Public beliefs and attitudes toward schizophrenia and depression in Taiwan: A nationwide survey

Changes in family functioning among primary family caregivers of patients with schizophrenia

INTRODUCTION

Family functioning, particularly among primary family caregivers for patients with schizophrenia, is a global concern that poses unprecedented challenges. The family unit is a pivotal agent for the preservation of the integrity of individual members. Little attention has been paid to the changes in family functioning and their predictors in primary family caregivers. This study aimed to examine the changes in and the correlates of family functioning in primary family caregivers of individuals with schizophrenia over a 6-month post-discharge period.

DESIGN

A prospective, longitudinal study was conducted.

METHODS

A total of 58 primary family caregivers of patients with schizophrenia were recruited from two psychiatric hospitals in Taiwan. Data were collected four times, including 1 week before hospital discharge and at 1-, 3-, and 6-month intervals post-discharge. Demographic and clinical questionnaires, the Affiliate Stigma Scale, the Family Empowerment Scale, and the General Functioning subscale were used to collect data. Generalized Estimating Equations were applied for data analysis.

RESULTS

Approximately 59.6%-77.6% of primary family caregivers presented unhealthy family functioning during the 6-month post-discharge period. Significant reductions in family functioning of primary family caregivers were noted in the group with unhealthy family functioning; however, family functioning of primary family caregivers remained unchanged in the group with healthy family functioning over 6 months. Affiliate stigma and family empowerment significantly accounted for the changes in family functioning of primary family caregivers in the groups with unhealthy and healthy family functioning, respectively.

CONCLUSION

This study highlights affiliate stigma and family empowerment as long-term predictors of changes in family functioning for primary family caregivers and as pivotal targets of mental health care.

CLINICAL RELEVANCE

Family-centered interventions with a focus on ameliorating affiliate stigma and enhancing family empowerment are recommended to improve family functioning for primary family caregivers of patients with schizophrenia at different periods after hospital discharge.

What Do Patients Want in the Treatment of Major Depressive Disorder? Taiwan's TAILOR Survey

In Taiwan, the number of patients being treated for depression has been increasing over recent decades, but there remain some key unmet needs for these patients. One issue is the low rate of help-seeking, which may be at least partially attributable to the stigma of depression in Asian societies. Stigma also contributes to underdiagnosis, because stigmatised patients may emphasise somatic symptoms (e.g. lethargy/fatigue, sleep disorders or changes in appetite), fearing how they will be perceived if they discuss psychological symptoms with their physician. Underdiagnosis may also result from cross-cultural differences, because assessment scales and screening tools are usually developed in Western populations and may not have the same validity in Asian patients. Depression in Taiwan appears to be undertreated, with a high rate of suboptimal antidepressant dosages and inadequate duration of therapy. Patients may discontinue treatment earlier than recommended for a number of reasons related to their own beliefs about treatment, their relationship with their physicians, or the effects of the medication (adverse effects, slow onset of effect, or lack of effect on comorbid symptoms). Moreover, frequently there is discordance between how patients and physicians define treatment success in depression. Patients are more likely to achieve a benefit from treatment which remains persistent when physicians and patients are closely aligned on treatment goals. To better understand the experiences, preferences and attitudes of patients with depression in Taiwan, the Target Antidepressant Initiation choice to unLock positive patient Outcomes and Response (TAILOR) survey was conducted in 340 adult outpatients receiving treatment for major depressive disorder (MDD). The results of the TAILOR survey highlight the personal and perceived stigma of depression, current barriers to seeking help and maintaining treatment, and opportunities to improve shared decision-making, medication adherence and clinical outcomes for Taiwanese patients with MDD.

Population-based prevalence of somatic symptom disorder and comorbid depression and anxiety in Taiwan

OBJECTIVE

The nationwide prevalence of somatic symptom disorder (SSD) has not yet been investigated in Asia. SSD is often comorbid with depression and anxiety, and the effects of these conditions on medical utilization await clarification. We hence performed a study in Taiwan to explore these issues.

METHODS

Using telephone-based sampling and interview, we obtained data for 3161 participants whose age, gender and living area were compatible with the Taiwan population. We gathered scores of the Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ) and Patient Health Questionnaire-4 (PHQ-4). Individuals with a PHQ-15 score of at least 4 and a HAQ score of at least 17 were considered to have SSD. Descriptive statistics were used to clarify the prevalence and normative data of the questionnaires. We used multiple logistic regression analyses to investigate the relation between diagnoses and medical utilization.

RESULTS

The prevalence of SSD was 5.00% and women had a higher SSD prevalence than men; participants aged 40-49 years had the highest SSD prevalence. In SSD patients, 33.58% had depression or anxiety. After correcting for demographics, SSD and anxiety (but not depression) were associated with a significantly high level of outpatient/emergency department attendance. Comorbid depression or anxiety did not significantly increase the medical utilization of SSD patients.

CONCLUSION

The nationwide SSD prevalence in Taiwan is compatible with the description in the DSM-5. The comorbidity of SSD and depression/anxiety is common, but depression or anxiety does not significantly increase the SSD patients' medical utilization.

Understanding stigma toward schizophrenia

Schizophrenia is arguably one of the most stigmatized psychiatric disorders, with patients frequently seeing the burden of stigmatization as a "second illness." Thus, the purpose of this study was to investigate the relationships among the main aspects of the stigma toward schizophrenia. This study used a vignette methodology with 2053 individuals from the general population in Italy. The main aspects of stigma - causal beliefs, recommended treatments, social distance, perception of dangerousness, and avoidance - were investigated through participants' responses, and a latent variable structural equation model (SEM) approach was used to test the relationships among them. Perceived dangerousness predicts the desire for social distancing from an individual with schizophrenia, which predicts the desire for avoidance. In addition, biogenetic causal beliefs of schizophrenia and position on the appropriate medical treatment predict the perception of dangerousness and thus a greater desire for social distance. This study contributes to the literature on the stigmatization of mental health by improving our understanding of the phenomenon. Highlighting the relationships between aspects of stigma allows for a discussion of the implications for anti-stigma interventions.

The mediating effect of social support and coping strategies on the relation between family stigma and caregiver burden among Israeli Arab family caregivers of people with Alzheimer's disease (AD)

OBJECTIVES

Many studies have attempted to identify the factors that are associated with caregiver burden among family caregivers of people with Alzheimer's disease (AD), because of its plethora of negative consequences. One unique factor that has been investigated recently is family stigma. However, the path leading from family stigma to caregiver burden has not been thoroughly studied. Hence, this study had two main objectives. The first was to examine whether family stigma was a predictor of caregiver burden among Israeli Arab family caregivers of a person with AD. The second was to examine the interplay of family stigma and caregiver burden with coping strategies and social support.

METHODS

Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (adult children and spouses) of elderly people with AD (87.4% female; 71.4% adult children; mean age = 54.28).

RESULTS

Overall, the participants reported moderate levels of caregiver burden and family stigma. Additionally, as expected, family stigma made a unique - although modest - contribution to the explanation of caregiver burden. Whereas neither problem-focused coping nor emotion-focused coping played a significant role in mediating the relation between family stigma and caregiving burden, social support did mediate the relation between these variables.

CONCLUSIONS

Our findings reveal how social support is important as a specific way to reduce the impact of family stigma on caregiver burden.

The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys

Background: Research on social distancing from patients with depression has primarily focused on individual-level factors rather than context-level factors. This study aimed to investigate the relationship between individual-level and context-level factors and social distancing from depressive patients. Methods: Sample data were collected via computer-assisted telephone interviews with 800 Taiwanese adults aged 20 to 65 years in 2016. All effects were tested using multilevel analysis. Results: With regard to individual-level variables, male sex, older age, people with more perceived dangerousness and those with more emotional reaction of fear were associated with greater social distancing from depressive patients. After controlling for individual-level variables, a positive association was found between the degree of urbanization and social distancing. We also found the interaction between the density of psychiatric rehabilitation services and perceived dangerousness to be associated with social distance. This finding revealed that persons with more perceived dangerousness and living in a region with higher density of psychiatric rehabilitation services were associated with greater social distance. Conclusions: We found that social distancing from depressive patients is not only determined by individual-level factors but influenced by the surroundings. This study provides useful directions for the implementation of optimal anti-stigma interventions for patients with depression.

An Anti-Stigma Course for Occupational Therapy Students in Taiwan: Development and Pilot Testing

Attitudes of healthcare professionals towards people with disorders/disabilities are important for the development of therapeutic relationships, as well as to the evaluation and intervention processes. Therefore, it is critical to be aware and reduce stigmatizing attitudes in future healthcare professionals. An 18-week anti-stigma course was developed for occupational therapy students based on literature review and focus group interview. The course consisted of three components, including social contact, roleplaying, and critical reflection strategies. A quasi-experimental design was implemented to evaluate participants at three time points (i.e., pre-test, post-test, and one year after completion) using the Social Distance Scale and several questionnaires (i.e., stigmatising attitudes towards mental illness, physical disabilities, and children with emotional behavioural disorders). A total of 16 students completed the course and had significantly decreased social distance and stigmatising attitudes towards mental illness and emotional behavioural disorders in the post-test. These decreases remained one year later. The results support the provision of an anti-stigma course for occupational therapy students to reduce stigmatising attitudes. Future research should extend the anti-stigma course to occupational therapy students at other universities to increase both the sample size and overall generalisability.

The Views of Non-psychiatric Medical Specialists About People with Schizophrenia and Depression

This study explored the views of non-psychiatric medical specialists about people with schizophrenia and depression and examined whether specialists' approach to these clients, and their perception of dangerousness and social distance, differed by disorder. Non-psychiatric medical specialists working in community centers in Italy read either a schizophrenia or depression description and then completed a questionnaire on their views about people with that disorder. The schizophrenia-group (N = 114) was more sure than the depression-group (N = 97) that the patients should be approached differently in outpatient specialized clinics like those where the respondents worked; are incapable of caring for their own health; and are kept at distance by others. Perceived dangerousness did not significantly differ between the two groups. These findings highlight the potential effects of attitudes on medical practice and outline the need to educate non-psychiatric medical specialists on stigma as a strategy to reduce health discrepancies, particularly toward people diagnosed with schizophrenia.

The self-stigmatization of patients with schizophrenia: A phenomenological study

This study aimed to explore the self-stigma of schizophrenia patients. Qualitative phenomenological approach, purposive sampling and unstructured one-on-one interviews were used. Narratives were analyzed using Colaizzi's method. Data saturation was reached after 15 had been interviewed. Three themes and six sub-themes were revealed: the origin of the self-stigma (experience of self-stigma from the outside and the inside), the suffering experience of self-stigma (alienation from others and negative inner feelings), and coping with the self-stigma (acceptance and change of mind). The study supports the importance to increase awareness of self-stigma and suggests effective measures to help patients deal with this challenge.

Bad things happen and can drive you crazy: The causal beliefs of 701 people taking antipsychotics

In almost all countries the public prefers psycho-social explanations of 'schizophrenia' to bio-genetic ones. The causal explanations of people who experience psychosis have been under-researched, and, if they diverge from the dominant bio-genetic paradigm, can be dismissed as 'lack of insight'. 701 people, from 30 countries, who completed an online survey about their experiences on antipsychotics, answered an open question about what had caused the problems for which they had been prescribed the drugs. On a 'Bio-Social' likert scale, from 1 = 'Purely Biological' to 5 = 'Purely Social', the mean score was 4.24. Thematic analysis of 1,063 causal statements produced seven themes: Social (49.9%), Psychological (12.1%), Bio-genetic (11.6%), Iatrogenic (11.3%), Drug and Alcohol (6.7%), Medical Condition (4.5%) and Insomnia (4.0%). Respondents were 13 times more likely to report predominantly or exclusively Social causes as to report predominantly or exclusively Bio-genetic causes. Those with a psychosis diagnosis were even more likely than others to report a Social cause. The causal beliefs of this sample are consistent with previous studies of people diagnosed with 'schizophrenia' and the beliefs of the public. They are also aligned with recent research into the social causes of psychosis. It is argued that rather than dismiss the beliefs as 'lack of insight' it is more respectful and productive to listen carefully and adjust our understandings and services accordingly.