Physical proximity in anticipation of meeting someone with schizophrenia: the role of explicit evaluations, implicit evaluations and cortisol levels

How to measure mental illness stigma at work: development and validation of the workplace mental illness stigma scale

Introduction

The study objective was to design a new theoretically driven multidimensional scale for the use in the empirical measurement of stigmatizing attitudes towards persons with mental illness within the return-to-work process as this integral part of vocational reintegration has been widely neglected by scholars so far.

Methods

Therefore, we developed and validated a 21-item instrument to comprehensively measure the three-factorial structure of stigmatizing attitudes (affect, cognition, behavior) across two studies (overall N = 251).

Results

In both studies the new scale proved to be highly internally consistent, and its proposed three-factor structure was equally supported across the two studies. Convergent and discriminant validity were demonstrated by moderate and high correlations or zero correlations with pertinent measures. Furthermore, construct validity of the new scale was supported by significant positive associations with relevant personality characteristics within stigma research.

Discussion

The WMISS is the first instrument to measure mental health stigma specifically within the return-to-work-process and demonstrates strong psychometric properties. Inclusion of this scale in future research can help facilitate understanding of mental illness stigma within the occupational sector and assist with targeted intervention development.

Social exclusion in psychotic disorders: An interactional processing model

Psychotic disorders are among the most highly stigmatized mental disorders, and individuals with psychosis experience significant exclusion from the community. Stigma reduction programs have done little to reduce social exclusion of individuals with psychosis, and there are significant limitations to the traditional stigma model as it applies to social exclusion. Herein, we present the Interactional Processing Model (IPM) of social exclusion towards individuals with psychosis. The IPM considers social exclusion to be the result of two interacting pathways with additional consideration for a feedback loop through which social exclusion sets in motion natural behavioural responses of individuals with psychosis that inadvertently perpetuates exclusion. The IPM considers initial social exclusion to be the result of an interaction between these two pathways. The first path aligns with the traditional stigma model and consists of the community becoming aware that an individual is diagnosed with a psychotic disorder and then excluding the individual based on pre-existing, generalized knowledge about the disorder. The second path to exclusion involves the observation of atypical behaviours from the individual, and generation of an individualized exclusion response. We provide initial empirical support for the IPM of social exclusion, outline testable hypotheses stemming from the model, and discuss implications for novel ways to consider both societal stigma reduction and personalized intervention.

Examining the effect of religiosity, moral disengagement, personal attribution, comprehension and proximity on juror decision making regarding insanity pleas

Legal attitudes, religion, and attributions relate to insanity defense attitudes and legal decisions in insanity cases. Religious fundamentalism has consistently predicted punitiveness associated with insanity; however, the current research focuses on moral disengagement as an explanatory link in the fundamentalist and insanity chain. Additional exploratory interests examined how defendants' perceived proximity to jurors might act as a potential moderator. The current study uses factorial survey design to examine the relationships between the variables using a mock jury insanity trial. Results suggest religious fundamentalism is related to harsher verdicts and sentences, and these relationships are mediated by moral disengagement attributions, authoritarian attitudes towards the persons with mental illness, and negative attitudes towards the insanity defense. Based on findings, prosecution and defense should consider moral and religious themes presented in their arguments. Additionally, defendants pleading insanity should be aware of how juror attitudes and biases might affect the trial and verdict processes.

What's in a Name? Evaluating the Public Stigma of Gambling Disorder

Public stigma of gambling disorder has negative effects on the mental health and functioning of affected individuals and impedes treatment-seeking. One factor thought to be implicated in stigma is the label used to describe the condition. The aims of this research were to: (1) evaluate whether different labels for problematic gambling behavior influence public stigma; and (2) compare public stigma of gambling disorder to other health conditions. Separate samples of university student (Study 1) and general population (Study 2) participants were randomly assigned to label conditions and completed questionnaires assessing stigma and attitudes towards the assigned label. In Study 1, the eight conditions included four gambling labels (problem gambling, pathological gambling, gambling disorder, and gambling addiction) and four psychiatric or health comparison labels (depression, obsessive-compulsive disorder, alcohol use disorder, and asthma). In Study 2, compulsive buying disorder was added as a fifth psychiatric comparison for a total of nine conditions. The results indicated that the four gambling label conditions elicited similar attitudes and stigma. Those conditions were also more stigmatized than the depression, obsessive-compulsive disorder, and asthma conditions. The gambling conditions elicited similar stigmatizing attitudes as alcohol use disorder but were slightly more stigmatized than compulsive buying disorder, with these conditions showing both similarities and differences across the stigma-related outcomes. The results were largely consistent across both samples and contribute to knowledge of the nature and origins of gambling-related stigma.

Stigma Surrounding the Use of Medically Assisted Treatment for Opioid Use Disorder

This study sought to determine whether certain factors influenced public stigma toward the use of medication to treat opioid use disorders (MOUD). Method: In a series of 3 studies using between-subjects designs, hypothetical MOUD patients matched in age and educational status with the participants were varied in systematic ways to determine whether certain factors influenced stigmatizing views of the patients. Results: Study 1 (n = 142) determined that stigma levels were elevated for hypothetical patients receiving agonist medication for OUD compared to other medications or no medication at all. Study 2 (n = 144) found that hypothetical patients receiving opioid agonist medication for either heroin or pain pills were equally stigmatized and stigmatized more than hypothetical patients on nicotine agonist medication. Study 3 (n = 151) showed that stigmatizing attitudes did not change as a result of enhanced treatment services for hypothetical MOUD patients (i.e. therapy as a supplement to medication). Conclusions/Importance: Results indicate that patients receiving agonist medication for an OUD may be the target of public stigma. Public education on the efficacy of agonist medications for OUD is urgently needed to help reduce such stigma, which may facilitate treatment delivery, treatment adherence, and treatment success.

Sex differences in cortisol and memory following acute social stress in amnestic mild cognitive impairment

OBJECTIVE

Older adults with amnestic mild cognitive impairment (aMCI) develop Alzheimer's type dementia approximately 10 times faster annually than the normal population. Adrenal hormones are associated with aging and cognition. We investigated the relationship between acute stress, cortisol, and memory function in aMCI with an exploratory analysis of sex.

METHOD

Salivary cortisol was sampled diurnally and during two test sessions, one session with the Trier Social Stress Test (TSST), to explore differences in the relationship between cortisol and memory function in age-normal cognition (NA) and aMCI. Participants with aMCI (n = 6 women, 9 men; mean age = 75) or similarly aged NA (n = 9 women, 7 men, mean age = 75) were given tests of episodic, associative, and spatial working memory with a psychosocial stressor (TSST) in the second session.

RESULTS

The aMCI group performed worse on the memory tests than NA as expected, and males with aMCI had elevated cortisol levels on test days. Immediate episodic memory was enhanced by social stress in NA but not in the aMCI group, indicating that stress-induced alterations in memory are different in individuals with aMCI. High cortisol was associated with impaired performance on episodic memory in aMCI males only. Cortisol in Session 1 moderated the relationship with spatial working memory, whereby higher cortisol was associated with worse performance in NA, but better spatial working memory in aMCI. In addition, effects of aMCI on perceived anxiety in response to stress exposure were moderated by stress-induced cortisol in a sex-specific manner.

CONCLUSIONS

We show effects of aMCI on Test Session cortisol levels and effects on perceived anxiety, and stress-induced impairments in memory in males with aMCI in our exploratory sample. Future studies should explore sex as a biological variable as our findings suggest that effects at the confluence of aMCI and stress can be obfuscated without sex as a consideration.

Factors Influencing Stigma Toward Individuals Who Have Substance Use Disorders

OBJECTIVE

This study investigated whether certain misperceptions of substance use disorders (SUDs) would influence stigmatizing attitudes toward individuals who have SUDs.

METHOD

Using a between-subjects design, 1059 young adults (77.2% women) read vignettes describing characters with high or low levels of the following factors: responsibility, controllability, immorality, willpower, consequences, and accountability. Participants then completed measures of stigma toward each character (i.e., affective reactions, negative judgments, and social distancing).

RESULTS

Characters described as having low levels of accountability (i.e., denial), low levels of willpower, and severe consequences for their SUDs elicited higher levels of stigma compared to characters without these qualities. However, experimental manipulations of responsibility for one's SUD, controllability of one's SUD, and level of immorality associated with one's SUDs had no significant effect on stigmatizing attitudes.

CONCLUSIONS

These findings have important implications for educational programs aimed at reducing public stigma toward SUDs.

The differential effects of a focus on symptoms versus recovery in reducing stigma of schizophrenia

PURPOSE

We extend investigations of the impact of the content of video contact with an individual with schizophrenia on stigma reduction. We examine whether differential impacts persist over a 2-week period and the extent to which they are mediated by perceived similarity and feelings of empathy and/or sympathy.

METHOD

We used a randomized control trial wherein participants were exposed to a video in which an individual described his recovery from schizophrenia, or the same person described acute symptoms of schizophrenia, or a no-video control condition. Outcomes included impressions of and preferred social distance to the person in the video and people in general with schizophrenia and well as perceptions of similarity and feelings of sympathy and empathy. We also measured an overt behaviour, seating distance, at 2-week follow-up.

RESULTS

The recovery-focused material was generally more effective in improving impressions and reducing preferred level of social distance. Although the symptom-focused video resulted in great sympathy for the person, this did not translate into positive impressions or reduced social distance. Mediational analyses yielded findings consistent with the benefits of the recovery video being mediated by increased perceptions of similarity and lower feelings of sympathy. Exposure to the recovery-focused video resulted in less anxiety in anticipation of meeting the person in the video relative to the control condition.

CONCLUSIONS

Video contact emphasizing potential for recovery from schizophrenia was more effective in reducing stigmatizing responses than contact highlighting acute symptoms. Increased sympathy does not necessarily translate into reductions in stigma.

Where does one stand: a biological account of preferred interpersonal distance

What determines how close you choose to stand to someone? Why do some people prefer farther distances than others? We hypothesized that an important factor is one's sensory sensitivity level, i.e. how sensitive one is to nearby visual stimulation, noise, touch or smell. This study characterizes the behavioral, hormonal and electrophysiological metrics of interpersonal distance (IPD) preferences in relation to levels of sensory sensitivity. Using both an ecologically realistic task and electroencephalogram (EEG), we found that sensory sensitivity levels predicted IPD preferences, such that the more sensitive one is the farther distance they prefer. Furthermore, electrophysiological evidence revealed that individuals with higher sensory sensitivity show more alpha suppression for approaching stimuli, strengthening the notion that early sensory cortical excitability is involved in one's social decision of how close to stand to another. The results provide evidence that a core human metric of social interaction is influenced by individual levels of sensory sensitivity.

Neurophysiological evidence for a processing bias towards schizophrenia-associated communication abnormalities

BACKGROUND

The current study aimed to examine the effects of diagnostic and symptomatic information on auditory linguistic event-related potentials (ERPs) in the listener, in response to speech containing schizophrenia-associated communication abnormalities.

METHODS

73 participants listened to conversation segments while continuous EEG was recorded. Participants were told that the responder in the conversation was either a university student, had symptoms from a stroke, had symptoms from schizophrenia, or had recovered from schizophrenia. The final word of the response was randomly presented as a typical ending, word approximation, neologism, or filler ending.

RESULTS

A significant N400 was observed over centro-parietal electrode sites in response to word approximations and neologisms in the university student condition only. There were no differences between conditions in the N100 ERP, and EEG measures were not related to either subjective or objective measures of stigmatizing attitudes.

CONCLUSIONS

The N400 effect may represent disengagement, at a semantic level, from what an individual is saying based on symptomatic or diagnostic information about schizophrenia.

Does labeling matter? An examination of attitudes and perceptions of labels for mental disorders

PURPOSE

Labeling research in various domains has found that attitudes and perceptions vary as a function of the different labels ascribed to a group (e.g., overweight vs. obese). This type of research, however, has not been examined extensively in regards to labels for mental disorders. The present study examined whether common psychiatric labels (i.e., mental disease, mental disorders, mental health problems, and mental illness) elicited divergent attitudes and perceptions in a group of participants. These labels were also compared to the specific label of depression.

METHODS

Undergraduate psychology students (N = 124) were given identical questionnaire packages with the exception of the label used. That is, each participant received a set of questionnaires that referred to only one of the five labels. The questionnaire package contained various quantitative measures of attitudes and social distance, in addition to a short qualitative measure.

RESULTS

Analyses demonstrated equivalence among the four general psychiatric labels on measures of attitudes, social distance, and general perceptions. However, results also suggested that the general labels diverged from the depression label, with the latter being generally more negatively perceived. Some analyses demonstrated that participants' understanding of the terminology might be incorrect. The results of the investigation are discussed with a focus on its relationship with current research in stigma.

CONCLUSION

Within the current sample, general psychiatric labels did not appear to distinguish themselves from each other on measures of attitude and social distance but did so when compared to a relatively more specific term. Future research should examine the underlying mechanism driving this finding, with the ultimate goal of reducing the stigma faced by those with mental disorders.

The Generalised Anxiety Stigma Scale (GASS): psychometric properties in a community sample

BACKGROUND

Although there is substantial concern about negative attitudes to mental illness, little is known about the stigma associated with Generalised Anxiety Disorder (GAD) or its measurement. The aim of this study was to develop a multi-item measure of Generalised Anxiety Disorder stigma (the GASS).

METHODS

Stigma items were developed from a thematic analysis of web-based text about the stigma associated with GAD. Six hundred and seventeen members of the public completed a survey comprising the resulting 20 stigma items and measures designed to evaluate construct validity. Follow-up data were collected for a subset of the participants (n = 212).

RESULTS

The factor structure comprised two components: Personal Stigma (views about Generalised Anxiety Disorder); and Perceived Stigma (views about the beliefs of most others in the community). There was evidence of good construct validity and reliability for each of the Generalised Anxiety Stigma Scale (GASS) subscales.

CONCLUSIONS

The GASS is a promising brief measure of the stigma associated with Generalised Anxiety Disorder.