Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence

Discrimination and Social Exclusion of People Experiencing Mental Disorders in Burkina Faso: A Socio-anthropological Study

Stigma has been pointed out as a barrier to mental healthcare in sub-Saharan Africa. Among the manifestations of stigma, the use of physical restraints is condemned as a form of violation of basic human rights. Research on this phenomenon is limited in West Africa and more particularly in Burkina Faso. This study explores the phenomenon of stigma of individuals experiencing mental disorders in Bobo-Dioulasso (Burkina Faso). As part of 8 months of socio-anthropological fieldwork, we interviewed 94 informants (7 focus groups and 25 individual interviews) to document exclusionary practices, their perceptions, and justifications. Exclusionary practices can be divided in five subgroups: ignoring, physically and sexually abusing, abandoning, banning, and restraining. Some practices were linked to a lack of financial and material resources, while others were justified by an inferior moral status. We observed differences in the type of exclusion experienced between men and women. Restrictive, abusive, and exclusionary measures are common in Bobo-Dioulasso. These practices can either be understood as part of families' adaptative strategies when dealing with chronic conditions, as part of security measures in the case of patients with aggressive behaviors, or as part of punitive measures when transgressions are committed. We conclude the article by addressing the tensions between local and global meanings of stigma.

Psychiatric polygenic risk scores: Experience, hope for utility, and concerns among child and adolescent psychiatrists

Recent advances in psychiatric genetics have enabled the use of polygenic risk scores (PRS) to estimate genetic risk for psychiatric disorders. However, the potential use of PRS in child and adolescent psychiatry has raised concerns. This study provides an in-depth examination of attitudes among child and adolescent psychiatrists (CAP) regarding the use of PRS in psychiatry. We conducted semi-structured interviews with U.S.-based CAP (n = 29) who possess expertise in genetics. The majority of CAP indicated that PRS have limited clinical utility in their current form and are not ready for clinical implementation. Most clinicians stated that nothing would motivate them to generate PRS at present; however, some exceptions were noted (e.g., parent/family request). Clinicians spoke to challenges related to ordering, interpreting, and explaining PRS to patients and families. CAP raised concerns regarding the potential for this information to be misinterpreted or misused by patients, families, clinicians, and outside entities such as insurance companies. Finally, some CAP noted that PRS may lead to increased stigmatization of psychiatric disorders, and at the extreme, could be used to support eugenics. As PRS testing increases, it will be critical to examine CAP and other stakeholders' views to ensure responsible implementation of this technology.

Asymmetrical genetic attributions for the presence and absence of health problems

OBJECTIVE

Recent research has suggested that people more readily make genetic attributions for positively valenced or desirable traits than for negatively valenced or undesirable traits-an asymmetry that may be mediated by perceptions that positive characteristics are more 'natural' than negative ones. This research sought to examine whether a similar asymmetry in genetic attributions would emerge between positive and negative health outcomes.

DESIGN

Across seven experiments, participants were randomly assigned to read a short vignette describing an individual experiencing a health problem (e.g. hypertension) or a corresponding healthy state (e.g. normal blood pressure).

MAIN OUTCOME MEASURES

All participants provided ratings of naturalness and genetic attributions for the outcome described in their assigned vignette.

RESULTS

For diagnoses other than addictive disorders, participants rated the presence of a diagnosis as less genetically caused than its absence; for addictive disorders, the presence of a diagnosis was rated as more genetically caused than its absence. Participants consistently rated the presence of a health problem as less natural than its absence.

CONCLUSION

Even within a single domain of health, people ascribe differing degrees of 'naturalness' and genetic causation to positive versus negative health outcomes, which could impact their preferences for treatment and prevention strategies.

Stigmatization of drinking patients with liver cancer: The role of socioeconomic status

Patients with liver cancer may face stigmatization due to cancer, alcohol consumption, or both. This study addresses gaps in the existing literature regarding stigmatization of alcohol-related liver cancer patients, particularly its connection with socioeconomic status (SES). The study explores whether the SES of a fictional character with alcohol addiction and liver cancer influences stigma levels reported by participants. Additionally, it investigates how participants' personal characteristics, such as alcohol consumption and healthcare professional status, impact stigmatization. This study aims to provide new insights regarding the role of stigmatization in liver cancer treatment and management, emphasizing in socioeconomic determinants. The method is based on three scenarios describing a woman character with alcohol abuse and liver cancer. The scenarios depicted a woman character with either low, medium or high SES. Each participant (N = 991) was randomly assigned to one of the three scenarios. After reading it, each participant answered questionnaires assessing negative attitudes towards the character. Four scales were used: "Negative attributions about people with health problems", "Causality of cancer", "Controllability of drinking" and "Reluctance to helping behavior". Data were analyzed using ANOVA and t-tests. The scenario describing a character with a low SES significantly received more "Negative attributions about people with health problems" than the character with medium or high SES. Participants having higher alcohol consumption themselves showed lower stigma scores for three out of four scales than participants with lower consumption. In addition, participants identified as health professionals had lower stigma scores regarding the scales "Negative attributions about people with health problems" and "Controllability of drinking", and higher scores for the subscale "Reluctance to helping behavior", compared with non-professionals. A character with low SES received more negative attributions than the one with higher SES. Participants' own alcohol consumption and professional status (being health professional or not), influenced their stigmatizing attitudes.

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.

Ethnoracialized group differences in attitudes and knowledge about schizophrenia and willingness to engage in biomarker research: The UBIGR Study

Although there is renewed optimism in biomarker research in schizophrenia, there is also need for greater inclusion of historically underrepresented groups in the research. In the present study, we surveyed 599 African American, 352 American Indian/Alaska Native, and 725 NonHispanic White participants about their attitudes toward research, knowledge and attitudes about schizophrenia, and willingness to engage in biomarker testing. Attitudes toward research were examined using the standardized 7-item Research Attitudes Questionnaire (RAQ) measure. Using structural equation modeling (SEM), we tested our predictive model of the likelihood of willingness to engage in biomarker testing for schizophrenia risk. Members of historically underrepresented groups were less willing to engage in biomarker testing. Overall, attitudes toward research, particularly trust, influenced biomarker testing willingness. These findings suggest that factors influencing willingness to engage in schizophrenia biomarker testing may be modifiable by outreach engagement and education.

Leaving the stigma to the patients? Frequency of crisis experiences among mental health professionals in Berlin and Brandenburg and how they cope with it

BACKGROUND

Although mental health professionals' mental health problems are gaining increased attention, there is little systematic research on this topic.

AIMS

This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities.

METHODS

An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated.

RESULTS

Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues.

CONCLUSION

The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed.

People with mental illness stigmatize mental illness less: A comparison study between a hospital-based sample of people with mental illness and a non-clinical general population sample in urban India

Evidence shows that stigma negatively influences the quality of life of persons with severe mental illness. Nonetheless, stigma towards mental illness is lower among persons with a lived experience of mental illness compared to the rest of the population. Understanding the association between stigma of mental illness and the mental status of individuals living in urban India and whether this association is moderated by demographic factors opens a new avenue for prevention of social exclusion. Persons diagnosed with schizophrenia, bipolar disorder, or severe unipolar depression (cases, n  =  647) were recruited from among hospital patients in New Delhi between November 2011 and June 2012 and matched with non-psychiatric urban dwellers by age, sex, and location of residence (controls, n  =  649). Propensity score matching with multivariable linear regression was used to test whether stigma towards mental illness, measured by a 13-item Stigma Questionnaire, differed between cases and controls. Cases reported significantly lower stigma scores than controls (b  =  -0.50, p < 0.0001). The strength of the association between mental illness and stigma was not affected after controlling for age, caste, sex, education, and employment status, while wealth marginally reduced the strength of the association. These findings suggest individuals with a lived experience of mental illness, in New Delhi, India, may be more tolerant towards mental illness and support the need to involve persons with lived experience in the development and implementation of health promotional campaigns and programs aimed at reducing stigma towards mental illness.

(Mis)understanding alcohol use disorder: Making the case for a public health first approach

'Alcohol use disorder' (AUD) is used by several contemporary conceptualizations to identify, treat and prevent problems associated with alcohol use. Such conceptualizations encompass diagnostic classifications and broader frameworks for policy and practice. However, current AUD concepts are subject to multiple tensions and limitations in capturing and responding to the complex and heterogeneous nature of alcohol problems. Further, public understandings of alcohol problems are heavily divergent from professional AUD concepts and remain embedded within an 'alcoholism' master narrative in which disease model stereotypes come with multiple costs for prevention and 'recovery'. The persistence of a problematic 'alcoholism' paradigm reflects the coalescing of multiple forces including the cognitive appeal of reductionism, motives to stigmatize and 'other', and an over-emphasis on AUD as an individually located biomedical problem. Public misperceptions of AUD as a matter of the individual, the individual's essence, and misconceived notions of responsibility and control have been bolstered by industry interests and the ascension of neuroscience and genetics, in turn diverting attention from the importance of the environmental and commercial determinants of health and the effectiveness of under-utilized public health policies. We call for multiple stakeholders to support efforts to prioritize a public health first approach to advancing AUD research, policy and treatment in order to make significant advances in AUD prevention and treatment. We offer several recommendations to assist in shifting public understanding and scientific limitations in AUD concepts and responses.

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.

Lifestyle causal beliefs are associated with higher personal and perceived stigma regarding depressive disorders: results from a representative population survey

BACKGROUND

Depression is a prevalent and severe disorder associated with considerable stigma. This stigma contributes to the suffering and impedes help seeking behaviour of those affected. Stigma can be influenced by causal beliefs about depression and personal contact with people suffering from depression. The aim of this study was to investigate (1) the associations between beliefs about the aetiology of depression and personal / perceived stigma, as well as (2) a possible moderating effect of personal contact with people with depression on these associations.

METHODS

Stigma, causal beliefs, and contact with depression were assessed in a representative online survey among German adults (N = 5,000). Multiple regression analyses were performed with contact levels (unaffected vs. personally affected (diagnosed) vs. personally affected (undiagnosed) vs. affected by relatives with depression vs. persons who treat depression) and causal beliefs (biogenetic vs. psychosocial vs. lifestyle) as predictor variables for personal and perceived stigma as dependent variables.

RESULTS

Higher personal stigma was associated with lifestyle causal beliefs (p < .001, f² = 0.07), lower personal stigma with biogenetic (p = .006, f² = 0.01) and psychosocial (p < .001, f² = 0.02) causal beliefs. A positive interaction between psychosocial beliefs and the contact group "relatives" (p = .039) further suggests that this contact group does not benefit so strongly from psychosocial causal beliefs regarding personal stigma. Higher perceived stigma was associated with psychosocial (p < .001, f² = 0.01) and lifestyle (p < .011, f² = 0.01) causal beliefs. Regarding contact levels, the "unaffected" had significantly higher personal stigma scores than each of the other contact groups (p < .001). The contact group "affected (diagnosed)" had significantly higher perceived stigma scores than "unaffected".

CONCLUSIONS

The available data show that anti-stigma campaigns should clearly communicate, that depression is not caused by an unfavorable lifestyle. In general, psychosocial or biological explanatory models should be explained. Especially for the target group "relatives of depressive patients", who can be an important support for patients, education about biogenetic explanatory models should be provided. However, it is important to note that causal beliefs are only one of many factors that impact on 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.

Should we promote alcohol problems as a continuum? Implications for policy and practice

The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.

[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.

Psychological comorbidities in osteoarthritis in Germany

Osteoarthritis is a degenerative joint disease associated with pain, loss of function and reduced quality of life. Concomitant psychological disorders can significantly influence treatment outcomes. Therefore, we aimed to answer the following research questions: (1) How has the incidence of primary coxarthrosis and gonarthrosis developed over the last decade? (2) How high is the prevalence of osteoarthritis patients with concomitant psychological diagnoses? (3) Which psychological comorbidities are most prevalent in coxarthrosis and gonarthrosis patients, respectively? For this cross-sectional study, a dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 to 2019 was analysed. Incidences of the codes "M16.1" and "M17.1", unilateral primary coxarthrosis and unilateral primary gonarthrosis, were quantified. Prevalence rates of secondary diagnoses of the chapter F of the ICD-10 were determined. Incidences were 230.7/100,000 inhabitants for coxarthrosis and 224.2/100,000 inhabitants for gonarthrosis. Patients with psychological comorbidities constituted 9.0% of coxarthrosis cases and 8.9% of gonarthrosis cases, respectively. Between 2009 through 2019, the proportion of patients with a concomitant "F" diagnoses of the ICD-10 increased by + 37.8% for coxarthrosis and by 17.9% for gonarthrosis. The most prevalent secondary diagnoses were affective disorders (F3), whereby numbers increased over the years. Increasing psychological comorbidities advocate for the implementation of screening tools, prevention strategies, interdisciplinary approaches and psychological support in the treatment of osteoarthritis.

Mental Health Public Stigma in US Jewish Communities

Stigma is a multifaceted barrier for individuals living with mental illness, contributing to negative stereotypes, prejudice, and discrimination, and is underinvestigated in minority ethnic groups. This study examines the stigma within the US Jewish communities, specifically the following: a) differences in public stigma dimensions based on mental illness ( e.g. , major depressive disorder, anxiety disorder, schizophrenia, or alcohol use disorder) and sex; and b) whether participant characteristics influence the public stigma. A community-based sample of 317 self-identified Jewish individuals participated in an experimental randomized vignette survey on stigma and help-seeking beliefs toward various mental illness. Findings indicate differences in stigma based on stigmatized individuals' sex and diagnosis as well as participants' demographics. Schizophrenia and alcohol use disorder were stigmatized similarly, with lower stigma for depression and the least stigma toward anxiety. Of interest, younger males have the most treatability and professional efficacy stigma, and tailored stigma-reducing interventions are recommended.

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 (M_age = 42.38, SD_age = 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.

Lived experiences matter: The role of mental health professionals' psychological crises and vulnerability in shaping their health beliefs and concepts

BACKGROUND

Mental health professionals are often affected by mental health problems and disorders. Yet, the effects of these lived experiences on their causal beliefs and health concepts have not been investigated. The current study investigates how professionals' lived depressive experiences and their perceived vulnerability to mental illness affect their causal beliefs about mental disorders, their general concept of mental health and their specific concepts of depression and burnout.

METHODS

An online survey was conducted with 218 mental health professionals from 18 psychiatric clinic departments in the German federal states of Berlin and Brandenburg, investigating their experiences with depression, self-assessed vulnerability, their causal beliefs of mental illness, their general health concept and specific illness concepts of depression and burnout. A path model was calculated to examine the relationships between these variables. Participants with and without lived experience of depression were grouped.

RESULTS

Lived experience of depression was indicated by 126 participants. For participants with no experience of depression, perceived vulnerability negatively predicted beliefs in biological causation, which positively predicted higher differentiation between depression and burnout. For participants with previous depression experiences, perceived vulnerability positively predicted beliefs in psychological and social causation. Continuum belief was predicted only in this group by the three variables of causal beliefs. Psychological and social causation was positively associated, while biological causes were negatively associated with continuum beliefs.

CONCLUSION

Mental health professionals are not external to the clinical situation. Their lived experiences do matter, shaping their beliefs and concepts and, thus, possibly also their actions toward patients.

Mental Health Nurses' Social Representations of People Who Experience Mental Illness: A Story of Paradoxes

Public representations of people who experience mental illness (PEMI) have been well documented within the stigma literature. However, studies about mental health nurses' representations of PEMI are still scarce and characterized by contradictions. Using the theoretical concept of social representation instead of stigma, the current study aims to explore and understand mental health nurses' social representations of PEMI. Qualitative research was conducted based on 13 semi-structured interviews with nurses from two psychiatric units in general hospitals. Data were analyzed using interpretative phenomenological analysis. Results showed that nurses' social representations were characterized by paradoxes. They explicitly displayed positive social representations, while nuancing them from an implicit point of view. The nurses wanted to work toward a destigmatizing voice for PEMI while nuancing their assertions to sound honest and accurate, which led them to a state of cognitive dissonance.

Understanding stigma toward schizophrenia

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

Die Ökonomisierung des Sozialen und der Zwang zur Selbstoptimierung – Implikationen für die Einstellungen der Bevölkerung zu Menschen mit Schizophrenie

Die Einstellungen gegenüber Menschen mit Schizophrenie haben sich in den letzten Jahren verschlechtert. Wir argumentieren, dass dies mit einem Prozess der Ökonomisierung des Sozialen zusammenhängt, der insbesondere in der marktradikalen Fassung des Neoliberalismus den Wettbewerbscharakter in der Gesellschaft als prior platziert hat. Der kalkulatorische Umgang mit sich selbst ist individuell wie gesellschaftlich dominant. In den letzten Jahren ist daraus ein anhaltender Trend zur Selbstoptimierung entstanden, der auch inklusive Qualitäten besitzt: Wer mithält, gehört dazu. Auf der anderen Seite beinhaltet er aber auch eine exkludierende Qualität. Menschen mit Schizophrenie werden im Zuge dessen verstärkt als potenziell belastend bilanziert, als Minderung der eigenen Chancen. Dies trägt möglicherweise zu den beobachteten negativen Einstellungsveränderungen bei.

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.

The effect of alcohol use disorder symptom and recovery narratives on problem-recognition: A randomized online trial

BACKGROUND

Low problem recognition is a barrier to seeking treatment for alcohol use disorder ("AUD"). Promoting continuum belief narratives, which conceptualize AUD as a spectrum, together with narratives that promote non-abstinence recovery may boost self-recognition of risky drinking. This experimental study examines the effect of dichotomous vs continuous symptom narratives and non-abstinence vs abstinence recovery narratives on self-recognition of risky drinking among students.

METHODS

N = 489 participants were randomized to one of four interventions combining a continuous vs dichotomous AUD symptom narrative with an abstinence vs moderated drinking AUD recovery narrative in a 2×2 design. Participants completed demographic and alcohol use (AUDIT-C) preintervention measures and postintervention measures assessing self-recognition of risky drinking and endorsement of continuum beliefs.

RESULTS

Moderate drinking recovery narratives resulted in higher endorsement of continuum beliefs (F (1, 485) = 16.27, p <.001, η2p =.032 90 % CI [0.01, 0.06]). Recognizing own risky drinking behavior was unaffected by the interventions. However, in a subgroup of participants without prior AUD experience who met AUDIT-C criteria for risky drinking, the combination of a continuous symptom narrative and moderated drinking recovery narrative resulted in higher problem recognition (F (1, 48) = 5.79, p =.020, η2p =.10, 90 % CI [0.01, 0.25]).

CONCLUSIONS

Exposure to moderated drinking recovery narratives may help develop an awareness in young adults that problematic alcohol use exists on a spectrum. Among those at increased risk for AUD, exposure to narratives that promote a continuous model of AUD and non-abstinence recovery may increase problem recognition.

Alcohol use disorder and disability insurance in Switzerland: the attitudes and views of lawyers, insurance medical experts, and addiction-specialist therapists

BACKGROUND

According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent.

METHODS

Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases.

RESULTS

Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent.

CONCLUSIONS

Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings.

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.

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.

Public Stigma and Personal Networks: Confronting the Limitations of Unidimensional Measures of Social Contact

One of the most promising directions for reducing mental illness stigma lies in Allport's contact theory, which suggests that intergroup interactions reduce stigma. Here, we argue that stigmatizing attitudes are driven by the nature, magnitude, and valence of community-based ties to people with mental illness (PMI), not simply their presence. Using the 2018 General Social Survey (N = 1,113), we compare network-based measures of contact to traditional survey indicators. We find that knowing someone with mental illness, or even number of people known, explains little about desire for social distance, perceptions of dangerousness, or endorsement of treatment coercion. However, having stronger relationships with more PMI, having more friends and family (but not more peripheral ties) with mental illness, and knowing people in treatment are associated with less stigma endorsement. In contrast, we find that exposure to PMI who are perceived as dangerous is associated with greater levels of stigma.

Prevalence of psychological comorbidities in bone infection

OBJECTIVE

Bone infections represent a major complication in orthopedic and trauma surgery. Concomitant psychological disorders can significantly influence treatment outcomes. However, these are often overlooked. Therefore, we aimed to determine the nationwide epidemiology of fracture-related infection (FRI) and osteomyelitis in combination with psychological comorbidities.

METHODS

A dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 to 2019 was analysed. Incidences of the codes "T84.6, infection and inflammatory reaction due to internal fixation device" and "M86.-, osteomyelitis" were quantified. Proportions of secondary diagnoses of the chapter F of the ICD-10 were determined.

RESULTS

Incidences were 19.1/100,000 inhabitants for osteomyelitis and 10.5/100,000 inhabitants for FRI. Patients with psychological comorbidities constituted 14.6% of osteomyelitis cases and 26.5% of FRI cases, respectively. Between 2009 through 2019, the proportion of patients with a concomitant "F" diagnoses of the ICD-10 increased by 27.3% for osteomyelitis and by 24.1% for FRI. Most prevalent secondary diagnoses were organic, including symptomatic, mental disorders (F0), affective disorder (F3) and mental and behavioral disorders due to psychoactive substance use (F1), whereby the latter decreased over the years.

CONCLUSION

The implementation of prevention strategies, interdisciplinary approaches and psychological support in orthopaedics and trauma surgery is warranted.

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.

How can the utilisation of help for mental disorders be improved? A quasi-experimental online study on the changeability of stigmatising attitudes and intermediate variables in the process of utilisation

Background

Epidemiological studies show that even in highly developed countries many people with depression do not seek help for their mental health issues, despite promising prevention approaches encouraging people to seek help and reduce self-stigma. Therefore, an anti-stigma intervention study to support help-seeking behaviour will be developed on the basis of the newly explicated “Seeking Mental Health Care Model”.

Methods

A quasi-experimental online study will be carried out to assess the effect of different intervention variables relevant for the help-seeking process. The study is conceived as a fractional factorial design. Participants will be screened for depressive complaints (PHQ-9 sum score ≥ 8) and current psychiatric/psychotherapeutic treatment. After baseline assessment the participants will be randomly allocated into one of the 24 study groups receiving different combinations of the vignette-based intervention aiming to reduce stigma and support help-seeking. Next, relevant outcome measures will be administered a second time. In a 3- and 6-month follow-up help-seeking behaviour will be measured. Gamified elements and avatar-choice techniques will be used to heighten study immersion and adherence.

Discussion

On the basis of the project results, promising research and intervention perspectives can be developed. Results, firstly, allow for a more detailed empirical investigation and conceptualisation of the stages of mental health care utilisation, as well as an examination of theoretical approaches to stigmatisation. Secondly, our online study could provide insights for an evidence-based design and evaluation of online interventions for people with a mental illness.

Trial registration

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

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12125-5.

Naturalistic conceptions of genetic optimism and precision psychiatry among those at clinical high-risk for psychosis

AIM

Fuelled by genomics advances, recent emphasis on the concept of "precision medicine," and public optimism towards genetic advances, it is important to understand how those who are considered to be at clinical high-risk for psychosis (CHR) perceive possible benefits of genetic testing to inform future stakeholder education efforts.

METHODS

Semistructured interviews were completed with 20 participants who met CHR criteria. Coding for genetic optimism was completed.

RESULTS

Participants endorsed many conceptualizations of the link between genetics, the development of psychosis, and the benefits of genetic testing. Specifically, themes emerged surrounding how genetic testing may lead to greater genetic knowledge and tailored treatment.

CONCLUSIONS

Our results demonstrate that CHR participants generally endorse several precision psychiatry concepts, including how genetic testing may lead to tailored treatment advances. This knowledge may aid development of best communication practices regarding forthcoming genetic advances in diagnosis and treatment among CHR.

Stigmatization of people with alcohol use disorders: An updated systematic review of population studies

BACKGROUND

We summarize research on the public stigmatization of persons with alcohol use disorder (AUD) in comparison with other mental health conditions and embed the results into a conceptual framework of the stigma process.

METHODS

We conducted a systematic search using Embase, MEDLINE, PubMed and PsycINFO (via Ovid), and Web of Science for population-based studies on the public stigma in AUD and at least 1 other mental health condition, published between October 1, 2010 and December 20, 2020, thus including all studies published since the last systematic review on this topic. The study is registered with PROSPERO (registration number: CRD42020173054).

RESULTS

We identified 20,561 records, of which 24 met the inclusion criteria, reporting results from 16 unique studies conducted in 9 different countries. Compared to substance-unrelated mental disorders, persons with AUD were generally less likely to be considered mentally ill, while they were perceived as being more dangerous and responsible for their condition. Further, the public desire for social distance was consistently higher for people with AUD. We found no consistent differences in the public stigma toward persons with AUD in comparison with other substance use disorders.

CONCLUSION

The stigmatization of persons with AUD remains comparatively high and is distinct from that of other substance-unrelated disorders.

Development and examination of the attribution questionnaire-substance use disorder (AQ-SUD) to measure public stigma towards adolescents experiencing substance use disorders

BACKGROUND

Public stigma may significantly impact adolescents with substance use disorders (SUDs), leading to limited treatment accessibility and utilization. However, few measures have been validated to assess public SUD stigma towards adolescents. In this study we developed the Attribution Questionnaire-Substance Use Disorder (AQ-SUD) by modifying the Attribution Questionnaire, a commonly used measure of public mental illness stigma. We examined 1) the psychometric properties of the AQ-SUD with supporting data from other stigma scales and 2) preliminary data on adults' perceptions of public stigma toward adolescents with SUDs.

METHODS

Adult participants (n = 304) were randomly assigned to one of four vignettes about an adolescent with a specific SUD diagnosis (opioid, marijuana, alcohol, and stimulant use disorders). Participants completed the AQ-SUD and three other measures of public stigma designed to assess convergent and divergent validity.

RESULTS

Analyses indicated that the modified AQ-SUD has good psychometric properties, and revealed a four-factor structure: negative emotions, assessment of responsibility, social disengagement, and lack of empathy. Additional public stigma scales demonstrated good psychometrics and provided evidence of both convergent and divergent validity for the AQ-SUD. Preliminary analysis of public stigma towards adolescents with a SUD suggests that attitudes about marijuana use disorder differ significantly from attitudes about other SUDs.

CONCLUSIONS

This study is the first to modify and validate a measure designed to assess perceptions of public SUD stigma towards adolescents, the AQ-SUD. Preliminary analyses suggest that adults view adolescent marijuana use disorders as less severe compared to other SUDs, which may have implications for adults' motivation to support youth in seeking treatment.

Attention Deficit Hyperactivity Disorder in Children and Adults: A Population Survey on Public Beliefs

Objective: To investigate beliefs and attitudes of the public toward attention deficit hyperactivity disorder (ADHD) in children and adults. Method: In a representative population survey in Germany (N = 1,008) using computer-assisted telephone interviews, we asked participants about causal beliefs, illness recognition, treatment recommendations, and beliefs about ADHD, presenting an unlabelled vignette of a child or an adult with ADHD. Results: The most frequently endorsed causal beliefs for the depicted child with ADHD were "TV or Internet," "lack of parental affection," and "broken home." In comparison with the child vignette, biological causal beliefs were endorsed more often after the adult vignette. In the child vignette, 66% advised against a treatment with stimulant medication. About 90% of respondents had heard of ADHD. Of those, 20% said they believed ADHD to be not a real disease. Conclusion: Beliefs of the German public partly contradict evidence and should be considered in therapeutical and public contexts.

Testing the mixed-blessings model: What is the role of essentialism for stigmatizing attitudes towards schizophrenia?

It is well established that emphasizing a biogenetic etiology of mental health problems in anti-stigma interventions inadvertently increases potentially stigmatizing attitudes. The “mixed-blessings” model suggests that biogenetic explanations and greater stigma are linked by essentialism. The present study tests this hypothesis experimentally. In this online experiment, 367 subjects read either a biogenetic or a psychosocial explanation for the etiology of schizophrenia, followed by a vignette describing an individual who has schizophrenia. Subsequently, we measured (a) causal beliefs on the etiology of schizophrenia (as a manipulation check), (b) the degree of essentialist beliefs (mediator), (c) the extent to which subjects subscribed to assumptions of dangerousness, (d) prognostic pessimism, and (e) desire for social distance. Subjects reported a stronger agreement with the etiology they had been presented. Against our expectations, this did not result in higher levels of stigmatizing attitudes in the biogenetic vignette group. Correspondingly, mediation through essentialism could not be tested. In the psychosocial vignette group, biogenetic causal beliefs were associated with a stronger desire for social distance. Essentialist thinking fully mediated this effect. The evidence we found for the assumptions of the mixed-blessings extended to the psychosocial vignette group only. We explain this by the subjects’ different readiness to subscribe to biogenetic and psychosocial causal beliefs. We argue that the same levels of essentialism between the experimental groups contributed to the equal levels of stigmatizing attitudes. This underlines the fundamental importance of essentialism in stigma, going beyond a role in the psychological effects of biogenetic causal models.

Does selectively endorsing different approaches to treating mental illness affect lay beliefs about the cause and course of mental illness?

The current paper reports three experimental studies that investigate how selectively emphasising different treatment approaches (biological, psychological or social) for mental health difficulties affects lay beliefs about those illnesses. Online experimental vignettes exposed participants to different treatment narratives for a clinical case of Major Depressive Disorder (Study 1; n=164), Generalized Anxiety Disorder (Study 2; n=173) and Schizophrenia (Study 3, n=170). Measures of causal attributions and illness perceptions assessed effects on beliefs about the causes and course of the illness. Emphasising psychological treatment of Major Depressive Disorder promoted more causal attributions to personal weakness, while endorsing biological treatment weakened confidence in individual control over the course of the illness. For Generalized Anxiety Disorder, stressing social treatment encouraged more causal attributions to personal weakness and lifestyle factors. Causal attributions for Schizophrenia did not shift according to treatment modality, but highlighting biological treatment made the symptoms appear more treatable, while emphasising psychological treatment made the illness seem more personally controllable. As lay understandings of the causes and course of mental illness have implications for help-seeking, treatment engagement and stigma, effects on illness beliefs may be an important consideration when endorsing a particular treatment approach in public discourse or clinical communication.

Comparison of the Effects of a Genetic, a Mild Encephalitis, and a Psychosocial Causal Explanation of Schizophrenia on Stigmatizing Attitudes - a Pilot Study With a Quasi-Experimental Design

Background: Previous research has shown that the endorsement of biogenetic causal explanations of schizophrenia is associated with stronger stigmatizing attitudes against people with schizophrenia than the endorsement of psychosocial explanations. However, little is known about whether different biogenetic causal explanation beliefs differentially affect stigmatizing attitudes. This is particularly valid for the endorsement of the mild encephalitis hypothesis of schizophrenia. Aim: To examine to what extent different causal explanations of schizophrenia influence the desire for social distance from persons with schizophrenia. Methods: A study with a prospective, quasi-experimental design was carried out with students in Germany (N = 333). A case vignette depicting a person with schizophrenia-typical symptoms was presented, and a social distance scale (SDS) was used to measure the stigmatizing attitude against the person described. Participants were randomly assigned to one of three groups receiving different causal explanations of schizophrenia (genetic, mild encephalitis hypothesis, or psychosocial) without treatment information. Results: A one-way ANOVA showed that the mean SDS was lowest in the group with the mild encephalitis hypothesis explanation, followed by the genetic explanation group, and highest in the psychosocial explanation group. However, the differences between the groups were small and not significant. A subanalysis revealed a significant interaction between gender and causal explanation. Women showed a significantly lower desire for social distance than men when receiving the mild encephalitis hypothesis. Neither the study discipline nor the number of semesters of study had significant effects on the mean SDS. The differences between the mean SDS scores for the different items were much bigger than the differences for the different causal explanations. Regardless of the causal explanation, the extent of the desired social distance depends strongly on social proximity. Conclusion: The present study fits into previous research, which has found that biogenetic beliefs were either associated with more social distance or did not yield a statistically significant association. Although we found a small gender-specific effect of the endorsement of the mild encephalitis hypothesis, we do not recommend gender-specific anti-stigmatization campaigns because they might rightly raise suspicions of dishonesty and manipulation. Rather we support recovery-oriented messages focusing on effective treatments.

The beliefs of non-psychiatric doctors about the causes, treatments, and prognosis of schizophrenia

OBJECTIVES

To examine the causal beliefs about schizophrenia of non-psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors' views about treatments and prognosis.

DESIGN AND METHODS

Three hundred and five non-psychiatric doctors working in outpatient community centres completed the 'Opinions on mental disorders Questionnaire' after reading a clinical description of people with schizophrenia.

RESULTS

The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy-five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty-two per cent of respondents thought it 'completely true' that drugs are useful in schizophrenia, and 33.9% thought it 'completely true' that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia.

CONCLUSIONS

These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed.

PRACTITIONER POINTS

Viewing schizophrenia as mainly due to a biological cause is associated with greater confidence in the usefulness of drugs, higher belief in the need for lifelong pharmacological treatments, and greater prognostic pessimism. Belief in a biologically oriented model of schizophrenia may lead doctors to underestimate the value of psychologists. Prognostic pessimism among doctors may negatively influence clinical decisions, the information doctors provide to their clients, and clients' own beliefs about their chances of recovery. Belief in the need for lifelong pharmacological treatments in schizophrenia may lead doctors to resist drug withdrawal in case of severe side effects.

Schizophrenia stigma in mental health professionals and associated factors: A systematic review

BACKGROUND

The consequences of schizophrenia stigma are numerous and highly damaging to individuals, their families, the health care system and society. Mental health professionals (MHP) are considered to be one of the main sources of stigmatization.

OBJECTIVES

To identify the characteristics of MHP stigma in schizophrenia in comparison with other psychiatric disorders, the specificities of MHP compared with other social groups, and associated factors.

METHODS

Following PRISMA guidelines, we systematically searched multiple electronic databases for articles: (i) reporting original data published in English in peer-reviewed journals, (ii) reporting quantitative data with statistical analysis, (iii) assessing stigma in a broad sense, and (iv) including samples composed only of MHP.

RESULTS

A total of 38 articles published from 1999 to 2019 and involving 10,926 MHP fulfilled our inclusion criteria. Studies showed that schizophrenia is the most stigmatized mental illnesses in MHP, despite recent results suggesting that borderline personality disorder and substance abuse may be more stigmatized. In comparison with other social groups, MHP reported less dangerousness beliefs and more positive beliefs regarding pharmacological treatment. Nevertheless, results were less consistent regarding prognosis and desire for social distance. Age, education level, type of mental health profession, or length of practice were associated factors that showed inconsistent relations with stigma. Work setting and biological causal beliefs were more clearly associated with MHP stigma.

CONCLUSION

These findings provide strong support for the need to conduct specific research on schizophrenia stigma in MHP and the importance of controlling for several variables to identify predictors of stigma.

What Contributes to Stigma Towards Autistic University Students and Students with Other Diagnoses?

Little remains known about the degree to which autistic university students are stigmatized relative to students with other diagnoses. We conducted an online survey with students in New York City (n = 633) and Beirut (n = 274). Students with diagnoses that were perceived as dangerous (e.g., psychopathy) were more stigmatized than students with diagnoses that were perceived as less dangerous (e.g., autism). Disruptive autistic behaviors (described via vignettes) evoked more stigma than withdrawn behaviors. Perceived dangerousness predicted autism stigma. Greater acceptance of inequality, less openness, and lower cognitive empathy co-occurred with heightened stigma towards most conditions. Diagnostic labels were typically less stigmatized than behaviors. Findings suggest that interventions are needed to decrease stigma towards varied diagnoses in collegiate communities.

Recovery from mental illness versus substance use disorder

Purpose

While serious mental illness (SMI) and substance use disorders (SUD) are common, less research has focused on causal beliefs across conditions. This is an important question when trying to understand the experience of dual diagnosis. The purpose of this paper is to examine how three factors representing causal beliefs (biogenetic, psychosocial or childhood adversity) differ by SMI and SUD. This study also examined how causal beliefs were associated with overall, process and outcome beliefs about recovery.

Design/methodology/approach

Using Mechanical Turks online panel, 195 research participants from the general public completed measures of recovery – overall, outcome and process – for SMI and SUD. Participants also completed the Causal Beliefs Scale yielding three causal factors for SMI and separately for SUD: biogenetic, psychosocial and childhood adversity.

Findings

Results indicated participants endorsed biogenetic cause more for SMI and SUD. Moreover, research participants endorsed biogenetic causes more than the other two for SMI. Results also showed the psychosocial cause was positively associated with recovery for SMI. Biogenetic causes were not. Almost none of the causal indicators was significantly associated with recovery for SUD.

Originality/value

Implications of these findings for future research and public efforts to enhance attitudes about recovery are discussed.

Biological causal beliefs and depression stigma: the moderating effects of first- and second-hand experience with depression

Background: Essentialist theory (ET) links biological attributions for mental illnesses to pessimistic prognostic beliefs and stigma. The commonsense model (CSM) provides a nuanced framework for studying illness beliefs as shaped by experience.Aims: ET-informed hypotheses linking causal and prognostic beliefs and stigmatizing attitudes concerning depression were tested using CSM constructs with a focus on the moderating effects of self-reported experience with this disorder.Methods: U.S. adults (N = 319) completed online questionnaires assessing depression-related beliefs, attitudes and experience. Multiple regression analysis focused on predictive effects of neurobiological and genetic attributions. Potential mediators (prognosis) and moderators (experience) of the biological attribution-stigma link also were tested.Results: Neurobiological attributions predicted viewing depression as more consequential, longer lasting, and unexpectedly, more treatable. Neurobiological attributions were inversely related to stigma, a link partially mediated by beliefs about depression's consequences and duration. However, both biological attributions' relationships to stigma were moderated by experience. Stronger biological attributions predicted less stigma specifically among participants reporting first- or second-hand experience with depression.Conclusion: Experience with depression may shape the relationships of specific causal and prognostic beliefs with depression stigma. Psychoeducation in clinical and public health contexts may be informed by further research using CSM constructs.

Effects of biogenetic beliefs for schizophrenia on potential caregivers in China: Exploring the role of affiliate stigma

Schizophrenia affects more than eight million people in China. Stigmatization of schizophrenia may prevent family members and close others from providing social support to those with schizophrenia. This article aims to investigate the potential use of a biogenetic approach to reduce the stigma of schizophrenia using a cross-sectional (study 1, n = 141) and an experimental design (study 2, n = 100) in China. In the first study, mediation analysis reveals that perceived affiliate stigma, the negative prejudice, and discrimination towards family members of individuals with socially stigmatized identities due to their affiliation with the person mediates the path between biogenetic beliefs and desire for social distance. This pattern is replicated in study 2 in which two 10-min lectures were created and used to influence participants' beliefs in biogenetic causes of schizophrenia. Findings suggest that the biogenetic approach may increase Chinese participants' desired social distance towards their family members with schizophrenia through increasing their concerns about the negative consequences of being affiliated with the family member. Therefore, future research should investigate aspects of biogenetic anti-stigma campaigns that do not increase participants' perception of affiliate stigma in China.

Causal attributions for somatic symptom disorder

OBJECTIVES

Two research questions will be addressed: (1) What does the German public think about possible causes of somatic symptom disorder (SSD) and are there differences in causal attributions according to symptom and course of SSD? (2) Are causal attributions associated with beliefs about treatment and stigmatizing attitudes?

METHODS

Two vignettes with symptoms of SSD were used in a national telephone survey in Germany (N = 1004). Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Respondents were asked about their agreement with five causal beliefs (broken home, heredity, lack of willpower, work stress, and misinterpretation of body signals).

RESULTS

About 90% of the respondents agreed that work stress is a possible cause of the SSD symptoms. Agreement was significantly more pronounced in case of a person with fatigue and an earlier severe somatic disease. A quarter endorsed lack of willpower as a possible cause. Lack of willpower was associated with a significant increase of desire for social distance in both vignettes. Work stress was associated with a significantly increased likelihood of positively evaluating the effectiveness of psychotherapy in both cases of SSD.

CONCLUSIONS

Public beliefs about causes of SSD are associated with stigma and treatment beliefs. Emphasising work stress as a cause may promote the belief that psychotherapy is effective for treatment of SSD.

The ethics of global psychiatric genomics: Multilayered challenges to integrating genomics in global mental health and disability-A position paper of the Oxford Global Initiative in Neuropsychiatric GenEthics (NeuroGenE)

Psychiatric genomics has the potential to radically improve the prevention and early intervention of serious mental and neurodevelopmental disorders worldwide. However, little work has been done on the ethics of psychiatric genomics-an oversight that could result in poor local uptake, reduced practical/clinical application, and ethical violations in this rapidly developing area of scientific research. As part of the Global Project of the Stanley Center for Psychiatric Research, the Global Initiative in Neuropsychiatric GenEthics (NeuroGenE) based at the University of Oxford aims to embed ethical inquiry within scientific investigation and engage with fundamental ethical questions around a psychiatric genomics approach to mental and neurodevelopmental disorder. This position paper sets out the core aims of the NeuroGenE research programme and explores the importance of a crosscutting research orientation in this field based on multidisciplinary methodologies which can ensure that efforts to translate and apply global psychiatric genomics in public policy and clinical practice are ethically grounded strategies, respectful of different cultures and contexts.

Changes in Attitudes toward Mental Illness in Healthcare Professionals and Students

Mental-illness-related stigma not only exists in the public but also in healthcare systems. Healthcare providers (HCPs) who have stigmatizing attitudes or behaviors might be thought of as a key barrier to mental health service use, and influence the quality of healthcare. Although cumulative projects have been conducted to reduce stigma related to mental illness among HCPs around the world, little is known about whether the attitudes of HCPs toward mental illness have changed over time. Research on this topic is mixed with respect to whether attitudes of HCPs toward mental illness have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on the Social Distance Scale (SDS), Opinions about Mental Illness (OMI), and Community Attitudes towards Mental Illness (CAMI) measures among health care professionals and students (N = 15,653) from 1966 to 2016. Our results indicated that both social distance (β = -0.32, p < 0.001) and attitudes (β = 0.43, p = 0.007) of HCPs toward mental illness have become increasingly positive over time. These findings provide empirical evidence to support that the anti-stigma programs and courses have positive effects on HCPs and can inform future anti-stigma programs focusing on improving the attitudes of HCPs toward mental illness, thereby improving the quality of healthcare provided.