Biogenetic explanations and stigma: A meta-analytic review of associations among laypeople

Associations between a Brazilian suicide awareness campaign and suicide trends from 2000 to 2019: Joinpoint and regression discontinuity analysis

BACKGROUND

Suicide is a global health concern whose rates are soaring in many low-and-middle-income countries. Public awareness campaigns have been implemented in Brazil; however, their impact is uncertain.

METHODS

This was an ecological study using population data from DATA-SUS, a Brazilian official notification system, selecting only deaths that were voluntarily self-inflicted (CID-10 × 60-X84). We analyzed all available data from 2000 to 2019 to assess trends before and after the national Yellow September (YS) campaign started in 2015. Differences in trends were assessed by Joinpoint Analysis (JA) and Regression Discontinuity Analysis (RDD), unadjusted and adjusted for economic factors.

RESULTS

Overall, there was a progressive increase in the rate of relative (per 100,000 inhabitants) number of suicides over time between 2000 and 2019 (57 % increase). The JA detected a change in the slope of the curve representing an acceleration in suicides starting in the year 2015. Adjusted RDD revealed the year that Yellow September started significantly change the slope of the association between time and rates of suicide (pinteraction < 0.01), and marginal analysis detected the coefficient increased from 0.07 (95%CI 0.04-0.10) to 0.27 (95%CI -0.07-0.60) suicides/year per 100,000 inhabitants.

LIMITATIONS

The ecological nature of the manuscript compromises causational implications.

CONCLUSIONS

We found an increase in suicidal trends in Brazil, against the global trend that coincides with the beginning of a large national awareness campaign. Although we cannot attribute causality, our results reinforce the need of further studies to better understand the role of awareness campaigns in suicide reduction interventions, including potential unintended effects.

Chemical imbalance and etiological beliefs about depression among college students

Etiological beliefs of depression have differing impacts on motivation, hope, and treatment expectations. However, it is unclear where people are exposed to these beliefs. Objective: This study examined beliefs about depression and their relations to symptoms, attitudes about depression, and treatment preferences. Participants: 426 undergraduates attending a large midwestern university. Methods: Participants completed an online survey asking about causes of depression, if and where they had heard about the "chemical imbalance" explanation of depression, attitudes about depression, as well as measures of their symptoms, treatment history, and hypothetical treatment preferences. Results: Sixty-two percent of the sample had heard of the chemical imbalance explanation, most commonly from the classroom. Biochemical beliefs about depression were most strongly endorsed among participants with a family history of depression and who had had personal experience with treatment. The chemical imbalance belief was uniquely related to dysfunctional beliefs about depression. Etiological beliefs were largely unrelated to treatment preferences. Conclusion: College students are exposed to models of mental health that may not be ideal for treatment and recovery.

Changes in the ability to correctly identify schizophrenia and depression: results from general population surveys in Germany over 30 years

PURPOSE

This study aims to examine time trends in the ability to correctly identify schizophrenia and major depression within the German general population from 1990 to 2020, as an indicator of changing mental health literacy (MHL). Additionally, we investigated shifts in the use of stigmatizing language.

METHODS

Our analysis is based on four waves of representative population surveys in Germany in 1990/1993 (West Germany: N = 2044, East Germany: N = 1563), 2001 (N = 5025), 2011 (N = 2455), and 2020 (N = 3042) using identical methodology. Respondents were presented with an unlabelled case vignette describing a person who exhibited symptoms of either schizophrenia or major depression. Participants were then asked to name the problem described in the vignette using an open-ended question.

RESULTS

From 1990/1993 to 2020, correct identification of schizophrenia increased from 18% to 34% and from 27% to 46% for major depression. However, derogatory labels remained constant throughout all survey waves, particularly for schizophrenia (19% in 1990/1993 and 18% in 2020). For depression, more trivializing and potentially devaluing statements were recorded.

CONCLUSION

Despite the increasing use of psychiatric terminology among the general population, the persistence of derogatory labels suggests that improved MHL, reflected in higher recognition rates, may not automatically translate into a reduction in stigmatizing language. With depression, a normalization and trivialization of a severe illness could pose new challenges to people with major depression. Dedicated efforts to combat the stigma of severe mental illness are still needed.

Teaching gene-environment interaction concepts with narrative vignettes: Effects on knowledge, stigma, and behavior motivation

Gene-environment interaction (GxE) concepts underlie a proper understanding of complex disease risk and risk-reducing behavior. Communicating GxE concepts is a challenge. This study designed an educational intervention that communicated GxE concepts in the context of eating behavior and its impact on weight, and tested its efficacy in changing knowledge, stigma, and behavior motivation. The study also explored whether different framings of GxE education and matching frames with individual eating tendencies would result in stronger intervention impact. The experiment included four GxE education conditions and a control condition unrelated to GxE concepts. In the education conditions, participants watched a video introducing GxE concepts then one of four narrative vignettes depicting how a character's experience with eating hyperpalatable or bitter tasting food (reward-based eating drive vs. bitter taste perception scenario) is influenced by genetic or environmental variations (genetic vs. environmental framings). The education intervention increased GxE knowledge, genetic causal attributions, and empathetic concern. Mediation analyses suggest that causal attributions, particularly to genetics and willpower, are key factors that drive downstream stigma and eating behavior outcomes and could be targeted in future interventions. Tailoring GxE education frames to individual traits may lead to more meaningful outcomes. For example, genetic (vs. environmental) framed GxE education may reduce stigma toward individuals with certain eating tendencies among individuals without such tendencies. GxE education interventions would be most likely to achieve desired outcomes such as reducing stigma if they target certain causal beliefs and are strategically tailored to individual attributes.

Causal beliefs about mental illness: A scoping review

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

Expanding the notion of mechanism to further understanding of biopsychosocial disorders? Depression and medically-unexplained pain as cases in point

Evidence-Based Medicine has little consideration for mechanisms and philosophers of science and medicine have recently made pleas to increase the place of mechanisms in the medical evidence hierarchy. However, in this debate the notions of mechanisms seem to be limited to 'mechanistic processes' and 'complex-systems mechanisms,' understood as 'componential causal systems'. I believe that this will not do full justice to how mechanisms are used in biological, psychological and social sciences and, consequently, in a more biopsychosocial approach to medicine. Here, I propose, following (Kuorikoski, 2009), to pay more attention to 'abstract forms of interaction' mechanisms. The present work scrutinized review articles on depression and medically unexplained pain, which are considered to be of multifactorial pathogenesis, for their use of mechanisms. In review articles on these disorders there seemed to be a range of uses between more 'abstract forms of interaction' and 'componential causal system' mechanisms. I therefore propose to expand the notions of mechanisms considered in medicine to include that of more 'abstract forms of interaction' to better explain and manage biopsychosocial disorders.

Reliability and validity evaluation of the stigma of loneliness scale in Chinese college students

BACKGROUND

The stigma of loneliness exacerbates the negative effect of loneliness, reduces the willingness to seek help, damages interpersonal relationships, and threatens health status. However, there is currently no valid scale for measuring the stigma of loneliness in China. The study aims to translate the Stigma of Loneliness Scale (SLS) and evaluate the reliability and validity of the Chinese version.

METHODS

The investigation was conducted in two phases. In the first phase, the SLS was used to conduct a questionnaire survey on 657 college students aged 17 to 24; in the second phase, the SLS, the UCLA Loneliness Scale (ULS-8), the Distress Disclosure Index (DDI), the Revised Cheek and Buss Shyness Scale (RCBS), the Self-Concealment Scale (SCS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS), the Kessler Psychological Distress Scale (K10), and the Rosenberg Self-Esteem Scale (RSES) were used to conduct the questionnaire survey on 801 college and graduates students aged 18 to 39.

RESULTS

Two dimensions of Self-stigma of Loneliness and Public Stigma of Loneliness were extracted with a cumulative factor interpretation rate of 74.60% when conducting exploratory factor analysis on the first-stage data. The factor loading of each item ranged from 0.585 to 0.890, and the commonality ranged from 0.609 to 0.735. The confirmatory factor analysis and reliability and validity test were carried out on the data gathered in the second phase, indicating that the two-factor model fits well. In addition, the scores of SLS and all dimensions were significantly positively correlated with the total scores of ULS-8, RCBS, SCS, SIAS, SPS, and K10, and negatively correlated with those of DDI and RSES. The Cronbach's alpha coefficients for SLS and SSL and PSL dimensions were 0.957, 0.941, and 0.955. The cross-group invariance test found that the SLS was equivalent for males and females. Meanwhile, males scored significantly higher than females on both the total scores of SLS score and each dimension.

CONCLUSIONS

The Chinese version of SLS displayed satisfactory psychometric properties and can be a valid tool to assess the stigma of loneliness among Chinese young people.

The Influence of Using Novel Predictive Technologies on Judgments of Stigma, Empathy, and Compassion among Healthcare Professionals

BACKGROUND

Our objective was to evaluate whether the description of a machine learning (ML) app or brain imaging technology to predict the onset of schizophrenia or alcohol use disorder (AUD) influences healthcare professionals' judgments of stigma, empathy, and compassion.

METHODS

We randomized healthcare professionals (N = 310) to one vignette about a person whose clinician seeks to predict schizophrenia or an AUD, using a ML app, brain imaging, or a psychosocial assessment. Participants used scales to measure their judgments of stigma, empathy, and compassion.

RESULTS

Participants randomized to the ML vignette endorsed less anger and more fear relative to the psychosocial vignette, and the brain imaging vignette elicited higher pity ratings. The brain imaging and ML vignettes evoked lower personal responsibility judgments compared to the psychosocial vignette. Physicians and nurses reported less empathy than clinical psychologists.

CONCLUSIONS

The use of predictive technologies may reinforce essentialist views about mental health and substance use that may increase specific aspects of stigma and reduce others.

The undue influence of genetic information on senior medical students' treatment decisions

BACKGROUND

Knowledge of the genetic basis of health conditions can influence how the public perceives their own and others' health. When there are known genetic associations for such conditions, genetic essentialist biases facilitate deterministic thinking and an over-emphasis of genetic causality. This study investigates the role that genetic essentialist biases play in medical decision-making.

METHODS

Senior postgraduate medical students (N = 102) read a scenario in which a patient presents with gastroenterological symptoms. Half of the students were told that the patient tested positive for HLADQ2 - a gene implicated in, but not deterministic of, coeliac disease. The other half received no genetic information. Students were assessed on their recommendations for investigation and management using a multiple-choice questionnaire. Twenty-two of these students participated in a qualitative follow-up which used focus groups and semi-structured interviews to explore the reasoning behind students' responses.

RESULTS

Management recommendations differed between the two groups, with those receiving genetic information more likely to recommend a gluten free diet. Recommendations for further investigation did not differ significantly between groups. Interviews suggested that these findings arose despite the students' good understanding of the common non-deterministic nature of genes, such as HLADQ2.

CONCLUSION

Differences in management recommendations suggest that the inclusion of genetic information unduly biased students towards a premature diagnosis of a serious health condition, coeliac disease. Follow-up interviews introduced the possibility that observed manipulation-based differences may have been based on anticipated expectations of examiners, rather than perceived future clinical practice. Based on the present results it is unclear whether intentional exam-taking strategies fully account for medical students' decisions, or if they contribute in addition to the activation of genetic essentialist biases. Further research in clinical settings may ascertain whether genetic essentialist biases would truly influence medical student and doctors within their clinical practice environment.

Adversity versus fate, genetics, and the environment: Causal beliefs and attitudes toward intellectual disability

The present study investigated the role of demographic and personal factors concerning the attitudes toward intellectual disability. Our sample consisted of 482 Romanians aged 18 to 74. We measured the overall attitudes toward intellectual disability, as well as some specific dimensions, i.e., integration or segregation, social distance, private rights, and subtle derogatory changes. Our results suggested that the most significant predictor of the overall positive attitude toward intellectual disability, as well as for the subtle derogatory beliefs and integration/segregation dimensions, was the perceived environmental causal belief about intellectual disability. Next, the biomedical causal was the most significant predictor for the social distance dimension. Finally, the perceived fate-related causal belief was the most significant predictor for the private rights dimension. We discuss our findings concerning their role in designing targeted public awareness programs.

Analysis of YouTube content on substance use disorder treatment and recovery

BACKGROUND AND AIM

Emerging literature suggests the role of social media in substance use disorders (SUD). This study aimed to explore the content of YouTube videos for persons on SUD treatment/recovery, describing the users' exposure and engagement metrics and understanding viewers' perspectives.

METHODS

We generated a set of 10 key phrases to search on YouTube. Eighty eligible videos were analyzed using a mixed-methods approach. Content analysis of all videos and thematic analysis of 30 videos were done using the three most viewed videos from each key phrase. The reliability of videos was assessed using a modified DISCERN. The total number of views, likes, dislikes, and comments were noted and created engagement metrics. The linguistic analysis of viewers' comments was done to assess their perspectives.

RESULTS

Sixty-three (78.8%) videos were from the US, and 59 (73.8%) were intended for persons or families with substance misuse. Persons in recovery uploaded 23 (28.7%) videos. We identified five themes - reasons for using drugs, symptoms of addiction, consequences of drug use, how to stop drug use, and expressed tone in the language. The positivity and relative positivity ratios were highest for videos developed by persons in recovery. There was a negative correlation between the relative positivity ratio and content fostering internalized stigma. Words with negative emotional experiences dominated the viewers' comments.

CONCLUSION

YouTube content on SUD treatment and recovery is popular and revolves around the biopsychosocial understanding of addiction. There is an urgent need for a language policy and regulation of non-scientific content.

The effects of causal and self-efficacy beliefs on help-seeking for people with depressive complaints: a quasi-experimental online study

Background

Only approximately a third of people with depressive symptoms seek professional health care. Furthermore, people labelled as mentally ill may experience stigmatisation, which can impede help-seeking behaviour.

Aim

To examine the effects of three vignette-based interventions endorsing biopsychosocial causal beliefs and strengthening self-efficacy on help-seeking intention and behaviour, as well as the predictive values of these variables and previous treatment experience.

Method

A quasi-experimental online study utilising a fractioned factorial design was carried out. People were screened for depressive symptoms and their current treatment status. After baseline assessment, they were randomly allocated into one of 24 groups receiving a combination of interventional messages. Actual help-seeking behaviour was measured at follow-ups 3 and 6 months after baseline.

Results

Altogether, N = 1,368 participants were included in the final analyses and N = 983 provided data on their help-seeking behaviour within 3 to 6 months after the baseline assessment. The intention to seek help from a general practitioner or a mental health professional was significantly influenced by the interventions. However, help-seeking behaviour was not influenced by the interventions. On a conceptual level, biopsychosocial causal beliefs (β = 0.09-0.23) and self-efficacy to seek help (β = 0.16-0.25) predicted help-seeking intention. There was a negative interaction effect of both self-efficacy beliefs on intention and behaviour, which changed depending on depression severity. In all models, the intention was the main predictor of actual behaviour. Treatment experience predicted both help-seeking intention and behaviour.

Conclusion

Biopsychosocial causal beliefs and self-efficacy have a direct effect on help-seeking intention. Interventions should include information on how to actually seek help as a means to strengthen self-efficacy beliefs and simulate previous treatment experience. Further research is needed to investigate the respective interaction effects on intention and behaviour.

Clinical Trial Registration

https://drks.de/search/de/trial/DRKS00023557, German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111-1264-9954. Registered 16 February 2021.

Stigmatizing attitudes toward mental illness among caregivers of patients with mental disorders in China

Objective

This study aimed to investigate stigmatizing attitudes toward depression, schizophrenia, and general anxiety disorder (GAD) among caregivers of patients with mental disorders in China.

Methods

A cross-sectional study was conducted among 607 caregivers in China, using vignettes that described three mental illnesses. Data on the caregivers' attitudes and other people's attitudes toward individuals with mental disorders and their willingness to come in contact with people with mental disorders were collected.

Results

In the three vignettes, caregivers agreed that positive outcomes outnumbered negative outcomes. The top two statements endorsing the stigma were "the person could snap out of the problem" and "people with this problem are dangerous." In the section for perceived stigma, caregivers in the GAD vignette agreed that most people believed this problem is not a real medical illness, compared to schizophrenia. The rates of the statement endorsing unpredictability were significantly different in the schizophrenia (57.2%) and depression (45.5%) vignette, in comparison to the GAD (45.6%) vignette. For personal stigma, the caregivers tended to avoid people described in the depression vignette more often than in the GAD vignette. The caregivers were most unwilling to let the person described in the vignettes marry into their family, especially in the schizophrenia vignette.

Conclusion

Despite the stigma and desire for social distance associated with schizophrenia, depression, and GAD, caregivers often expect positive outcomes. Actions should be taken to improve caregivers' knowledge about mental health and reduce the stigma.

Does explaining psychogenic nonepileptic seizures using either a biomedical or biopsychosocial framework affect young people's illness representations? An experimental vignette study

Lay representations of psychogenic nonepileptic seizures (PNES) are important both for understanding public stigma and anticipating patient responses to PNES diagnosis. The current study presents the first evidence of the general public's representations of PNES and the malleability of these understandings to different ways of explaining PNES. An online experimental study exposed participants (n = 193, aged 18-25 years) to a vignette describing a case of PNES in biomedical terms, PNES in biopsychosocial terms, or epilepsy. Subsequent questionnaires assessed participants' illness representations, causal attributions, and stigmatising attitudes regarding the case about which they read. Results suggest that compared with biomedical framings, biopsychosocial explanations increased perceptions of PNES as threatening. While epilepsy was attributed to significantly more biological and less social causes than either of the PNES vignettes, causal attributions did not differ between biomedically- vs. biopsychosocially-framed PNES. Neither were there any differences between the three conditions in stigmatising attitudes towards people who experience seizures. These findings are useful for clinicians delivering a PNES diagnosis and patients disclosing a PNES diagnosis, in helping anticipate responses to these communications. Further research is required to confirm the clinical and societal significance of the study's first insights into the dynamics of lay responses to PNES.

Causes or Cures: What makes us think of attention issues as disorders?

Are attention issues disorders or not? Philosophers of medicine have tried to address this question by looking for properties that distinguish disorders from non-disorders. Such properties include deviation of a statistical norm, a loss of function or experienced suffering. However, attempts at such conceptual analysis have not led to a consensus on the necessary and sufficient conditions for the application of the concept of disorder. Recently, philosophers have proposed an experimental approach to investigate in which circumstances people think a specific concept is applicable. Here we present a quantitative vignette study investigating whether disorder attribution depends on the perceived cause and the perceived type of treatment for an attention problem. The results of our study indicate that the attribution of a disorder decreased when the attention problem was understood as caused by bullying (social environmental cause) or by an accident (non-social environmental cause) rather than a genetic cause. When prescribed a pill, attention problems were considered a disorder to a larger extent than when the child was prescribed an environmental treatment. Our study also suggests that whereas successful environmental treatments will not necessarily decrease the disorder attribution, successful pharmacological treatments will decrease the likelihood that a person is thought to still suffer from a disorder after receiving the treatment.

Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi

PURPOSE

While mental health stigma research is sparse in Malawi, research in other settings suggests that stigma represents a barrier to mental health treatment and recovery. Accordingly, we conducted an analysis to understand the role of treatment-related stigma in depression care in Malawi by estimating the effect of patients' baseline anticipated treatment-related stigma on their 3-month probability of depression remission when newly identified with depression.

METHODS

We conducted depression screening and treatment at 10 noncommunicable disease (NCD) clinics across Malawi from April 2019 through December 2021. Eligible cohort participants were 18-65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at the baseline and 3-month interviews included a vignette-based quantitative stigma instrument that measured treatment-related stigma, i.e., concerns about external stigma because of receiving depression treatment. Using inverse probability weighting to adjust for confounding and multiple imputation to account for missing data, this analysis relates participants' baseline levels of anticipated treatment stigma to the 3-month probability of achieving depression remission (i.e., PHQ-9 score < 5).

RESULTS

Of 743 included participants, 273 (37%) achieved depression remission by their 3-month interview. The probability of achieving depression remission at the 3-month interview among participants with high anticipated treatment stigma (0.31; 95% Confidence Interval [CI]: 0.23, 0.39)) was 10 percentage points lower than among the low/neutral stigma group (risk: 0.41; 95% CI: 0.36, 0.45; RD: -0.10; 95% CI: -0.19, -0.003).

CONCLUSION

In Malawi, a reduction in anticipated depression treatment-related stigma among NCD patients initiating depression treatment could improve depression outcomes. Further investigation is necessary to understand the modes by which stigma can be successfully reduced to improve mental health outcomes and quality of life among people living with depression.

[The German population's attitude towards mental disorders]

For many of those affected, a mental illness also means dealing with the reactions of their environment. These are shaped by culturally prevailing ideas about the cause, treatment, course, and biographical significance of the illness. This article provides an overview of the development of population attitudes towards individuals with mental illness in Germany between 1990 and 2020 with a focus on depression and schizophrenia.A look at the last 30 years shows that attitudes toward mental illness are not static; rather, they are subject to certain dynamics that can vary considerably depending on the type of mental illness. In summary, depression evokes far fewer negative emotions than is the case with schizophrenia. This gap in attitudes has widened over the last 30 years: people with depression are met with more understanding today than 30 years ago, while the stigma of schizophrenia seems to have increased. In addition to an increasing openness in dealing with mental stress, ideas of normality and concepts of mental illness seem to have also changed. Depressive states are more closely connected with people's perceptions of their own experiences today than they were ten years ago. Schizophrenia, in turn, seems to be perceived as even more unfamiliar. While the recommendation of both psychotherapy and medication increases over time, and both psychotherapists and psychiatrists are more readily recommended as a source of help, recommendation of spiritual support (pastor, priest) declines steadily since 1990. We discuss potential causes and consequences of these divergent time trends.

Influence of Biogenetic Explanations of Mental Disorders on Stigma and Help-Seeking Behavior: A Systematic Review and Meta-Analysis

BACKGROUND

Biogenetic causal explanations of mental disorders are commonly used for public education and campaigns. However, the influence of biogenetic explanations on the ideas about and attitudes toward mental illness is unclear. We examined the influence of biogenetic explanations on attitudes toward mental disorders using a meta-analytic method accompanied by subgroup analyses.

METHODS

The protocol for this meta-analysis was registered in PROSPERO (CRD42020158656) in March 2020. Experimental and correlational studies were analyzed separately. Five outcome measures related to attitudes toward mental disorders were included: 'attitude toward help-seeking,' 'blame,' 'perceived dangerousness,' 'prognostic pessimism,' and 'social distance.' Subgroup analyses were performed for the type of mental disorder, population, and geographic region for which a biogenetic explanation was provided.

RESULTS

A total of 44 studies were included, of which 24 were experimental and 20 were correlational. A positive attitude toward help-seeking was associated with having a biogenetic concept (d = 0.43; 95% confidence interval [CI], 0.18 to 0.67; P < 0.001) in general population and in Eastern countries in particular. Although a biogenetic explanation was associated with a decreased level of blame (d = -0.20; 95% CI, -0.38 to -0.02; P = 0.029) in the general population, it was also associated with significantly higher levels of perceived dangerousness (d = 0.13; 95% CI, 0.03 to 0.23; P = 0.008). A tendency toward a higher level of prognostic pessimism and social distance was associated with a biogenetic concept of mental disorders although there was no statistical significance.

CONCLUSION

Having a biogenetic concept of the cause of mental disorders was related with a positive attitude toward help-seeking, particularly in the general population and individuals living in Eastern countries. Providing a biogenetic explanation decreased blame toward individuals with mental illness but was associated with increased perceived dangerousness and prognostic pessimism. Therefore, although a biogenetic explanation promotes public use of mental health services, it should be carefully applied to avoid an increase in negative thoughts, such as that mental illness is biologically irreversible and untreatable.

The Seeking Mental Health Care model: prediction of help-seeking for depressive symptoms by stigma and mental illness representations

BACKGROUND

Only about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).

METHOD

All variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).

RESULTS

Altogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).

CONCLUSION

The Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111-1264-9954. Registered 16 February 2021.

Changes in mental illness stigma over 30 years - Improvement, persistence, or deterioration?

BACKGROUND

Large efforts have been made to erase the stigma of mental illness, but it is unclear whether they have succeeded on a population level. We examine how attitudes toward people with depression or schizophrenia have evolved in Germany since 1990, and whether there are different developments for both disorders.

METHODS

Using data from the three decades, four wave repeated cross-sectional representative population study in the "old" (western) states in Germany with surveys in 1990 (n = 2,044), 2001 (n = 4,005), 2011 (n = 1,984), and 2020 (n = 2,449), we calculate time-trends for social distance and emotional reactions toward someone with major depression or acute schizophrenia.

RESULTS

Social distance worsened in six out of seven situations for schizophrenia, whereas improving in two out of seven situations for depression. Emotions related to fear and uneasiness increased for schizophrenia, whereas tending to decrease for depression. Pro-social reactions like the desire to help increased for depression, but decreased for schizophrenia. Initially observed differences, favoring depression over schizophrenia, widened over the 30-year study period. For schizophrenia, the biggest negative changes occurred between 1990 and 2001, whereas some improvements with regard to depression occurred more recently.

CONCLUSION

Contrary to expectations, stigma has become more severe regarding acute schizophrenia in Germany over the last 30 years, whereas only slightly improving for depression. The apparent normalization of mental health problems seems not to directly translate into improving attitudes toward people with severe mental illness. Re-focusing of anti-stigma efforts on people with severe mental illness seems necessary.

The effect of neuroscientific evidence on sentencing depends on how one conceives of reasons for incarceration

Neuroscientific evidence is increasingly utilized in criminal legal proceedings, prompting discussions about how such evidence might influence legal decisions. The effect of neuroscientific testimony on legal decisions remains uncertain, with some studies finding no effect, others reporting that neuroscience has a mitigating impact, and some indicating neuroscience evidence has an aggravating effect. The present study attempts to explain these divergent findings by showing that the effect of neuroscience evidence on sentencing interacts with beliefs about the goals of the criminal legal system. Using a between-subjects design, participants (N = 784) were asked to assume different rationales for imprisonment, before receiving neuroscientific evidence about antisocial behavior and its potential relation to the defendant. Participants recommended a sentence for the defendant prior to and after reading the neuroscientific evidence. Participants who were given the rationale of retribution as the primary goal of imprisonment significantly decreased their sentencing recommendations. When the goal of imprisonment was to protect the public from dangerous people, participants provided longer post-testimony sentences. Lastly, when the goal was to rehabilitate wrongdoers, participants also increased sentences from pre to post. Thus, the impact of neuroscientific evidence is not monolithic, but can lead to either mitigated or aggravated sentences by interacting with penal philosophy.

Effectiveness of a Co-Production with Dialogue Program for Reducing Stigma against Mental Illness: A Quasi-Experimental Study with a Pre- and Post-Test Design

For people with mental illnesses, stigma represents a barrier to social participation. Health professionals, including students, often hold stigma toward such individuals, Further, people with a mental illness often have self-stigma. This study aimed to both develop and examine the effectiveness of a new program based on co-production with dialogue for reducing stigma among both health science students and people with mental illnesses. This was a quasi-experimental study, with a pre- and post-test design and no control group. The sample comprised 28 university students majoring in occupational therapy and 20 community-dwelling people with mental illnesses. The Co-Production with Dialogue Program for Reducing Stigma (CPD-RS) was administered to this sample. Link's Devaluation Discrimination Scale (DDS) was used to assess whether the program reduced stigma. Compared to their preintervention scores, the students' postintervention DDS scores significantly decreased, persisting for at least one month, but those of people with mental illnesses showed no significant change. Both the students and the people with mental illnesses evaluated the program as "positive" through a questionnaire administered two months after the intervention. These results suggest that the CPD-RS reduces health science students' stigma toward people with mental illnesses and fosters mutual understanding between the two groups.

Effects of a Cognitive Schema Account on the Stigma of Schizophrenia: A Study in a French University Student Sample

Among people with psychiatric disorders, those with schizophrenia are subject to high levels of stigmatization. Research is necessary to identify new strategies that may help reduce the stigma of schizophrenia. Educational strategies using cognitive accounts, particularly early maladaptive schemas (EMSs), have shown promising results in the context of depression, but they have not been evaluated in the context of schizophrenia. The present study compared the effect on the stigma of three different educational strategies, based on cognitive distortions, biogenetics, and EMSs. A total of 378 students were randomly assigned to 1 of 4 groups. Three experimental groups were presented with a vignette that introduced 1 of 3 different etiological accounts of schizophrenia (cognitive distortions, EMSs, or biogenetics). The fourth group was presented with a text unrelated to schizophrenia. The participants completed questionnaires that measured their attitudes, empathic concern, and social distance toward people with schizophrenia, before and after reading the text. The intervention using the EMS etiology account for schizophrenia was the only one that led to a significant decrease in stigma. The latter effect was driven mainly by an increase in the level of empathic concern toward people with schizophrenia. Given that similar results have been observed for depression and that the role of EMSs in many psychiatric disorders has been demonstrated, studying the effects of EMS explanations for other stigmatized disorders may be promising for reducing the stigma of psychiatric disorders.

Perceptions of causal attribution and attitudes to genetic testing among people with schizophrenia and their first-degree relatives

Rapid advances in the genetics of psychiatric disorders mean that diagnostic and predictive genetic testing for schizophrenia risk may one day be a reality. This study examined how causal attributions for schizophrenia contribute to interest in a hypothetical genetic test. People with schizophrenia and first-degree relatives of people with schizophrenia were recruited through a schizophrenia research bank and mental health organisation. Semi-structured telephone interviews were conducted with 13 individuals with schizophrenia and 8 first-degree relatives. Transcripts were subjected to a qualitative analysis using the thematic analysis framework. Five themes were developed: (i) "It is like a cocktail", with most participants aware that both genetic and environmental factors contributed to causation, and many mentioning the positive impact of genetic causal explanations; (ii) "Knowledge is power" (i.e., in favour of genetic testing); (iii) Genetic testing provides opportunities for early intervention and avoiding triggers, with participants citing a wide range of perceived benefits of genetic testing but few risks; (iv) Views on reproductive genetic testing for schizophrenia risk with a few participants viewing it as "playing God" but not necessarily being against it; and (v) "It snowballs", whereby participants' understanding of genetics was sophisticated with most believing that multiple rather than single genes contributed to schizophrenia. In conclusion, many individuals had a sound understanding of the role of genetic testing if it were to become available, with evidence of insight into the role of multiple genes and the contribution of other risk factors that may interact with any inherited genetic risk.

Luck, lottery, or legacy? The problem of confounding. A reply to Harden

A reply to Harden's response to Coop and Przeworski (2022).

'Finding my Hard Hat': Reflections of recovery from a service user and caring professional

ACCESSIBLE SUMMARY

What is known on the subject? Lived experience narratives of recovery can provide an insight and subtlety where academic papers can often fall short. There is a need for people who work in mental health services to address and take care of their own psychosocial needs. What the paper adds to existing knowledge? This paper provides a unique insight into a care professional's recovery from mental ill health. Looked at through this dual lens of service user and care professional provide the reader with a rich narrative from the perspective of both sides of the caring role. What are the implications for practice? People who work in caring roles need to be vigilant of their own needs and the impact that the work can have on them. Safety protocol for managing one's own mental health should be a requirement for people within the caring profession.

ABSTRACT

Introduction This is an account of my experiences becoming unwell and accessing general and mental health services in Ireland. Aim It is hoped that this lived narrative of my recovery will shed light on accessing mental health services from a dual lens; that of service user and social worker. Method It traces this experience from initial contact with my general practitioner, to admission to a secure psychiatric ward where recovery slowly began. Results It is also hoped that reading my experiences of recovery and some of the insights shared will help those in the nursing or social care profession consider how they may be affected by their work. Discussion It is important to note that this account views my experiences within a neurobiology framework and this might not align to other people's experiences. However, my narrative of help-seeking is complex and includes multiple points where I uncover insights and encounter different healthcare professionals.

Influence of mental health literacy on help-seeking behaviour for mental health problems in the Swiss young adult community: a cohort and longitudinal case-control study

Poor knowledge about mental health disorders and their treatment likely contributes to the large treatment gap reported for mental health problems. Therefore, we studied the association between mental health literacy (MHL) and active help-seeking in a community sample. Participants were recruited from an add-on questionnaire study to the 'Bern Epidemiological At-Risk' (BEAR) study on 16-40-year-old community subjects of the Swiss canton Bern. At baseline, data of N = 1504, and at 3-year follow-up, data of N = 535 were available. Based on an unlabelled case vignette (on depression or schizophrenia), MHL was assessed by the questionnaire of Angermeyer and colleagues. Cross-sectional and longitudinal baseline predictors of help-seeking were analysed using path analyses. Additionally, sensitivity analyses of the prospective model were computed for sex, vignette, and baseline mental health problems/disorders. Cross-sectionally, help-seeking was associated with non-endorsement of biogenetic causal explanations, presence of mental health problems/disorders, help-seeking before baseline, poorer functioning, and lower health satisfaction. The prospective model was similar; yet, help-seeking at follow-up was associated with endorsements of the causal explanation 'biogenetics' and, additionally, 'childhood trauma' but not the presence of baseline mental health problems/disorders. Sensitivity analyses revealed a significant impact on sex, vignette, and mental health problems/disorders. For example, actual functional problems were predictive in males, while health satisfaction was predictive in females. Our findings indicate that future studies on drivers of help-seeking should assess very large community samples with case vignettes on different mental disorders to examine appropriate subgroups and their likely interaction to address group-specific factors in awareness campaigns.

Charting an Alternative Course for Mental Health-Related Anti-Stigma Social and Behaviour Change Programmes

Mental health-related anti-stigma strategies are premised on the assumption that stigma is sustained by the public's deficiencies in abstract professional knowledge. In this paper, we critically assess this proposition and suggest new directions for research. Our analysis draws on three data sets: news reports (N = 529); focus groups (N = 20); interviews (N = 19). In each social context, we explored representations of mental health and illness in relation to students' shared living arrangements, a key group indicated for mental health-related anti-stigma efforts. We analysed the data using term-frequency inverse-document frequency (TF-IDF) models. Possible meanings indicated by TF-IDF modelling were interpreted using deep qualitative readings of verbatim quotations, as is standard in corpus-based research approaches to health and illness. These results evidence the flawed basis of dominant mental health-related anti-stigma campaigns. In contrast to deficiency models, we found that the public made sense of mental health and illness using dynamic and static epistemologies and often referenced professionalised understandings. Furthermore, rather than holding knowledge in the abstract, we also found public understanding to be functional to the social context. In addition, rather than being agnostic about mental health-related knowledge, we found public understandings are motivated by group-based identity-related concerns. We will argue that we need to develop alternative anti-stigma strategies rooted in the public's multiple contextualised sense-making strategies and highlight the potential of engaging with ecological approaches to stigma.

Why mental disorders are brain disorders. And why they are not: ADHD and the challenges of heterogeneity and reification

Scientific attempts to identify biomarkers to reliably diagnose mental disorders have thus far been unsuccessful. This has inspired the Research Domain Criteria (RDoC) approach which decomposes mental disorders into behavioral, emotional, and cognitive domains. This perspective article argues that the search for biomarkers in psychiatry presupposes that the present mental health categories reflect certain (neuro-) biological features, that is, that these categories are reified as biological states or processes. I present two arguments to show that this assumption is very unlikely: First, the heterogeneity (both within and between subjects) of mental disorders is grossly underestimated, which is particularly salient for an example like Attention Deficit/Hyperactivity Disorder (ADHD). Second, even the search for the biological basis of psychologically more basic categories (cognitive and emotional processes) than the symptom descriptions commonly used in mental disorder classifications has thus far been inconclusive. While philosophers have discussed this as the problem of mind-body-reductionism for ages, Turkheimer presented a theoretical framework comparing weak and strong biologism which is more useful for empirical research. This perspective article concludes that mental disorders are brain disorders in the sense of weak, but not strong biologism. This has important implications for psychiatric research: The search for reliable biomarkers for mental disorder categories we know is unlikely to ever be successful. This implies that biology is not the suitable taxonomic basis for psychiatry, but also psychology at large.

Morally excused but socially excluded: Denying agency through the defense of mental impairment

Defendants can deny they have agency, and thus responsibility, for a crime by using a defense of mental impairment. We argue that although this strategy may help defendants evade blame, it may carry longer-term social costs, as lay people’s perceptions of a person’s agency might determine some of the moral rights they grant them. Three randomized between-group experiments (N = 1601) used online vignettes to examine lay perceptions of a hypothetical defendant using a defense of mental impairment (versus a guilty plea). We find that using a defense of mental impairment significantly reduces responsibility, blame, and punitiveness relative to a guilty plea, and these judgments are mediated by perceptions of reduced moral agency. However, after serving their respective sentences, those using the defense are sometimes conferred fewer rights, as reduced agency corresponds to an increase in perceived dangerousness. Our findings were found to be robust across different types of mental impairment, offences/sentences, and using both manipulated and measured agency. The findings have implications for defendants claiming reduced agency through legal defenses, as well as for the broader study of moral rights and mind perception.

Effects of Biological Determinism on Beliefs and Attitudes About Transgender People: Psychological Essentialism and Biased Assimilation

This experimental study examined the effects of biological attributions on individuals' beliefs and attitudes toward transgender people and the moderating role of right-wing authoritarianism (RWA). We randomly assigned 183 Chinese university students (men: n = 85, women: n = 98) to read one of three fictitious articles. The first article suggested that transgender identity was causally linked to biology (biological determinist condition), the second one highlighted the interplay between biological and environmental factors (epigenetic condition), whereas the third article did not mention the origins of transgender identity (control condition). Consistent with the biased assimilation hypothesis, the effects of biological attributions depended on individual differences in RWA. Low-RWA participants showed higher levels of naturalness and discreteness/homogeneity beliefs about transgender identity in the biological determinist condition than those in the control condition. By contrast, high-RWA participants displayed higher levels of discreteness/homogeneity beliefs but similar levels of naturalness beliefs when they read the biological determinist message compared with the control group. Low-RWA participants showed higher levels of naturalness but similar levels of discreteness/homogeneity beliefs in the epigenetic condition compared with the control, whereas high-RWA participants exhibited lower levels of naturalness and higher levels of discreteness/homogeneity beliefs when they read the epigenetic message compared with the control group. This study also suggests that, contrary to attribution theory, presenting information regarding the biological basis of transgender identity does not necessarily lead to more positive attitudes because (a) it triggers essentialist thinking and (b) the effects of biological attributions depend on recipients' authoritarian dispositions.

Social Contact: Next Steps in an Effective Strategy to Mitigate the Stigma of Mental Illness

People living with mental illnesses and their families may conceal their conditions to avoid prejudice and discrimination. Stigma often prevents people from receiving adequate health care and other social support services which could exacerbate social and health consequences such as unemployment, homelessness, substance use, and compulsory hospitalization. In this paper, we discuss social contact as a promising anti-stigma strategy for enhancing social interactions among people with mental illnesses, their families, and those without mental illnesses. In particularly, we consider next steps for an approach that works to reduce the stigma-related burden of mental illness. For social contact to be effective in reducing mental illness stigma, it requires broad social buy-in as well as implementation within care systems. Engagement with this approach can be driven through diverse contact-based education using collaborative efforts of society, academic institutions, policy-makers, health professionals, media, and governments. Ultimately, this work aims to consider the next steps in enacting social contact as an anti-stigma strategy through direct interventions and contact-based education. The success of this approach requires pragmatic public policies to support its implementation.

Shaping Future Doctors' Minds: Effects of Biological and Social Models on Medical Students' Views on Depression

OBJECTIVE

The aim of this study was to explore how changes in biologically based narratives versus socially focused ones affect medical students' perceptions of causes, treatment strategies, and social distance towards patients and their beliefs that patients can improve.

METHODS

The sample consisted of 1652 medical students of 18 to 32 years of age from the Faculty of Medicine at the University of Belgrade. Three text passages describing a female with standard symptoms of depression were randomly assigned. Within the text, additional information about different circumstances was included: information about personal problems (group S), family mental disorder history (group B), or both (group BS).

RESULTS

Although family history of mental illness does not necessarily imply heredity, group B assumed a biological cause of depression to be more probable and identified medication prescription as a more effective treatment approach than the other groups did. Changes in views towards treatment strategies from the first year to later years were observed with the medical model becoming more dominant.

CONCLUSIONS

The results of this study warn us of a tendency towards thinking less about social causes and more about medication prescription when an indication of biological causes is present. Implications for the medical education of future doctors and clinical practitioners are discussed.

The Important Role of Stereotypes in the relation between Mental Health Literacy and Stigmatization of Depression and Psychosis in the Community

Increased mental health literacy (MHL) has not reduced stigmatization of people with mental disorder. Thus, we examined the role of stereotypes in the interplay of MHL (correct labelling, causal explanations) and the wish for social distance (WSD) from people with depressive and psychotic symptoms in a community sample of 1526 German-speaking participants in the Swiss 'Bern Epidemiological At-Risk' study (age 16-40 years; response rate: 60.1%). Following the presentation of an unlabelled case vignette of depression or psychosis, MHL, stereotypes and WSD were assessed in a questionnaire survey. Their interrelations were studied using structural equation modelling. MHL was not directly linked to WSD, only the psychosocial causal model was directly negatively associated with WSD. Perceived dangerousness particularly increased WSD, this was increased by a biogenetic causal model and decreased by a psychosocial causal model. Awareness-campaigns that, next to biological causes, emphasize psychosocial causes of mental disorders might better reduce stigmatization.

Humanizing Pedophilia as Stigma Reduction: A Large-Scale Intervention Study

The stigmatization of people with pedophilic sexual interests is a topic of growing academic and professional consideration, owing to its potential role in moderating pedophiles' emotional well-being, and motivation and engagement in child abuse prevention schemes. Thus, improving attitudes and reducing stigmatization toward this group is of paramount importance. Prior research has suggested that narrative humanization-presenting personal stories of self-identified non-offending pedophiles-could be one route to doing this. However, this work has only been conducted with students or trainee psychotherapists, meaning the public generalizability of this method is still unknown. In this study, we compared two stigma interventions to test whether narratives reduce stigma toward people with pedophilic interests more effectively than an informative alternative (scientific information about pedophilia). Using a longitudinal experimental design with a lack of non-intervention control (initial N = 950; final N = 539), we found that narratives had consistently positive effects on all measured aspects of stigmatization (dangerousness, intentionality), whereas an informative alternative had mixed results, and actually increased perceptions of pedophiles' levels of deviance. These effects were still present four months after the initial presentation. We discuss these data in relation to ongoing debates about treating pedophilia as a public health issue requiring a broad societal approach to well-being and child abuse prevention.

The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy

Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.

Public misconceptions about dyslexia: The role of intuitive psychology

Despite advances in its scientific understanding, dyslexia is still associated with rampant public misconceptions. Here, we trace these misconceptions to the interaction between two intuitive psychological principles: Dualism and Essentialism. We hypothesize that people essentialize dyslexia symptoms that they anchor in the body. Experiment 1 shows that, when dyslexia is associated with visual confusions (b/d reversals)—symptoms that are naturally viewed as embodied (in the eyes), laypeople consider dyslexia as more severe, immutable, biological, and heritable, compared to when dyslexia is linked to difficulties with phonological decoding (a symptom seen as less strongly embodied). Experiments 2–3 show that the embodiment of symptoms plays a causal role in promoting essentialist thinking. Experiment 2 shows that, when participants are provided evidence that the symptoms of dyslexia are embodied (i.e., they “show up” in a brain scan), people are more likely to consider dyslexia as heritable compared to when the same symptoms are diagnosed behaviorally (without any explicit evidence for the body). Finally, Experiment 3 shows that reasoning about the severity of dyslexia symptoms can be modulated by manipulating people’s attitudes about the mind/body links, generally. These results show how public attitudes towards psychological disorders arise from the very principles that make the mind tick.

Ethical concerns relating to genetic risk scores for suicide

Genome-wide association studies (GWAS) provide valuable information in research contexts regarding genomic changes that contribute to risks for complex psychiatric conditions like major depressive disorder. GWAS results can be used to calculate polygenic risk scores (PRS) for psychiatric conditions, such as bipolar disorder or schizophrenia, as well as for other traits, such as obesity or hypertension. Private companies that provide direct-to-consumer (DTC) genetic testing sometimes report PRS for a variety of traits. Recently, the first well-powered GWAS study for suicide death was published. PRS reports that claim to assess suicide risk are therefore likely to appear soon in the DTC setting. We describe ethical concerns regarding the commercial use of GWAS results related to suicide. We identify several issues that must be addressed before PRS for suicide risk is made available to the public through DTC: (a) the potential for misinterpretation of results, (b) consumers' perceptions about determinism and behavior change, (c) potential contributions to stigma, discrimination, and health disparities; and (d) ethical problems regarding the testing of children and vulnerable adults. Tests for genetic prediction of suicidality may eventually have clinical significance, but until then, the potential for individual and public harm significantly outweighs any potential benefit. Even if genetic prediction of suicidality improves significantly, information about genetic risk scores must be distributed cautiously, with genetic counseling, and with adequate safeguards.

Burdens in mental health recovery: Causal beliefs and their relation to stigma and help seeking recommendations

BACKGROUND

Lay attitudes are often seen as potential barriers to mental health recovery. But apart from perceiving them as potential barriers, they can also play an important role in stimulating individuals to consult (in)formal help sources, in particular through the process of help referral. Where existing research mainly focusses on actual help seeking behaviour, this study will focus on lay publics' referral behaviour.

AIMS

This study analyses the relation between causal beliefs and stigmatising attitudes and social distance on the one hand, and (in)formal help seeking recommendations on the other.

METHODS

Data from a survey carried out in 2019, assessing the attitudes of Public Health Insurance Provider (HIP) members towards mental health problems, was used. Part of the survey questions was based on a quantitative quasi-experimental design, using hypothetical written vignettes. The weighted data represent a sample of the adult Flemish population (22-94 years, N = 5675). Multiple linear regression analysis was used to examine the relation between causal beliefs and stigma, while binominal logistic regression analysis was used to investigate the relation between causal beliefs and help seeking recommendations.

RESULTS

The results reveal that causal beliefs significantly associate with stigma, measured by stigmatising attitudes and social distance: personal- or biogenetic beliefs associate with more stigma, where psychosocial beliefs associate with less stigma. Concerning help seeking recommendations, psychosocial beliefs associate with recommending psychological or psychotherapeutic care, biogenetic beliefs associate with advising help from general practitioners and suggesting psychiatric help, while personal beliefs negatively associate with recommending formal help. Meanwhile, biogenetic beliefs associate with less informal help seeking recommendations (e.g. family, friends and online self-help), where personal beliefs associate with more informal help seeking recommendations and psychosocial beliefs only associate with online help referral.

CONCLUSION

This study highlights the importance of causal beliefs in affecting public stigma and help seeking recommendations.

Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions

Stigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self-stigma than White American groups. In within-group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family's sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self-stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.

Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy

BACKGROUND

In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression.

METHODS

Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis.

RESULTS

Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent.

CONCLUSIONS

Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change.

TRIAL REGISTRATION

Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.

Beliefs About the Causes of Psychosis Among Persons With Psychosis and Mental Health Professionals: A Scoping Review

OBJECTIVE

The beliefs that people with psychosis hold about causes of their illness (causal beliefs) can affect their choice to adhere to treatment and engage in mental health services. However, less is known about causal beliefs of mental health professionals (MHPs) and their impact on treatment adherence and service engagement. This review explored literature focusing on MHPs' causal beliefs and mapped the degree of concordance between their causal beliefs and those of people with psychosis.

METHODS

A systematic literature search of PubMed, Embase, Scopus, PsycINFO, and Applied Social Sciences Index Abstracts and a gray-literature search of PsyArXiv and MedNar yielded 11,821 eligible references. The first author reviewed all titles and abstracts, and the coauthors reviewed 10% (N=1,200).

RESULTS

Forty-two articles were included. Most articles indicated that MHPs tend to endorse biogenetic beliefs (9 of 15 articles assessing MHPs' beliefs, 60%), whereas people with psychosis tend to endorse psychosocial beliefs (16 of 31 articles, 52%) and other nonbiogenetic beliefs (in 8 of 31 articles, 26%). Most studies did not compare causal beliefs of people with psychosis and their treating MHP. Studies varied in design, setting, and measures.

CONCLUSIONS

MHPs and people with psychosis often hold complex views composed of different types of causal beliefs. However, a gap in causal beliefs between these groups appears to exist, which may affect the therapeutic relationship and pose barriers to treatment adherence. Future studies should address this gap by developing interventions that facilitate open communication about causal beliefs to promote treatment alliance and shared decision making.

The role of genetic essentialism and genetics knowledge in support for eugenics and genetically modified foods

People are regularly exposed to discussions about the role of genes in their lives, despite often having limited understanding about how they operate. The tendency to oversimplify genetic causes, and ascribe them with undue influence is termed genetic essentialism. Two studies revealed that genetic essentialism is associated with support for eugenic policies and social attitudes based in social inequality, and less acceptance of genetically modified foods. These views about eugenics and genetically-modified foods were especially evident among people who had less knowledge about genes, potentially highlighting the value of education in genetics.

Multivariate analysis of 1.5 million people identifies genetic associations with traits related to self-regulation and addiction

Behaviors and disorders related to self-regulation, such as substance use, antisocial behavior and attention-deficit/hyperactivity disorder, are collectively referred to as externalizing and have shared genetic liability. We applied a multivariate approach that leverages genetic correlations among externalizing traits for genome-wide association analyses. By pooling data from ~1.5 million people, our approach is statistically more powerful than single-trait analyses and identifies more than 500 genetic loci. The loci were enriched for genes expressed in the brain and related to nervous system development. A polygenic score constructed from our results predicts a range of behavioral and medical outcomes that were not part of genome-wide analyses, including traits that until now lacked well-performing polygenic scores, such as opioid use disorder, suicide, HIV infections, criminal convictions and unemployment. Our findings are consistent with the idea that persistent difficulties in self-regulation can be conceptualized as a neurodevelopmental trait with complex and far-reaching social and health correlates.

Investigating perceived heritability of mental health disorders and attitudes toward genetic testing in the United States, United Kingdom, and Australia

Our beliefs about the heritability of psychiatric traits may influence how we respond to the use of genetic information in this area. In the present study, we aim to inform future education campaigns as well as genetic counseling interventions by exploring common fears and misunderstandings associated with learning about genetic predispositions for mental health disorders. We surveyed 3,646 genetic research participants from Australia, and 960 members of the public from the United Kingdom, and the United States, and evaluated attitudes toward psychiatric genetic testing. Participants were asked hypothetical questions about their interest in psychiatric genetic testing, perceived usefulness of psychiatric genetic testing, and beliefs about malleability of behavior, among others. We also asked them to estimate the heritability of alcohol dependence, schizophrenia, and major depression. We found a high interest in psychiatric genetic testing. In most cases, more than a third of the participants showed serious concerns related to learning about personal genetic predisposition, such as not wanting to have children if they knew they had a high genetic predisposition, or not wanting to choose a partner with a high genetic predisposition for a mental health problem. Finally, we found a significant association between most participants' attitudes and their lay estimates of heritability, which highlights the complexity of educating the public about genetics.

A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy

BACKGROUND AND AIMS

Drug-related impairment is persistently stigmatized delaying and preventing treatment engagement. To reduce stigma, various medical terms (e.g. 'chronically relapsing brain disease', 'disorder') have been promoted in diagnostic systems and among national health agencies, yet some argue that over-medicalization of drug-related impairment lowers prognostic optimism and reduces personal agency. While intensely debated, rigorous empirical study is lacking. This study investigated whether random exposure to one of six common ways of describing drug-related impairment induces systematically different judgments.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional survey, US general population, among a nationally representative non-institutionalized sample (n = 3635; 61% response rate; December 2019-January 2020).

INTERVENTION

Twelve vignettes (six terms × gender) describing someone treated for opioid-related impairment depicted in one of six ways as a(n): 'chronically relapsing brain disease', 'brain disease', 'disease', 'illness', 'disorder' or 'problem'.

MEASUREMENTS

Multi-dimensional stigma scale assessing: blame; social exclusion; prognostic optimism, continuing care, and danger (a = 0.70-0.83).

FINDINGS

US adults [mean age = 47.81, confidence interval (CI) = 47.18-48.44; 52.4% female; 63.14% white] rated the same opioid-impaired person differently across four of five stigma dimensions depending on which of six terms they were exposed to. 'Chronically relapsing brain disease' induced the lowest stigmatizing blame attributions (P < 0.05); at the same time, this term decreased prognostic optimism [mean difference (MD) = 0.18, 95% CI = 0.05, 0.30] and increased perceived need for continuing care (MD = -0.26, 95% CI = -0.43, -0.09) and danger (MD = -0.13, 95% CI = -0.25, -0.02) when compared with 'problem'. Compared with a man, a woman was blamed more for opioid-related impairment (MD = -0.08, 95% CI = -0.15, -0.01); men were viewed as more dangerous (MD = 0.13, 95% CI = 0.06, 0.19) and to be socially excluded (MD = 0.16, 95% CI = 0.09, 0.23).

CONCLUSIONS

There does not appear to be one single medical term for opioid-related impairment that can meet all desirable clinical and public health goals. To reduce stigmatizing blame, biomedical 'chronically relapsing brain disease' terminology may be optimal; to increase prognostic optimism and decrease perceived danger/social exclusion use of non-medical terminology (e.g. 'opioid problem') may be optimal.

Morally excused but socially excluded: Denying agency through the defense of mental impairment

Defendants can deny they have agency, and thus responsibility, for a crime by using a defense of mental impairment. We argue that although this strategy may help defendants evade blame, it may carry longer-term social costs, as lay people’s perceptions of a person’s agency might determine some of the moral rights they grant them. In this registered report protocol, we seek to expand upon preliminary findings from two pilot studies to examine how and why those using the defense of mental impairment are seen as less deserving of certain rights. The proposed study uses a hypothetical vignette design, varying the type of mental impairment, type of crime, and type of sentence. Our design for the registered study improves on various aspects of our pilot studies and aims to rigorously test the reliability and credibility of our model. The findings have implications for defendants claiming reduced agency through legal defenses, as well as for the broader study of moral rights and mind perception.