhan, China
| | - Pan Chen
- School of Nursing, Wuhan University, Wuhan, China
| | - Juan Ruan
- Wuhan Mental Health Center, Wuhan, China
| | - Xuan Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Luo
- School of Nursing, Wuhan University, Wuhan, China
| | - Yang Zhou
- Wuhan Mental Health Center, Wuhan, China
| | - Cong Yin
- Wuhan Mental Health Center, Wuhan, China
| | | | | | - Bing Xiang Yang
- School of Nursing, Wuhan University, Wuhan, China
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
- Population and Health Research Center, Wuhan University, Wuhan, China
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McKenzie SK, Oliffe JL, Black A, Collings S. Men's Experiences of Mental Illness Stigma Across the Lifespan: A Scoping Review. Am J Mens Health 2022; 16:15579883221074789. [PMID: 35125015 PMCID: PMC8832600 DOI: 10.1177/15579883221074789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The stigma of men's mental illness has been described as having wide-reaching and profound consequences beyond the condition[s] itself. Stigma negatively impacts men's mental health help-seeking and the use of services amid impeding disclosures, diminishing social connection and amplifying economic hardship. Although men often face barriers to discussing their struggles with, and help-seeking for mental illness challenges, research focused on men's lived experiences of mental illness stigma is, at best, emergent. This scoping review explores men's mental illness related stigmas synthesizing and discussing the findings drawn from 21 published qualitative articles over the last 10 years. Four thematic findings were derived: (a) the weight of societal stigma, (b) stigma in male-dominated environments, (c) inequity driven stigmas, and (d) de-stigmatizing strategies. Despite evidence that stigma is a common experience for men experiencing diverse mental illness challenges, the field remains underdeveloped. Based on the scoping review findings, research gaps and opportunities for advancing the field are discussed.
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Affiliation(s)
- Sarah K McKenzie
- Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, University of Melbourne, Victoria, Australia
| | - Alice Black
- Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Sunny Collings
- School of Health, Te Herenga Waka-Victoria University of Wellington, New Zealand
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Abstract
Humans, like other animals, are fundamentally motivated to pursue rewarding outcomes and avoid aversive ones. Anxiety disorders are conceptualized, defined, and treated based on heightened sensitivity to perceived aversive outcomes, including imminent threats as well as those that are uncertain yet could occur in the future. Avoidance is the central strategy used to mitigate anticipated aversive outcomes - often at the cost of sacrificing potential rewards and hindering people from obtaining desired outcomes. It is for these reasons that people are often motivated to seek treatment. In this chapter, we consider whether and how anhedonia - the loss of interest in pursuing and/or reduced responsiveness to rewarding outcomes - may serve as a barrier to recovering from clinically impairing anxiety. Increasingly recognized as a prominent symptom in many individuals with elevated anxiety, anhedonia is not explicitly considered within prevailing theoretical models or treatment approaches of anxiety. Our goal, therefore, is to review what is known about anhedonia within the anxiety disorders and then integrate this knowledge into a functional perspective to consider how anhedonia could maintain anxiety and limit treatment response. Our overarching thesis is that anhedonia disrupts the key processes that are central to supporting anxiety recovery. We end this chapter by considering how explicitly targeting anhedonia in treatment can optimize outcomes for anxiety disorders.
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Affiliation(s)
- Charles T Taylor
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Samantha N Hoffman
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Amanda J Khan
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Hanlon HR, Swords L. Adolescent Endorsement of the "Weak-Not-Sick" Stereotype for Generalised Anxiety Disorder: Associations with Prejudice, Discrimination, and Help-Giving Intentions toward Peers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155415. [PMID: 32731372 PMCID: PMC7432367 DOI: 10.3390/ijerph17155415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 12/02/2022]
Abstract
Stigma, comprising negative stereotypes, prejudice (negative affective reactions) and discrimination towards a member of a particular group, is of increasing interest in the context of mental illness. However, studies examining clinical anxiety stigma are lacking, particularly with regard to generalised anxiety disorder (GAD). There is also a lack of research into adolescent anxiety stigma, despite adolescence being a key period for early intervention for anxiety disorders, and research showing that stigma has been implicated in low rates of help-seeking and problematic peer relationships among adolescents with mental illness. Stigma has also been negatively associated with help-giving responses toward those with mental illness. Initial studies suggest that the ‘weak-not-sick’ (WNS) stereotype may be central to anxiety stigma. The present study aims to examine the endorsement of the WNS stereotype in the context of GAD, and its relationship to prejudice, discrimination, and help-giving responses among adolescents. A vignette-based survey measure was completed by 242 adolescents (74 male, 165 female, and three participants who recorded their gender as “other”) in Ireland aged between 15 and 19 years. The results of the study found that endorsement of the WNS stereotype was significantly associated with higher prejudice and discrimination, as well as lower levels of help-giving intentions. A multiple mediator model is presented showing both a direct relationship between endorsement of WNS and help-giving, and an indirect relationship between WNS and help-giving mediated by the prejudicial components of anger, fear and pity, and discrimination as assessed by desired social distance. This study adds to the limited knowledge base on stigma towards GAD in adolescents and provides a model for how anxiety stigma may relate to help-giving. This has implications for interventions to reduce stigmatising and increase help-giving responses.
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11
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Stigma towards depression in a community-based sample in China. Compr Psychiatry 2020; 97:152152. [PMID: 31838297 DOI: 10.1016/j.comppsych.2019.152152] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Understanding the general public's beliefs about depression is essential if public education and anti-stigma interventions are to be effective. This study aimed to examine Chinese respondents' personal attitudes towards depression and their perceptions about the attitudes of others regarding depression and to identify the correlates of personal stigma and perceived stigma towards depression. METHODS A community survey was conducted among 1697 residents aged between 16 and 89 years of a large city in central China using the Depression Stigma Scale. Participants completed questionnaires assessing experiences of depression and family functioning. RESULTS Participants reported high levels of stigma towards depression, with greater perceived stigma than personal stigma. Increasing age was correlated with greater personal stigma and perceived stigma. Higher personal stigma was also significantly correlated with being male, unemployed and good family function. CONCLUSION Concerningly high levels of stigmatizing beliefs towards depression were prevalent among the public. This may be a reason why people with mental disorders do not seek assistance. This highlights the importance of the need for health education and promotion activities. Findings from this study suggest that targeted, culturally appropriate education programs are needed to improve knowledge about depression in the broader community.
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12
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Wei Y, McGrath P, Hayden J, Kutcher S. The quality of mental health literacy measurement tools evaluating the stigma of mental illness: a systematic review. Epidemiol Psychiatr Sci 2018; 27:433-462. [PMID: 28462747 PMCID: PMC6999021 DOI: 10.1017/s2045796017000178] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/26/2017] [Indexed: 01/08/2023] Open
Abstract
AIMS Stigma of mental illness is a significant barrier to receiving mental health care. However, measurement tools evaluating stigma of mental illness have not been systematically assessed for their quality. We conducted a systematic review to critically appraise the methodological quality of studies assessing psychometrics of stigma measurement tools and determined the level of evidence of overall quality of psychometric properties of included tools. METHODS We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library and ERIC databases for eligible studies. We conducted risk-of-bias analysis with the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, rating studies as excellent, good, fair or poor. We further rated the level of evidence of the overall quality of psychometric properties, combining the study quality and quality of each psychometric property, as: strong, moderate, limited, conflicting or unknown. RESULTS We identified 117 studies evaluating psychometric properties of 101 tools. The quality of specific studies varied, with ratings of: excellent (n = 5); good (mostly on internal consistency (n = 67)); fair (mostly on structural validity, n = 89 and construct validity, n = 85); and poor (mostly on internal consistency, n = 36). The overall quality of psychometric properties also varied from: strong (mostly content validity, n = 3), moderate (mostly internal consistency, n = 55), limited (mostly structural validity, n = 55 and construct validity, n = 46), conflicting (mostly test-retest reliability, n = 9) and unknown (mostly internal consistency, n = 36). CONCLUSIONS We identified 12 tools demonstrating limited evidence or above for (+, ++, +++) all their properties, 69 tools reaching these levels of evidence for some of their properties, and 20 tools that did not meet the minimum level of evidence for all of their properties. We note that further research on stigma tool development is needed to ensure appropriate application.
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Affiliation(s)
- Y. Wei
- Faculty of Graduate Studies, Interdisciplinary PhD, Dalhousie University, Halifax, Nova Scotia, Canada
| | - P. McGrath
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - J. Hayden
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S. Kutcher
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Andrés-Rodríguez L, Pérez-Aranda A, Feliu-Soler A, Rubio-Valera M, Aznar-Lou I, Serrano-Blanco A, Juncosa M, Tosas A, Bernadàs A, Luciano JV. Effectiveness of the "What's Up!" Intervention to Reduce Stigma and Psychometric Properties of the Youth Program Questionnaire (YPQ): Results from a Cluster Non-randomized Controlled Trial Conducted in Catalan High Schools. Front Psychol 2017; 8:1608. [PMID: 28959228 PMCID: PMC5603659 DOI: 10.3389/fpsyg.2017.01608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/01/2017] [Indexed: 01/21/2023] Open
Abstract
Mental disorders are highly prevalent in the general population, and people who experience them are frequently stigmatized. Stigma has a very negative impact on social, academic/professional, and personal life. Considering the high rates of mental disorders among children and adolescents (13.4%) and how critical this age is in the formation of nuclear beliefs, many campaigns to combat stigma have been developed in the last decade, with mixed results. The OBERTAMENT initiative has produced various anti-stigma campaigns in Catalonia (Spain). In the present study, the main objective was to report on the effectiveness of the OBERTAMENT “What’s up!” intervention, a curricular intervention including education and social contact conducted by the teachers in the classroom with teenagers aged between 14 and 18. Prior to this, we examined the psychometric properties of the Youth Program Questionnaire (YPQ), our main outcome measure, in terms of dimensionality, reliability, and validity. A cluster non-randomized controlled trial was conducted to assess this intervention, which was tested in nine high schools situated in the Barcelona region. A convenience sample of 261 students formed the intervention group and 132 the control group (52% women, mean age = 14, SD = 0.47). The assignment to study conditions was conducted by Departament d’Ensenyament (Department of Education), Generalitat de Catalunya (Catalan Government). Participants were evaluated at baseline, post-intervention, and 9-month follow-up. The main outcome measure of this study was the YPQ. The Reported and Intended Behavior Scale (RIBS) was used as secondary outcome measure. The statistical analysis indicated that the YPQ possesses a two-factor structure (stereotypical attitudes and intended behavior) and sound psychometric properties. The multilevel mixed-effects models revealed statistically significant interactions for both study measures and post hoc intragroup analyses revealed a significant but small improvement in the YPQ and RIBS scores in the intervention group. Overall, our results indicate that “What’s up!” produced statistically significant, albeit small improvements in stereotypical attributions and intended behavior toward people with mental disorders. Some methodological limitations and the relatively low levels of stigma observed in our sample may undermine our results. The implications of our results are discussed in relation to stigma research.
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Affiliation(s)
- Laura Andrés-Rodríguez
- Institut de Recerca Sant Joan de DéuBarcelona, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de DéuBarcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (RedIAPP)Madrid, Spain
| | - Adrián Pérez-Aranda
- Institut de Recerca Sant Joan de DéuBarcelona, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de DéuBarcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (RedIAPP)Madrid, Spain
| | - Albert Feliu-Soler
- Institut de Recerca Sant Joan de DéuBarcelona, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de DéuBarcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (RedIAPP)Madrid, Spain
| | - María Rubio-Valera
- Institut de Recerca Sant Joan de DéuBarcelona, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de DéuBarcelona, Spain.,Centre for Biomedical Research in Epidemiology and Public HealthMadrid, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de DéuBarcelona, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de DéuBarcelona, Spain.,Centre for Biomedical Research in Epidemiology and Public HealthMadrid, Spain
| | - Antoni Serrano-Blanco
- Institut de Recerca Sant Joan de DéuBarcelona, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de DéuBarcelona, Spain.,Centre for Biomedical Research in Epidemiology and Public HealthMadrid, Spain
| | | | | | - Albert Bernadàs
- Institut de Recerca Sant Joan de DéuBarcelona, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de DéuBarcelona, Spain
| | - Juan V Luciano
- Institut de Recerca Sant Joan de DéuBarcelona, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de DéuBarcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (RedIAPP)Madrid, Spain
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Abstract
BACKGROUND Stigma towards individuals experiencing a mental illness is associated with a range of negative psychological, social and financial outcomes. Factors associated with stigma remain unclear; the relationship between stigma and various personal factors may depend on both the type of disorder being stigmatised and what type of stigma is assessed. Different forms of stigma include personal stigma (negative attitudes towards others), perceived stigma (perceived attitudes of others) and self-stigma (self-attribution of others' negative attitudes). METHOD Three hundred and fifty university students and members of the general public completed an online survey assessing contact with and knowledge of both depression and anxiety, age, gender, current depression and anxiety symptoms, and personal, perceived and self-stigma for both depression and anxiety. RESULTS Greater contact with, and knowledge of that illness predicted lower personal stigma for both anxiety and depression. Participants with greater levels of current depression symptomatology and females, reported higher perceived stigma towards depression. Males reported higher personal stigma for anxiety. For both anxiety and depression, higher current symptomatology was associated with greater levels of self-stigma towards the illness. CONCLUSIONS Findings confirm the role of contact and knowledge in personal stigma for both disorders, consistent with previous findings. This finding also supports evidence that interventions addressing these factors are associated with a decline in personal stigma. However, lack of relationship between contact with, and knowledge of a mental illness and perceived and self-stigma for either depression or anxiety suggests that these factors may not play a major role in perceived or self-stigma. The identification of symptomatology as a key factor associated with self-stigma for both anxiety and depression is significant, and has implications for community-wide interventions aiming to increase help-seeking behaviour, as well as individual treatment strategies for clinicians. Further research should examine whether these relationships hold for groups with clinically diagnosed depression and anxiety disorders.
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Li A, Huang X, Hao B, O'Dea B, Christensen H, Zhu T. Attitudes towards suicide attempts broadcast on social media: an exploratory study of Chinese microblogs. PeerJ 2015; 3:e1209. [PMID: 26380801 PMCID: PMC4570843 DOI: 10.7717/peerj.1209] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/03/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction. Broadcasting a suicide attempt on social media has become a public health concern in many countries, particularly in China. In these cases, social media users are likely to be the first to witness the suicide attempt, and their attitudes may determine their likelihood of joining rescue efforts. This paper examines Chinese social media (Weibo) users’ attitudes towards suicide attempts broadcast on Weibo. Methods. A total of 4,969 Weibo posts were selected from a customised Weibo User Pool which consisted of 1.06 million active users. The selected posts were then independently coded by two researchers using a coding framework that assessed: (a) Themes, (b) General attitudes, (c) Stigmatising attitudes, (d) Perceived motivations, and (e) Desired responses. Results and Discussion. More than one third of Weibo posts were coded as “stigmatising” (35%). Among these, 22%, 16%, and 15% of posts were coded as “deceitful,” “pathetic,” and “stupid,” respectively. Among the posts which reflected different types of perceived motivations, 57% of posts were coded as “seeking attention.” Among the posts which reflected desired responses, 37% were “not saving” and 28% were “encouraging suicide.” Furthermore, among the posts with negative desired responses (i.e., “not saving” and “encouraging suicide”), 57% and 17% of them were related to different types of stigmatising attitudes and perceived motivations, respectively. Specifically, 29% and 26% of posts reflecting both stigmatising attitudes and negative desired responses were coded as “deceitful” and “pathetic,” respectively, while 66% of posts reflecting both perceived motivations, and negative desired responses were coded as “seeking attention.” Very few posts “promoted literacy” (2%) or “provided resources” (8%). Gender differences existed in multiple categories. Conclusions. This paper confirms the need for stigma reduction campaigns for Chinese social media users to improve their attitudes towards those who broadcast their suicide attempts on social media. Results of this study support the need for improved public health programs in China and may be insightful for other countries and other social media platforms.
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Affiliation(s)
- Ang Li
- Department of Psychology, Beijing Forestry University , Beijing , China ; Black Dog Institute, University of New South Wales , Sydney, NSW , Australia ; Institute of Psychology, Chinese Academy of Sciences , Beijing , China
| | - Xiaoxiao Huang
- Institute of Psychology, Chinese Academy of Sciences , Beijing , China
| | - Bibo Hao
- Institute of Psychology, Chinese Academy of Sciences , Beijing , China ; School of Computer and Control, University of Chinese Academy of Sciences , Beijing , China
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales , Sydney, NSW , Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales , Sydney, NSW , Australia
| | - Tingshao Zhu
- Institute of Psychology, Chinese Academy of Sciences , Beijing , China ; Institute of Computing Technology, Chinese Academy of Sciences , Beijing , China
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Griffiths KM, Carron-Arthur B, Parsons A, Reid R. Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry 2014; 13:161-75. [PMID: 24890069 PMCID: PMC4102289 DOI: 10.1002/wps.20129] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The stigma associated with mental disorders is a global public health problem. Programs to combat it must be informed by the best available evidence. To this end, a meta-analysis was undertaken to investigate the effectiveness of existing programs. A systematic search of PubMed, PsycINFO and Cochrane databases yielded 34 relevant papers, comprising 33 randomized controlled trials. Twenty-seven papers (26 trials) contained data that could be incorporated into a quantitative analysis. Of these trials, 19 targeted personal stigma or social distance (6,318 participants), six addressed perceived stigma (3,042 participants) and three self-stigma (238 participants). Interventions targeting personal stigma or social distance yielded small but significant reductions in stigma across all mental disorders combined (d=0.28, 95% CI: 0.17-0.39, p<0.001) as well as for depression (d=0.36, 95% CI: 0.10-0.60, p<0.01), psychosis (d=0.20, 95% CI: 0.06-0.34, p<0.01) and generic mental illness (d=0.30, 95% CI: 0.10-0.50, p<0.01). Educational interventions were effective in reducing personal stigma (d=0.33, 95% CI: 0.19-0.42, p<0.001) as were interventions incorporating consumer contact (d=0.47, 95% CI: 0.17-0.78, p<0.001), although there were insufficient studies to demonstrate an effect for consumer contact alone. Internet programs were at least as effective in reducing personal stigma as face-to-face delivery. There was no evidence that stigma interventions were effective in reducing perceived or self-stigma. In conclusion, there is an evidence base to inform the roll out of programs for improving personal stigma among members of the community. However, there is a need to investigate methods for improving the effectiveness of these programs and to develop interventions that are effective in reducing perceived and internalized stigma.
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Affiliation(s)
- Kathleen M Griffiths
- Centre for Mental Health Research, Australian National University, Acton, Canberra, ACT 0200, Australia
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