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Klauber DG, Christensen SH, Fink-Jensen A, Pagsberg AK. I Didn't Want the Psychotic Thing to Get Out to Anyone at All: Adolescents with Early Onset Psychosis Managing Stigma. Cult Med Psychiatry 2024; 48:569-590. [PMID: 38869653 PMCID: PMC11362372 DOI: 10.1007/s11013-024-09859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/14/2024]
Abstract
The impact of stigmatisation on adults with mental illnesses has been thoroughly demonstrated. However, little is known about experiences of stigmatisation among adolescents with mental illness. Through semi-structured interviews with 34 Danish adolescents (14-19 years) diagnosed with psychosis, this study explores adolescents' experiences of psychosis stigma. On the basis of phenomenological analysis, we find that stigmatisation is widely experienced, and psychosis is generally regarded as more stigmatising than co-morbid mental illnesses. The participants engage in different strategies to manage possible stigma, especially strategies of (non-)disclosure. Disclosure is experienced as both therapeutic and normative, but also bears the risk of stigmatisation, and is therefore associated with numerous considerations. Being understood when disclosing is central to the participants, and lack of understanding from others is a continuous challenge. Nevertheless, participants experience benefits when feeling understood by people they confide in and can to a degree create the grounds for this through centralising aspects of their experiences of psychosis and mental illness. We argue that disclosure is both a stigma management strategy and a normative imperative, and that being understood or not is a challenge transcending stigma definitions.Clinical trial registration: Danish Health and Medicines Authority: 2612-4168. The Ethics Committee of Capital Region: H-3-2009-123. ClinicalTrials.gov: NCT01119014. Danish Data Protection Agency: 2009-41-3991.
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Affiliation(s)
- Dea Gowers Klauber
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Sofie Heidenheim Christensen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | - Anders Fink-Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen, Nordre Ringvej 26-67, 2600, Glostrup, Denmark
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
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2
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Skrobinska L, Newman-Taylor K, Carnelley K. Psychosis and help-seeking behaviour-A systematic review of the literature. Psychol Psychother 2024. [PMID: 39007652 DOI: 10.1111/papt.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/15/2024] [Accepted: 05/06/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE Many people with psychosis do not seek help which delays access to recommended treatments. Duration of untreated psychosis is associated with poor healthcare outcomes and increased risk of relapse. The reasons why people delay accessing treatment remain unclear. This is the first systematic review to synthesise the literature examining professional and non-professional help-seeking in psychosis across clinical and subclinical populations. METHODS We searched four databases (APA PsycINFO, APA PsycArticles, Medline and British Library EThOS) to generate a comprehensive account of the quantitative literature. Heterogeneity of measures precluded a meta-analysis. RESULTS We identified 19 articles (including 9686 participants) that met criteria for the review. Help-seeking in psychosis is associated with being female, having a higher level of education, and experiencing more than one symptom. People with psychosis report stigma, poor mental health literacy and lack of family support as key barriers. Clinicians report childhood physical abuse, insecure attachment and severity of psychosis as additional barriers. We also found differences in preferred sources of help across cultures. There is currently no consensus on reliable help-seeking measures. CONCLUSIONS This is the first systematic review to examine help-seeking behaviour in psychosis. Assertive and culturally sensitive engagement efforts should be targeted towards people with a history of early adversity, poor mental health literacy, limited social support and more severe psychosis.
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Affiliation(s)
- Laura Skrobinska
- Psychology Department, University of Southampton, Southampton, UK
| | - Katherine Newman-Taylor
- Psychology Department, University of Southampton, Southampton, UK
- Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK
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3
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Alliende LM, Strauss GP, Yang LH, Mittal VA. Perceptions of stigma in youth at clinical high risk for psychosis and depressive symptomatology. Schizophr Res 2024; 269:79-85. [PMID: 38754312 PMCID: PMC11249038 DOI: 10.1016/j.schres.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
It is unclear what types of stigma youth at clinical high risk for psychosis (CHR) experience, and the relationship between them and symptomatology. 94 CHR youth, and a control group of 45 youth with no psychosis spectrum symptoms (NP) were rated for perceived devaluation (i.e. negative views from others) and internalized mental health stigma (i.e. the extent to which they would agree with said views) as well as positive and mood symptomatology. CHR youth reported stigma more frequently than the NP group (χ2(1) = 53.55, p < .001) and at higher levels (perceived devaluation: t (137) = 8.54, p < .001; internalized stigma: t (137) = 7.48, p < .001). Surprisingly, in the CHR group, positive symptoms held no significant relationship to stigma measures. However, ratings of perceived devaluation stigma were associated with depressive symptomatology (β = 0.27, t = 2.68, p = .0087) and depression scores were conversely associated with perceived devaluation stigma (β = 0.30, t = 2.05, p = .043). These findings speak to the relationship between depressive symptomatology and perceived devaluation stigma in CHR youth. Perceived devaluation stigma showed greater clinical significance and could have different mechanisms than internalized stigma in CHR youth. It is also noteworthy that while positive symptoms play a central role in defining the CHR syndrome, they seem less relevant to the experience of stigma than mood symptoms. These findings highlight the importance of interventions aimed at ameliorating youth's exposure to negative views about mental health as those managing depressive symptomatology.
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Affiliation(s)
| | | | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
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Gonçalves CC, Waters Z, Quirk SE, Haddad PM, Lin A, Williams LJ, Yung AR. Barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with psychosis: a scoping review protocol. Syst Rev 2024; 13:143. [PMID: 38816775 PMCID: PMC11137929 DOI: 10.1186/s13643-024-02566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The prevalence of psychosis has been shown to be disproportionately high amongst sexual and gender minority individuals. However, there is currently little consideration of the unique needs of this population in mental health treatment, with LGBTQA+ individuals facing barriers in accessing timely and non-stigmatising support for psychotic experiences. This issue deserves attention as delays to help-seeking and poor engagement with treatment predict worsened clinical and functional outcomes for people with psychosis. The present protocol describes the methodology for a scoping review which will aim to identify barriers and facilitators faced by LGBTQA+ individuals across the psychosis spectrum in help-seeking and accessing mental health support. METHODS A comprehensive search strategy will be used to search Medline, PsycINFO, Embase, Scopus, LGBTQ+ Source, and grey literature. Original studies of any design, setting, and publication date will be included if they discuss barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with experiences of psychosis. Two reviewers will independently screen titles/abstracts and full-text articles for inclusion in the review. Both reviewers will then extract the relevant data according to pre-determined criteria, and study quality will be assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Key data from included studies will be synthesised in narrative form according to the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. DISCUSSION The results of this review will provide a comprehensive account of the current and historical barriers and facilitators to mental healthcare faced by LGBTQA+ people with psychotic symptoms and experiences. It is anticipated that the findings from this review will be relevant to clinical and community services and inform future research. Findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. SCOPING REVIEW REGISTRATION This protocol is registered in Open Science Framework Registries ( https://doi.org/10.17605/OSF.IO/AT6FC ).
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Affiliation(s)
- Cláudia C Gonçalves
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia.
| | - Zoe Waters
- Telethon Kids Institute, University of Western Australia, Perth, WA, 6009, Australia
| | - Shae E Quirk
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
| | - Peter M Haddad
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
- University Hospital Geelong, Barwon Health, Geelong, VIC, 3220, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
- School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
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5
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Ho G, Pratt DN, Bridgwater MA, Schiffman J, Ellman LM, Mittal VA. Factors impacting intent to seek treatment within youth at clinical high risk for psychosis. Schizophr Res 2024; 267:273-281. [PMID: 38581831 PMCID: PMC11102833 DOI: 10.1016/j.schres.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/25/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
Existing work indicates that there is unmet need for care in those at clinical high risk (CHR) for psychosis. However, research on the factors that drive treatment seeking behaviors in this population is limited. Further, it is unknown how help-seeking behavior in CHR individuals compares to those seen in mood disorders, who have a higher rate of treatment seeking behavior. Participants (n = 559) completed an assessment of their intent to seek mental health treatment, attenuated psychosis-risk symptoms, and psychiatric symptoms and diagnoses. Participants were divided into CHR (n = 91), Mood Disorders (MD) (n = 72), or Community Controls (CC) groups (n = 396), whose intent to seek treatment was compared. Associations between intent to seek treatment with past treatment, depression, anxiety, positive and negative symptoms, distress from symptoms, intelligence quotient (IQ) estimates, and insight were assessed in CHR individuals. Further, it was assessed how this differs for the MD group. The MD group reported higher intent to seek treatment than CHR individuals, which reported higher intent to seek treatment than the CC group. In those at CHR, previous treatment, greater depression and anxiety severity, and higher distress all independently predicted higher intent to seek treatment. Depression predicted intent to seek treatment in both MD and CHR individuals. Previous treatment predicted intent to seek treatment in those at CHR. Our findings suggest that depression and past treatment utilization are critical factors in increasing intent to seek treatment in those at CHR, potentially serving as important targets for engaging this population in treatment.
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Affiliation(s)
- Gillian Ho
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA.
| | - Miranda A Bridgwater
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Vijay A Mittal
- Institutes for Policy Research and Innovations in Developmental Sciences, Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
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6
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Tuaf H, Orkibi H. Community-based programs for youth with mental health conditions: a scoping review and practical implications. Front Public Health 2023; 11:1241469. [PMID: 38026340 PMCID: PMC10651729 DOI: 10.3389/fpubh.2023.1241469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Approximately 14% of all adolescents globally cope with mental health conditions. However, community-based psychosocial services for adolescents with mental health conditions are scarce and under-researched. Scant scholarly attention has been paid to leisure and/or social activities in community-based rehabilitation services for adolescents with mental health conditions. Objectives To begin to fill this gap, we chose a bottom-up framework to probe the following questions: Which community-based programs for adolescents with mental health conditions exist worldwide? What common characteristics do they present? What is their range of services? Method We systematically searched three leading academic databases, reference lists, and worldwide websites in English. Eligibility criteria Programs with information in English that provide services in a community setting, service content that includes leisure and/or social activities, cater to users aged 10-18, and content explicitly targets adolescents with mental health conditions. Results Twenty-seven psychosocial programs that provide leisure and/or social activities and encourage the promotion of adolescent mental health in the community were identified. We mapped and categorized the programs into three groups: integrated recovery, leisure recovery, and advocacy recovery. Conclusion Practical implications for implementation are suggested based on the findings. Specifically, service providers should attend to the psychological needs of adolescents by prioritizing peer interaction and offering suitable social and leisure activities. These activities can also boost adolescent participation in community-based rehabilitation programs and address the treatment gap. Comprehensive studies and uniform terminology in the field are needed.
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Affiliation(s)
- Hila Tuaf
- Drama & Health Science Lab, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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7
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Tran T, Holland AH, Zhang L, Raugh IM, Strauss GP. Letter to the Editor: Social media and internet use is associated with both adaptive and maladaptive changes in mental health during the COVID-19 pandemic in youth at clinical high-risk for psychosis. J Psychiatr Res 2022; 147:1-3. [PMID: 34998219 DOI: 10.1016/j.jpsychires.2021.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Tanya Tran
- Department of Psychology, Humphrey Hall, 62 Arch St, Queen's University, Kingston, ON, K7L 3L3, Canada
| | - Alexis H Holland
- Department of Psychology, 125 Baldwin St, University of Georgia, Athens, GA, USA, 30602
| | - Luyu Zhang
- Department of Psychology, 125 Baldwin St, University of Georgia, Athens, GA, USA, 30602
| | - Ian M Raugh
- Department of Psychology, 125 Baldwin St, University of Georgia, Athens, GA, USA, 30602
| | - Gregory P Strauss
- Department of Psychology, 125 Baldwin St, University of Georgia, Athens, GA, USA, 30602.
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Evans-Lacko S, Courtin E, Fiorillo A, Knapp M, Luciano M, Park AL, Brunn M, Byford S, Chevreul K, Forsman A, Gulacsi L, Haro J, Kennelly B, Knappe S, Lai T, Lasalvia A, Miret M, O'Sullivan C, Obradors-Tarragó C, Rüsch N, Sartorius N, Švab V, van Weeghel J, Van Audenhove C, Wahlbeck K, Zlati A, McDaid D, Thornicroft G. The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature. Eur Psychiatry 2020; 29:381-9. [DOI: 10.1016/j.eurpsy.2014.02.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractStigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
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Colizzi M, Ruggeri M, Lasalvia A. Should we be concerned about stigma and discrimination in people at risk for psychosis? A systematic review. Psychol Med 2020; 50:705-726. [PMID: 32063250 DOI: 10.1017/s0033291720000148] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies have provided initial evidence that people at risk for psychosis (PR) suffer from stigma and discrimination related to their condition. However, no study has systematically reviewed stigma and discrimination associated with being at PR and the potential underlying mechanisms. METHODS This work aimed to systematically review all studies addressing stigma and discrimination in PR people in order to assess: (1) the occurrence of this phenomenon and its different components (public, internalized, perceived, and labeling-related), (2) whether stigma affects outcomes of the PR state, and (3) whether other factors modulate stigma among PR individuals. RESULTS The reviewed studies (n = 38) widely differ in their design, methodological quality, and populations under investigation, thus limiting direct comparison of findings. However, converging evidence suggests that the general public endorses stigmatizing attitudes towards PR individuals, and that this is more frequent in people with a low educational level or with no direct experience of the PR state. PR individuals experience more internalized stigma and perceive more discrimination than healthy subjects or patients with non-psychotic disorders. Further, PR labeling is equally associated with both positive (e.g. validation and relief) and negative effects (e.g. status loss and discrimination). Moreover, stigma increases the likelihood of poor outcome, transition to full-psychosis, disengagement from services, and family stigma among PR individuals. Finally, very limited evidence awaiting replication supports the efficacy of cognitive therapies in mitigating the negative effects of stigma. CONCLUSIONS Evidence confirms previous concerns about stigma and its negative consequences for PR individuals, thus having important public health implications.
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Affiliation(s)
- Marco Colizzi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134Verona, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, LondonSE5 8AF, UK
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134Verona, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134Verona, Italy
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Uttinger M, Koranyi S, Papmeyer M, Fend F, Ittig S, Studerus E, Ramyead A, Simon A, Riecher-Rössler A. Early detection of psychosis: helpful or stigmatizing experience? A qualitative study. Early Interv Psychiatry 2018; 12:66-73. [PMID: 26362478 DOI: 10.1111/eip.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
AIM Despite the large scientific debate concerning potential stigmatizing effects of identifying an individual as being in an at-risk mental state (ARMS) for psychosis, studies investigating this topic from the subjective perspective of patients are rare. This study assesses whether ARMS individuals experience stigmatization and to what extent being informed about the ARMS is experienced as helpful or harmful. METHODS Eleven ARMS individuals, currently participating in the follow-up assessments of the prospective Basel Früherkennung von Psychosen (FePsy; English: Early Detection of Psychosis) study, were interviewed in detail using a semistructured qualitative interview developed for this purpose. Data were analysed using Interpretative Phenomenological Analysis. RESULTS Most individuals experiencing first symptoms reported sensing that there was 'something wrong with them' and felt in need of help. They were relieved that a specific term was assigned to their symptoms. The support received from the early detection centre was generally experienced as helpful. Many patients reported stigmatization and discrimination that appeared to be the result of altered behaviour and social withdrawal due to the prepsychotic symptoms they experienced prior to contact with the early detection clinic. CONCLUSIONS The results suggest that early detection services help individuals cope with symptoms and potential stigmatization rather than enhancing or causing the latter. More emphasis should be put on the subjective experiences of those concerned when debating the advantages and disadvantages of early detection with regard to stigma. There was no evidence for increased perceived stigma and discrimination as a result of receiving information about the ARMS.
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Affiliation(s)
- Martina Uttinger
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Susan Koranyi
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Martina Papmeyer
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland.,Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Fabienne Fend
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Avinash Ramyead
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Andor Simon
- Department of Psychiatry, Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Bruderholz, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
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Ose SO, Lilleeng S, Pettersen I, Ruud T, van Weeghel J. Risk of violence among patients in psychiatric treatment: results from a national census. Nord J Psychiatry 2017; 71:551-560. [PMID: 28737978 DOI: 10.1080/08039488.2017.1352024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adverse media coverage of isolated incidents affects the public perception of the risk of violent behavior among people with mental illness. However, the risk of violence is studied most frequently among inpatients, which falsely exaggerates the prevalence of people with mental illness because the majority of individuals receive treatment as outpatients. AIM To estimate the prevalence of the risk of violence among inpatients and outpatients in psychiatric treatment, as well as the associations with gender, age, socio-economic status and co-morbid substance use disorders in all major diagnostic categories. METHODS We conducted a national census of patients in specialist mental health services in Norway, which included 65% of all inpatients (N = 2,358) and 60% of all outpatients (N = 23,124). RESULTS The prevalence of the risk of violence was 32% among inpatients and 8% among outpatients, where 80% of the patients in specialist mental health services were outpatients. If we weight the prevalence rates accordingly, less than 2% of the patients in specialist mental health services had a high risk of violent behavior. CONCLUSIONS The stigma attached to those with mental illness is not consistent with the absence or low to modest risk of violent behavior in 98% of the patient group. Substance use disorders must be given priority in the treatment of all patient groups. Mental health care in general and interventions that target violent behavior in particular should address the problems and needs of these patients better, especially those who are unemployed, have a low level of education and have a background of being a refugee or an immigrant.
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Affiliation(s)
- Solveig Osborg Ose
- a Department of Health , SINTEF Technology and Society , Trondheim , Norway
| | - Solfrid Lilleeng
- b Department of Health Economics and Financing , The Norwegian Directorate of Health , Trondheim , Norway
| | - Ivar Pettersen
- c Department of Economics , Norwegian University of Science and Technology , Trondheim , Norway
| | - Torleif Ruud
- d Division of Mental Health Services , Akershus University Hospital , Lørenskog , Norway.,e Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Jaap van Weeghel
- f TS Social and Behavioral Sciences , Tilburg University , Utrecht , The Netherlands
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12
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Gronholm PC, Thornicroft G, Laurens KR, Evans-Lacko S. Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review. Psychol Med 2017; 47:1867-1879. [PMID: 28196549 DOI: 10.1017/s0033291717000344] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigma-related influences on pathways to care in the early stages of psychotic disorders have not been systematically examined. METHOD This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results. RESULTS The meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: 'sense of difference', 'characterizing difference negatively', 'negative reactions (anticipated and experienced)', 'strategies', 'lack of knowledge and understanding', and 'service-related factors'. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups. CONCLUSIONS Our findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care.
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Affiliation(s)
- P C Gronholm
- Health Service and Population Research Department,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - G Thornicroft
- Health Service and Population Research Department,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - K R Laurens
- Department of Forensic and Neurodevelopmental Science,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - S Evans-Lacko
- Health Service and Population Research Department,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
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13
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Pyle M, Morrison AP. Internalised stereotypes across ultra-high risk of psychosis and psychosis populations. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1295097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melissa Pyle
- The Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Department of Psychology, The University of Manchester, Manchester, UK
| | - Anthony P. Morrison
- The Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Department of Psychology, The University of Manchester, Manchester, UK
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Ta TMT, Zieger A, Schomerus G, Cao TD, Dettling M, Do XT, Mungee A, Diefenbacher A, Angermeyer MC, Hahn E. Influence of urbanity on perception of mental illness stigma: a population based study in urban and rural Hanoi, Vietnam. Int J Soc Psychiatry 2016; 62:685-695. [PMID: 27887028 DOI: 10.1177/0020764016670430] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS To examine, for the first time in Vietnam, whether urbanity of respondents among other socio-demographic factors affects the public perception of stigma attached to persons with mental illness in Hanoi. METHODS A general population-based survey was carried out in 2013 in the greater Hanoi area. The perception of stigma attached to people with mental illness was elicited using Link's perceived discrimination and devaluation scale (PDDS) carried out in Vietnamese language. The survey sample (n = 806) was stratified for gender, urban/rural location, age, household size and marital status, in accordance with the 2013 Vietnamese census. RESULTS Comparing the total score of the PDDS and its single items, we found less perceived stigma and discrimination among the rural population of Hanoi and in respondents who reported religious attainment to either Buddhism or Christianity. Logistic regression analyses found no significant influences of gender, age, household size or marital status regarding the perceived stigma toward persons with mental illness. CONCLUSION Less negative perception of stigma attached to persons with mental illness that was observed among the rural population in the Hanoi area may be interpreted in the light of possibly more demanding living conditions in modern urban Vietnam with less opportunities for mentally ill patients and points toward a dynamic interaction with rapidly changing living conditions in Asian megacities.
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Affiliation(s)
- Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University Greifswald, Germany.,HELIOS Hanseklinikum Stralsund, Germany
| | - Tien Duc Cao
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Academy of Medicine, Hanoi, Vietnam
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Xuan Tinh Do
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Academy of Medicine, Hanoi, Vietnam
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatic, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | | | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
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Zieger A, Mungee A, Schomerus G, Ta TMT, Dettling M, Angermeyer MC, Hahn E. Perceived stigma of mental illness: A comparison between two metropolitan cities in India. Indian J Psychiatry 2016; 58:432-437. [PMID: 28197001 PMCID: PMC5270269 DOI: 10.4103/0019-5545.196706] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE An increasing number of comparative studies are conducted on the stigmatization of persons with mental illness, in particular with regard to regional and diachronic variation. So far, there have been no studies comparing stigmatization of persons with mental illness in two different regions of India. Therefore, we examined the differences in perception of stigma attached to mental illnesses in Kolkata and Chennai, with regard to cultural and geographical differences to better understand the roots and origins of this issue. MATERIALS AND METHODS Explorative surveys in the context of public attitudes toward people with mental disorders were conducted among conveniently selected members of the general population in Chennai (n = 166) and Kolkata (n = 158) with identical methodology. Link's perceived devaluation-discrimination measure was used. The samples were matched for age, gender, and education. RESULTS The calculated sum score indicated that respondents from Kolkata had a higher level of perceived discrimination toward persons with mental illness than respondents from Chennai (P = 0.043). Furthermore, regression analysis revealed that lower perceived stigma was associated with stronger religious devotion (P = 0.049) and higher educational attainment (P = 0.001) in both cities. DISCUSSION The results showed that perceived stigma was higher in Kolkata than in Chennai. The correlation of higher stigma with lower education was in line with the previous research, and interestingly, it was found that higher stigma correlated with weaker religious devotion. Further studies exploring a wider variety of factors may provide us with a better understanding of the roots of perceived stigma in India.
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Affiliation(s)
- Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Stralsund, Germany; Department of Psychiatry, HELIOS Hanseklinikum, Stralsund, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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16
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Xu Z, Müller M, Heekeren K, Theodoridou A, Metzler S, Dvorsky D, Oexle N, Walitza S, Rössler W, Rüsch N. Pathways between stigma and suicidal ideation among people at risk of psychosis. Schizophr Res 2016; 172:184-8. [PMID: 26843510 DOI: 10.1016/j.schres.2016.01.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/14/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
Mental illness stigma may contribute to suicidality and is associated with social isolation and low self-esteem among young people at risk of psychosis. However, it is unclear whether mental illness stigma contributes to suicidality in this population. We therefore examined the associations of self-labeling and stigma stress with suicidality among young people at risk. Self-labeling as "mentally ill", stigma stress, social isolation, self-esteem, symptoms and suicidal ideation were assessed in 172 individuals at risk of psychosis. Self-labeling and stigma stress were examined as predictors of suicidality by path analysis. Increased self-labeling as "mentally ill" was associated with suicidality, directly as well as indirectly mediated by social isolation. More stigma stress was related to social isolation which in turn was associated with low self-esteem, depression and suicidal ideation. Social isolation fully mediated the link between stigma stress and suicidal ideation. Interventions to reduce the public stigma associated with risk of psychosis as well as programs to facilitate non-stigmatizing awareness of at-risk mental state and to reduce stigma stress among young people at risk of psychosis might strengthen suicide prevention in this population.
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Affiliation(s)
- Ziyan Xu
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland
| | - Sibylle Metzler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland
| | - Diane Dvorsky
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland
| | - Nathalie Oexle
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry, University of Zürich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience, LIM27, University of Sao Paulo, Brazil
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
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Self-labelling and stigma as predictors of attitudes towards help-seeking among people at risk of psychosis: 1-year follow-up. Eur Arch Psychiatry Clin Neurosci 2016; 266:79-82. [PMID: 25631617 DOI: 10.1007/s00406-015-0576-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/17/2015] [Indexed: 10/24/2022]
Abstract
Mental health service use is helpful but rare among young people at risk of psychosis. The label and stigma associated with mental illness may affect attitudes towards help-seeking. We examined 67 individuals at risk of psychosis over the course of 1 year. An increase of self-labelling as "mentally ill" predicted more positive attitudes towards psychiatric medication, while increased perceived stigma and the cognitive appraisal of stigma as a stressor predicted poorer attitudes towards psychotherapy after 1 year. Early intervention could improve non-stigmatizing awareness of at-risk mental state and reduce the public stigma associated with at-risk status to facilitate help-seeking.
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18
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Abstract
Prevention of mental disorders can be effective, but is rarely implemented in routine settings. Here we propose a matrix to show how different aspects of stigma, discrimination and lack of knowledge can hinder different types of prevention, including early intervention. Programmes to reduce stigma's impact and so to facilitate prevention are needed.
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Affiliation(s)
- Nicolas Rüsch
- Nicolas Rüsch, MD, Department of Psychiatry II, University of Ulm, Germany, and Health Service and Population Research Department, King's College London, Institute of Psychiatry, UK; Graham Thornicroft, MD, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, UK
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19
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Müller M, Rodgers S, Rössler W, Castelao E, Preisig M, Ajdacic-Gross V, Vandeleur C. Discrepancies between clinical needs and helpseeking behaviors in co-occurring posttraumatic stress and alcohol use disorders. Compr Psychiatry 2015; 62:209-17. [PMID: 26343486 DOI: 10.1016/j.comppsych.2015.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/25/2015] [Accepted: 07/22/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of the study was to compare subjects dually diagnosed with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) to those with only one or none of these conditions regarding helpseeking needs and behaviors. METHOD Data from a large community sample (N=3694) were used to assess the associations among lifetime PTSD and AUD, other psychiatric disorders, clinical characteristics and lifetime helpseeking behaviors derived from a semi-structured interview. RESULTS Comorbid individuals had more severe clinical profiles and were more impaired than individuals with either PTSD or AUD alone or those with no/other psychiatric conditions. However, they did not differ in overall helpseeking behavior from any other group. Those with comorbid PTSD/AUD were even less likely than the other groups to seek help for depression and anxiety disorders through specific treatment facilities or the use of prescribed psychotropic drugs. CONCLUSIONS Despite a greater need for treatment the comorbid group did not seek more help than the others. Their lower use of prescribed drugs supports the self-medication hypothesis, suggesting that those individuals relieve their symptoms through higher alcohol use instead. Our findings underline the need for health care facilities to encourage helpseeking behavior in the aftermath of stressful life events.
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Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland.
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil
| | - Enrique Castelao
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Caroline Vandeleur
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
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20
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Falkenberg I, Valmaggia L, Byrnes M, Frascarelli M, Jones C, Rocchetti M, Straube B, Badger S, McGuire P, Fusar-Poli P. Why are help-seeking subjects at ultra-high risk for psychosis help-seeking? Psychiatry Res 2015; 228:808-15. [PMID: 26071897 DOI: 10.1016/j.psychres.2015.05.018] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 05/11/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
Abstract
In addition to attenuated psychotic symptoms, individuals at high clinical risk of developing psychosis display a wide range of psychopathological features. Some of these may be subjectively perceived as more troubling than others and may therefore be more likely to trigger help-seeking behavior. We aimed at investigating the nature and prevalence of symptoms subjectively considered most distressing by high-risk individuals at the time of their presentation to early recognition services and to determine their impact on baseline and longitudinal functional and clinical outcomes. The clinical records of 221 clients meeting ultra-high risk (UHR) criteria and receiving care at a specialized early intervention service ("Outreach and Support in South London") between 2001 and 2011 were reviewed. Main outcome measures were reason to seek help as subjectively reported by the clients, comorbid DSM-IV SCID diagnoses, transition to psychosis, psychosocial functioning at baseline and after a median follow-up period of 4.5 years. Affective symptoms, i.e., depression and/or anxiety, were the most commonly reported subjective reasons to seek help (47.1%). Sub-threshold psychotic symptoms were reported by 39.8%. There was no significant association between subjective complaints at presentation and transition to psychosis. However, the group reporting affective symptoms as their main subjective reason to seek help at baseline had a significantly poorer longitudinal outcome in psychosocial functioning relative to the group reporting sub-threshold psychotic symptoms. Assessment of subjective complaints in UHR individuals at initial presentation may help to identify predictors of future functional outcome and tailor treatments accordingly.
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Affiliation(s)
- Irina Falkenberg
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
| | - Lucia Valmaggia
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Majella Byrnes
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Marianna Frascarelli
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Ceri Jones
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Matteo Rocchetti
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
| | - Steven Badger
- OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom.
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Jones N, Shattell M. Beyond easy answers: facing the entanglements of violence and psychosis. Issues Ment Health Nurs 2014; 35:809-11. [PMID: 25259645 DOI: 10.3109/01612840.2013.856971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nev Jones
- DePaul University, Department of Psychology, Chicago, Illinois, USA
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22
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Theodoridou A, Heekeren K, Dvorsky D, Metzler S, Franscini M, Haker H, Kawohl W, Rüsch N, Walitza S, Rössler W. Early Recognition of High Risk of Bipolar Disorder and Psychosis: An Overview of the ZInEP "Early Recognition" Study. Front Public Health 2014; 2:166. [PMID: 25325050 PMCID: PMC4181243 DOI: 10.3389/fpubh.2014.00166] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/14/2014] [Indexed: 11/29/2022] Open
Abstract
Early detection of persons with first signs of emerging psychosis is regarded as a promising strategy to reduce the burden of the disease. In recent years, there has been increasing interest in early detection of psychosis and bipolar disorders, with a clear need for sufficient sample sizes in prospective research. The underlying brain network disturbances in individuals at risk or with a prodrome are complex and yet not well known. This paper provides the rationale and design of a prospective longitudinal study focused on at-risk states of psychosis and bipolar disorder. The study is carried out within the context of the Zurich Program for Sustainable Development of Mental Health services (Zürcher Impulsprogramm zur Nachhaltigen Entwicklung der Psychiatrie). Persons at risk for psychosis or bipolar disorder between 13 and 35 years of age are examined by using a multi-level-approach (psychopathology, neuropsychology, genetics, electrophysiology, sociophysiology, magnetic resonance imaging, near-infrared spectroscopy). The included adolescents and young adults have four follow-ups at 6, 12, 24, and 36 months. This approach provides data for a better understanding of the relevant mechanisms involved in the onset of psychosis and bipolar disorder, which can serve as targets for future interventions. But for daily clinical practice a practicable “early recognition” approach is required. The results of this study will be useful to identify the strongest predictors and to delineate a prediction model.
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Affiliation(s)
- Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland
| | - Diane Dvorsky
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland
| | - Sibylle Metzler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland
| | - Maurizia Franscini
- University Hospital of Child and Adolescent Psychiatry, University of Zurich , Zurich , Switzerland
| | - Helene Haker
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland ; Translational Neuromodeling Unit, University of Zurich and ETH Zurich , Zurich , Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland
| | - Nicolas Rüsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland
| | - Susanne Walitza
- University Hospital of Child and Adolescent Psychiatry, University of Zurich , Zurich , Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland ; Collegium Helveticum , Zurich , Switzerland
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Longitudinal course of self-labeling, stigma stress and well-being among young people at risk of psychosis. Schizophr Res 2014; 158:82-4. [PMID: 25086660 DOI: 10.1016/j.schres.2014.07.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/08/2014] [Accepted: 07/12/2014] [Indexed: 11/22/2022]
Abstract
Stigma may undermine the well-being of young people at risk of psychosis. We therefore measured self-labeling, stigma variables and well-being at baseline and again one year later among 77 at-risk participants. An increase in self-labeling during this period predicted heightened stigma stress after one year and a decrease in stigma stress predicted better well-being at follow-up, controlling for symptoms, psychiatric comorbidity and sociodemographic variables. Besides early intervention programmes, strategies are needed to reduce the public stigma associated with at-risk status and to support young people at risk to better cope with self-labeling and stigma stress.
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Abstract
PURPOSE OF REVIEW There are complexities in communicating diagnostic information relating to schizophrenia spectrum disorders. There is a current dearth of research in understanding how clinicians effectively communicate with service users about such diagnostic news. In this review, we aim to synthesize the latest research throughout 2012 and 2013 that presented data relating to the communication of a diagnosis of schizophrenia spectrum disorders, including individuals who had experienced first-episode psychosis or were in at-risk mental states. Comprehensive database and manual searches were conducted which obtained data from both service users and health professional groups. RECENT FINDINGS Fourteen quantitative and qualitative studies were found. The majority of studies were descriptive and heterogeneous in content. Key themes included service user preferences towards disclosure and diagnostic terminology, health professional training, stigma-related issues and the use of diagnostic communication models. SUMMARY Overall, communication models that foster therapeutic relationships and actively encourage the health professional to reduce stigma may be a key to initial diagnostic discussions in clinical practice. Such communication models and intervention require further more rigorous evaluation, as none have been tested through randomized controlled protocols in clinical settings.
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Is living with psychosis demoralizing? Insight, self-stigma, and clinical outcome among people with schizophrenia across 1 year. J Nerv Ment Dis 2014; 202:521-9. [PMID: 24933416 DOI: 10.1097/nmd.0000000000000160] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lack of insight is a major target in the treatment of schizophrenia. However, insight may have undesirable effects on self-concept and motivation that can hinder recovery. This study aimed to examine the link between insight, self-stigma, and demoralization as predictors of symptoms and functioning. Insight, self-stigma, depressive and psychotic symptoms, and functioning were assessed among 133 outpatients with schizophrenia at baseline and 12 months later. The data were analyzed by hierarchical multiple linear regressions. More insight at baseline and an increase in self-stigma over 12 months predicted more demoralization at follow-up. Insight at baseline was not associated with any outcome variable, but self-stigma at baseline was related to poorer functioning and more positive symptoms at follow-up. More demoralization at baseline predicted poorer functioning 12 months later. Demoralization did not mediate the relationship between self-stigma at baseline and functioning after 1 year. Given the decisive role of self-stigma regarding recovery from schizophrenia, dysfunctional beliefs related to illness and the self should be addressed in treatment. Different psychotherapeutical approaches are discussed.
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26
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Wang C, Wan X, Wang K, Li J, Sun T, Guan X. Disease stigma and intentions to seek care for stress urinary incontinence among community-dwelling women. Maturitas 2014; 77:351-5. [PMID: 24602555 DOI: 10.1016/j.maturitas.2014.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Urinary incontinence (UI) threatens women's physical and mental health, but few women seek healthcare for their incontinence. Evidence is substantial that stigma may be associated with health service utilization for such diseases as mental illness, but sparse for UI. We examine the relationship between disease stigma and intentions to seek care for UI. DESIGN AND SETTING A cross-sectional community-based study was used. A purposive sample of 305 women aged 40-65 years in a Chinese city who had stress urinary incontinence (SUI) was enrolled from May to October in 2011. MEASUREMENTS Data were collected on socio-demographic characteristics, UI symptoms, disease stigma and intentions to seek care. RESULTS Social rejection was positively linearly related to intentions to seek care for UI (β=0.207; 95% CI=0.152, 0.784), indicating that more social rejection predicted stronger intentions to seek care. Significant curvilinear association between internalized shame and intentions to seek care was observed (β=-0.169; 95% CI=-0.433, -0.047). Compared to women with the low and high levels of internalized shame, those with the moderate level of internalized shame reported stronger intentions to seek care. CONCLUSION The impact of stigma on intentions to seek care varies by aspects and levels of stigma. Social rejection enhances intentions to seek care while internalized shame influences intentions to seek care in a quadratic way. The crucial step of targeted interventions will be to disentangle subgroups of SUI women with different aspects and levels of stigma.
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Affiliation(s)
- Cuili Wang
- School of Nursing, Shandong University, PO Box 141, 250012 Jinan, China.
| | - Xiaojuan Wan
- School of Nursing, Shandong University, PO Box 141, 250012 Jinan, China.
| | - Kefang Wang
- School of Nursing, Shandong University, PO Box 141, 250012 Jinan, China.
| | - Jingjing Li
- School of Nursing, Shandong University, PO Box 141, 250012 Jinan, China.
| | - Tao Sun
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China.
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