1
|
Speerforck S, Jürgensen V, Göbel M, Meyer N, Schomerus G. 'Concept creep' in perceptions of mental illness - an experimental examination of prevalence-induced concept change. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01737-0. [PMID: 38233638 DOI: 10.1007/s00406-023-01737-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
The perception of what constitutes mental illness is influenced by various social and medical developments. Prevalence-induced concept change is a phenomenon where decreasing the prevalence of a category leads people to expand their judgment of that concept. In this study, we tested whether changing the prevalence of statements describing mental illness results in a change in the concept of mental illness. Based on a population survey (n = 1031), we created a validated set of 273 brief statements depicting either clear symptoms of mental illness, clear examples of healthy behaviour, or ambiguous situations. We presented a subset of statements to 138 students, asking them to judge whether each statement represented mental illness, or not. After 96 statements, we reduced the prevalence of clearly mentally ill statements in one group, while the proportion of statements denoting clear mental illness remained the same in the other group. In the group where the proportion of clearly mentally ill statements was reduced during the experiment, a concept change of mental illness evolved: participants were more likely to identify a statement as denoting a mental illness. The results indicate that the perceived prevalence of symptoms of mental illness is important for conceptualizing mental illness and that decreasing prevalence broadens the concept of mental illness. These findings add a novel perspective to current debates around diagnostic thresholds, the treatment-prevalence paradox, the medicalization of emotions, and the focus of anti-stigma campaigns.
Collapse
Affiliation(s)
- Sven Speerforck
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Semmelweißstraße 10, 04103, Leipzig, Germany.
| | - Vanessa Jürgensen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Semmelweißstraße 10, 04103, Leipzig, Germany
| | - Mirjam Göbel
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Semmelweißstraße 10, 04103, Leipzig, Germany
| | - Nicholas Meyer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Semmelweißstraße 10, 04103, Leipzig, Germany
| |
Collapse
|
2
|
Kim IB, Choi J, Park SC, Koike S, Kwon JS, Kim E, Choi HS, Lee JY, Lee YS. Data-mining analysis of media frame effects on social perception of schizophrenia renaming in Korea. BMC Psychiatry 2023; 23:882. [PMID: 38012639 PMCID: PMC10683161 DOI: 10.1186/s12888-023-05386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND In 2011, Korean Neuropsychiatric Association renamed schizophrenia from 'mind split disorder' ('Jungshinbunyeolbyung' in Korean) to 'attunement disorder' ('Johyeonbyung' in Korean), in a strategic way to reduce social stigma toward people with schizophrenia. However, there remains an elusive consensus that how the renaming effort has contributed to changes in the social perception of schizophrenia in Korea. METHODS With this regard, we explored whether media frames alter the social perception, in ways of respecting or disrespecting schizophrenia patients before and after the renaming. This study extensively investigated media keywords related to schizophrenia across the time by applying both language and epidemiologic analyses. RESULTS In results, the media keywords have been negatively described for schizophrenia patients both before and after the renaming. Further, from an analysis using the regression model, a significant correlation was observed between the frequency of negative keywords and the hospitalization frequency of schizophrenia patients. CONCLUSIONS These findings suggest that the social perception of schizophrenia has been scarcely changed, but rather remained negatively biased against schizophrenia patients, in spite of the renaming effort. Notably, the biased media frames have been demonstrated to negatively impact on the social perception, and even on the medical use patterns of general schizophrenia patients. In conclusion, we suggest that the unbiased media frames along with the renaming effort may collectively help reduce the negative social perception of schizophrenia. TRIAL REGISTRATION This study was approved from the Institute of Review Board (IRB) of the Yoing-In Mental Hospital (IRB No. YIMH-IRB-2019-02).
Collapse
Affiliation(s)
- Il Bin Kim
- Department of Psychiatry, CHA Gangnam Medical Center, CHA University School of Medicine, Gangnam, Republic of Korea
| | - Joonho Choi
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Shinsuke Koike
- University of Tokyo Institute for Diversity and Adaptation of Human Mind (UTIDAHM), University of Tokyo, Tokyo, Japan
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eunkyung Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Hyo Sun Choi
- Medicine Center for Mental health research, Hanyang University College, Seoul, Republic of Korea
| | - Ju Yeon Lee
- Medicine Center for Mental health research, Hanyang University College, Seoul, Republic of Korea
| | - Yu Sang Lee
- Department of Psychiatry, Yong-In Mental Hospital, 940 Jungbu-daero, Giheung-gu, Yongin, Republic of Korea.
| |
Collapse
|
3
|
van Os J, Scheepers F, Milo M, Ockeloen G, Guloksuz S, Delespaul P. "It has to be better, otherwise we will get stuck." A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands. Clin Pract Epidemiol Ment Health 2023; 19:e17450179271206. [PMID: 38680529 PMCID: PMC11046893 DOI: 10.2174/0117450179271206231114064736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 05/01/2024]
Abstract
Background The current state of mental health care in the Netherlands faces challenges such as fragmentation, inequality, inaccessibility, and a narrow specialist focus on individual diagnosis and symptom reduction. Methods A review suggests that in order to address these challenges, an integrated public health approach to mental health care that encompasses the broader social, cultural, and existential context of mental distress is required. Results A Mental Health Ecosystem social trial seeks to pilot such an approach in the Netherlands, focusing on empowering patients and promoting collaboration among various healthcare providers, social care organizations, and peer-support community organizations, working together in a regional ecosystem of care and committed to a set of shared values. In the ecosystem, mental health problems are examined through the prism of mental variation in context whilst scaling up the capacity of group-based treatment and introducing a flexible and modular approach of (2nd order) treatment by specialists across the ecosystem. The approach is to empower naturally available resources in the community beyond professionally run care facilities. Digital platforms such as psychosenet.nl and proud2bme.nl, which complement traditional mental health care services and enhance public mental health, will be expanded. The capacity of recovery colleges will be increased, forming a national network covering the entire country. GEM will be evaluated using a population-based approach, encompassing a broad range of small-area indicators related to mental health care consumption, social predictors, and clinical outcomes. The success of GEM relies heavily on bottom-up development backed by stakeholder involvement, including insurers and policy-making institutions, and cocreation. Conclusion By embracing a social trial and leveraging digital platforms, the Dutch mental health care system can overcome challenges and provide more equitable, accessible, and high-quality care to individuals.
Collapse
Affiliation(s)
- Jim van Os
- Department of Psychiatry, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Floortje Scheepers
- Department of Psychiatry, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Michael Milo
- Milo Health Care Connector and Change Management Consultant, Berlagehof 14, 1067 NB Amsterdam, The Netherlands
| | - Gijs Ockeloen
- Reframing Studio Design Introspector, Bilderdijkkade 50 A11053 VN Amsterdam, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Mondriaan Mental Health Trust, 6401 CX Heerlen, The Netherlands
| |
Collapse
|
4
|
Bitta MA, Baariu J, Grassi S, Kariuki SM, Lennox B, Newton CRJC. Effectiveness of participatory video in lowering stigma against people with mental, neurological and substance use disorders in Kenya. BJPsych Open 2023; 9:e215. [PMID: 37955040 PMCID: PMC10753966 DOI: 10.1192/bjo.2023.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Globally, stigma associated with mental, neurological and substance use (MNS) disorders is rampant and a barrier to good health and overall well-being of people with these conditions. Person-centred digital approaches such as participatory video may reduce stigma, but evidence on their effectiveness in Africa is absent. AIMS To evaluate the effectiveness of participatory video in reducing mental health-related stigma in a resource-limited setting. METHOD We evaluated the effectiveness of using participatory video and face-to-face interaction between people with MNS disorders and a target audience in lowering stigma among 420 people living in Kilifi, Kenya. Changes in knowledge, attitudes and behaviour (KAB) were measured by comparing baseline scores with scores immediately after watching the participatory videos and 4 months after the intervention. Sociodemographic correlates of stigma scores were examined using multivariable linear regression models. RESULTS Compared with baseline, KAB scores significantly improved at both time points, suggesting reduced stigma levels. At 4 months, the changes in scores were: knowledge (β = 0.20, 95% CI 0.16-0.25; P < 0.01), liberal attitude (β = 1.08, 95% CI 0.98-1.17; P < 0.01), sympathetic attitude (β = 0.52, 95% CI 0.42-0.62; P < 0.01), tolerant attitude (β = 0.72, 95% CI 0.61-0.83; P < 0.01) and behaviour (β = 0.37, 95% CI 0.31-0.43; P < 0.01). Sociodemographic variables were significantly correlated with KAB scores; the correlations were not consistent across the domains. CONCLUSIONS Participatory video is a feasible and effective strategy in improving knowledge, attitudes and intended behaviour in a resource-limited setting. Further studies are required to understand the mechanisms through which it lowers stigma and to examine long-term sustainability and the effectiveness of multicomponent interventions.
Collapse
Affiliation(s)
- Mary A. Bitta
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; and Department of Psychiatry, University of Oxford, Oxford, UK
| | - Judy Baariu
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Simone Grassi
- Documentary Institute of Eastern Africa, Nairobi, Kenya
| | - Symon M. Kariuki
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK; and Department of Public Health, Pwani University, Kilifi, Kenya
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | |
Collapse
|
5
|
Helmert C, Speerforck S, Fleischer T, Otten D, Kasinger C, Brähler E, Muehlan H, Altweck L, Hahm S, Schmidt S, Reusche M, Glaesmer H, Hinz A, Reyes N, Wirkner K, Engel C, Schomerus G, Ulke C. Explorative analyses on spatial differences in the desire for social distance toward people with mental illness in a diverging city. Front Public Health 2023; 11:1260118. [PMID: 38026313 PMCID: PMC10665488 DOI: 10.3389/fpubh.2023.1260118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Stigma is an individual and societal process based on attitudes and power and relates to both spatial disparities and social distinction. In this study, we examined differences in desire for social distance toward people with mental illness within a city using social and spatial information. Methods ANOVAs and Scheffé post-hoc tests analyzed varying desires for social distance toward people with mental illness within Leipzig (East Germany). Joint Correspondence Analyses (JCA) explored correspondences between desire for social distance, socio-economic status, age, life orientation, social support, duration of living in Leipzig, and shame toward having a mental illness in five city districts of Leipzig in LIFE study participants (by Leipzig Research Center for Civilization Disease, data collected 2011-2014 and 2018-2021, n = 521). Results Stigma varied among Leipzig's districts (F(df = 4) = 4.52, p = 0.001). JCAs showed that a higher desired social distance toward people with mental illness corresponded with spatial differences, high levels of pessimism, high shame of being mentally ill, low social support, low socio-economic status, and older age (75.74 and 81.22% explained variances). Conclusion In terms of stigma, where people with mental illness live matters. The results identified target groups that should be addressed by appropriate intervention and prevention strategies for mental health care.
Collapse
Affiliation(s)
- Claudia Helmert
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| | - Toni Fleischer
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| | - Danielle Otten
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Kasinger
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Holger Muehlan
- Department of Health and Prevention, Institute of Psychology, Greifswald University, Greifswald, Germany
| | - Laura Altweck
- Department of Health and Prevention, Institute of Psychology, Greifswald University, Greifswald, Germany
| | - Stefanie Hahm
- Department of Health and Prevention, Institute of Psychology, Greifswald University, Greifswald, Germany
| | - Silke Schmidt
- Department of Health and Prevention, Institute of Psychology, Greifswald University, Greifswald, Germany
| | - Matthias Reusche
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Leipzig University, University Medical Center, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, Leipzig University, University Medical Center, Leipzig, Germany
| | - Nigar Reyes
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Kerstin Wirkner
- Department of Medical Psychology and Medical Sociology, Leipzig University, University Medical Center, Leipzig, Germany
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Christoph Engel
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| |
Collapse
|
6
|
Nan D, Chong ESK, Dannuo W, Zewei L, Zexuan M, Shuyu D, Huang YT. Prevalence, risk, and protective factors of self-stigma for people living with depression: A systematic review and meta-analysis. J Affect Disord 2023; 332:327-340. [PMID: 37060952 DOI: 10.1016/j.jad.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND People living with depression are subjected to widespread stigmatization worldwide. Self-stigma may negatively affect patients' treatment, recovery, and psychological well-being. This review aims to summarize and synthesize the evidence on the prevalence, risk, and protective factors of depression self-stigma. METHODS Four online databases, PubMed, PsycINFO, Web of Science, and Embase, were searched to identify eligible studies. Fifty-six studies involving a total of 11,549 samples were included in the final analysis. Four reviewers independently screened the literature, extracted data, and assessed the risk of bias in eligible studies. Pearson's r was chosen as the effect size metric of risk and protective factors. RESULTS The results showed that the global prevalence of depression self-stigma was 29 %. Levels of self-stigma varied across regions, but this difference was not significant. Two demographic factors were identified: ethnicity (r = 0.10, p < 0.05) and having a partner/married (r = -0.22, p < 0.001). Five risk factors were identified: depression severity (r = 0.33, p < 0.01), public stigma (r = 0.44, p < 0.001), treatment stigma (r = 0.46, p < 0.001), perceived stigma (r = 0.37, p < 0.001), and enacted stigma (r = 0.71, p < 0.001). Five protective factors were identified: quality of life (r = -0.38, p < 0.001), social relationship (r = -0.26, p < 0.05), self-esteem (r = -0.46, p < 0.001), extroversion (r = -0.32, p < 0.001), and social functioning (r = -0.49, p < 0.001). LIMITATIONS Heterogeneity was observed in some of the results. Causality cannot be inferred due to the predominance of cross-sectional designs among the included literature. CONCLUSIONS Risk and protective factors of depression self-stigma exist across many dimensions. Future research should examine the inner mechanisms and effectiveness of interventions to reduce stigma.
Collapse
Affiliation(s)
- Du Nan
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Eddie S K Chong
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Wei Dannuo
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Liu Zewei
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Mu Zexuan
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Deng Shuyu
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
| | - Yu-Te Huang
- Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China.
| |
Collapse
|
7
|
Gagné T, Henderson C, McMunn A. Is the self-reporting of mental health problems sensitive to public stigma towards mental illness? A comparison of time trends across English regions (2009-19). Soc Psychiatry Psychiatr Epidemiol 2023; 58:671-680. [PMID: 36473961 PMCID: PMC9735159 DOI: 10.1007/s00127-022-02388-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The prevalence of mental health problems has rapidly increased over time. The extent to which this captures changes in self-reporting due to decreasing stigma is unclear. We explore this by comparing time trends in mental health and stigma-related indicators across English regions. METHODS We produced annual estimates of self-reported mental disorders (SRMDs) across waves of the Health Survey for England (2009-18, n = 78,226) and three stigma-related indicators (knowledge, attitudes, and intended behaviour) across waves of the Attitudes Towards Mental Illness survey (2009-19, n = 17,287). Differences in trends were tested across nine Government Office Regions using linear models, adjusting for age, sex, ethnicity, marital status, and social class. RESULTS In 2009, SRMDs did not vary by region (p = 0.916), whereas stigma-related indicators did (p < 0.001), with London having the highest level of stigma and the North East having lowest level of stigma. Between 2009 and 2018, the prevalence of SRMDs increased from 4.3 to 9.1%. SRMDs increased and stigma-related indicators improved at different rates across regions over time (SRMDs p = 0.024; stigma-related indicators p < 0.001). London reported the lowest increase in SRMDs (+ 0.3 percentage point per year) yet among the largest improvements in attitudes and intended behaviour across regions. CONCLUSIONS Improvements in attitudes towards mental illness did not mirror changes in self-reported mental health problems across English regions over the past decade. The findings do not support the argument that changes in public stigma, at least when defined at this regional scale, have been driving the increase in self-reported mental health indicators in recent years.
Collapse
Affiliation(s)
- Thierry Gagné
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, Office 346, London, WC1E 7HB, UK.
- International Centre for Lifecourse Studies in Society and Health, London, UK.
| | - Claire Henderson
- Health Service and Population Research Department, King's College London, London, UK
| | - Anne McMunn
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, Office 346, London, WC1E 7HB, UK
- International Centre for Lifecourse Studies in Society and Health, London, UK
| |
Collapse
|
8
|
[The German population's attitude towards mental disorders]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:416-422. [PMID: 36853345 PMCID: PMC9972325 DOI: 10.1007/s00103-023-03679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
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.
Collapse
|
9
|
Public awareness of Misophonia in U.S. adults: a Population-based study. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-022-04180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
10
|
Changes in continuum beliefs for depression and schizophrenia in the general population 2011-2020: a widening gap. Soc Psychiatry Psychiatr Epidemiol 2023; 58:17-23. [PMID: 35304612 PMCID: PMC9845162 DOI: 10.1007/s00127-022-02272-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/08/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE The public discourse about mental health and mental illness seems to have become more open over the last decade, giving rise to the hope that symptoms of mental illness have become more relatable. We examine whether continuum beliefs regarding schizophrenia and depression have increased on a population level over a period of 9 years, and whether notions of unfamiliarity and incomprehensibility have decreased. METHODS In 2011 (n = 2455) and 2020 (n = 3042), two methodologically identical cross-sectional population surveys were conducted in Germany. After the presentation of an unlabeled case vignette depicting someone with schizophrenia or depression, we asked about continuum beliefs, perceived unfamiliarity and perceived incomprehensibility of the person described. RESULTS Multinomial logit models holding sociodemographic variables fixed at their means for both surveys showed that agreement with continuum beliefs increased in depression from 43 to 46% [change 4%; 95% confidence interval (CI) 0; 8], but decreased in schizophrenia from 26 to 20% (change - 6%, 95% CI - 9; - 3). Unfamiliarity (change - 4%; 95% CI - 7; 0) and incomprehensibility (change - 7%, 95% CI - 10; - 4) decreased for depression, while remaining largely unchanged for schizophrenia. CONCLUSION An already pronounced gap in the perception of both disorders with regard to continuity of symptom experiences and perceived otherness further widened over the last decade. While the public's increasing familiarity with symptoms of depression might be further aided by using continuum beliefs as part of anti-stigma messages and awareness campaigns, promulgating continuity models for schizophrenia seems more challenging.
Collapse
|
11
|
Schomerus G, Schindler S, Sander C, Baumann E, Angermeyer MC. Changes in mental illness stigma over 30 years - Improvement, persistence, or deterioration? Eur Psychiatry 2022; 65:e78. [PMID: 36328960 PMCID: PMC9724218 DOI: 10.1192/j.eurpsy.2022.2337] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/05/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Stephanie Schindler
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Eva Baumann
- Department of Journalism and Communication Research, Hannover University of Music, Drama, and Media, Hannover, Germany
| | | |
Collapse
|
12
|
González-Sanguino C, Muñoz M. Predictors of Implicit and Explicit Internalized Stigma in a Sample With Different Mental Illness Diagnoses. J Nerv Ment Dis 2022; 210:665-671. [PMID: 35344973 DOI: 10.1097/nmd.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This research aimed to study implicit and explicit internalized stigma and its relationship with other variables in a sample of people with distinct mental illness diagnoses ( N = 160). Descriptive analysis, mean differences, correlations, and stepwise regression models were conducted. Implicit and explicit internalized stigma was found throughout the sample with differences depending on certain sociodemographic variables. Regression models revealed symptomatology, physical environment, personality traits, references to mental illness, and the time taken to seek professional help as predictors of explicit internalized stigma. At the implicit level, only self-esteem was found as a predictor explaining a low percentage of the variance. The results obtained underline the differences between implicit and explicit stigma, suggesting different relevant variables for interventions focused on prevention and internalized stigma reduction.
Collapse
Affiliation(s)
- Clara González-Sanguino
- Department of Clinical Psychology, School of Psychology, University Complutense of Madrid, Campus de Somosaguas, Madrid, Spain
| | | |
Collapse
|
13
|
Attitudes Towards Mental Health Services During the COVID-19 Pandemic: Findings from a Nationally Representative Sample of Irish Adults. J Behav Health Serv Res 2022; 49:397-405. [PMID: 35028873 PMCID: PMC8757921 DOI: 10.1007/s11414-021-09785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/24/2022]
Abstract
This study sought to determine the public’s attitudes towards mental health services during the COVID-19 pandemic and examine the sociodemographic and psychological factors associated with these attitudes to gain an understanding of the best course of action to increase favourable attitudes. Data from the Republic of Ireland arm of the COVID-19 Psychological Research Consortium (C19PRC) study was used to fulfil the objectives of this study. Participants were asked to indicate their level of agreement with statements regarding mental health services and the COVID-19 pandemic. Levels of agreement were then scored, and the relationships between attitude scores and sociodemographic and psychological factors were evaluated utilizing hierarchical multiple regression analysis. Sociodemographic factors associated with positive attitudes towards mental health were older age, experience with mental health treatment, and experience with internalizing distress. These factors should be considered when developing strategies to increase favourable public attitudes towards mental health services in Ireland.
Collapse
|
14
|
Henderson C, Potts L, Robinson EJ. Mental illness stigma after a decade of Time to Change England: inequalities as targets for further improvement. Eur J Public Health 2021; 30:526-532. [PMID: 32531039 PMCID: PMC7292343 DOI: 10.1093/eurpub/ckaa013] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background England’s Time to Change programme to reduce mental health-related stigma and discrimination included a social marketing campaign using traditional and social media, and targeted middle-income groups aged 25–45 between 2009 and 2016. From 2017, the same age group on low to middle incomes were targeted, and the content focused on men’s mental health, by changing the advertising and adapting the ‘key messages’. This study investigates changes in stigma-related public knowledge, attitudes and desire for social distance in England since Time to Change began in 2008–19 and for 2017–19. Methods Using data from a face-to-face survey of a nationally representative quota sample of adults for England, we evaluated longitudinal trends in outcomes with regression analyses and made assumptions based on a simple random sample. The pre-existing survey used a measure of attitudes; measures of knowledge and desire for social distance were added in 2009. Results Reported in standard deviation units (95% CI), the improvement for knowledge for 2009–19 was 0.25 (0.19, 0.32); for attitudes, 2008–19, 0.32 (0.26, 0.39) and for desire for social distance, 2009–19 0.29 (0.23, 0.36). Significant interactions between year and both region and age suggest greater improvements in London, where stigma is higher, and narrowing of age differences. There were significant improvements between 2017 and 2019 in knowledge [0.09 (0.02, 0.16)] and attitudes [0.08 (0.02, 0.14)] but not social distance. Conclusion The positive changes support the effectiveness of Time to Change but cannot be definitively attributed to it. Inequalities in stigma by demographic characteristics present targets for research and intervention.
Collapse
Affiliation(s)
- Claire Henderson
- Health Service and Population Research Department P029, King's College London, London, SE5 8AF, UK
| | - Laura Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Emily J Robinson
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King's College London, London, SE5 8AF, UK
| |
Collapse
|
15
|
Potts LC, Henderson C. Evaluation of anti-stigma social marketing campaigns in Ghana and Kenya: Time to Change Global. BMC Public Health 2021; 21:886. [PMID: 33964900 PMCID: PMC8106856 DOI: 10.1186/s12889-021-10966-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background Launched in 2018, Time to Change Global is a new anti-stigma programme to tackle stigma and discrimination towards people with mental health problems in low- and middle-income countries. Our aim was to evaluate pre-post changes in stigma within the target populations for the social marketing campaigns ran in Ghana and Kenya carried out as components of the wider Time to Change Global programme. Methods Using data collected before and after each campaign in Accra and Nairobi, we investigated pre-post differences in stigma-related outcome measures: mental health-related knowledge (MAKS), mental health-related attitudes (CAMI), and desire for social distance (RIBS), with regression analyses. Other covariates were included in the models to control for differences in participant demographics. Results A significant positive change in a stigma related outcome was found at each site. Reported in standard deviation units, desire for social distance from people with mental health problems in Accra was lower after the launch of the campaign, measured as an increase in intended contact (β = 0.29, 95% CI = 0.14 to 0.43, p < 0.001). In Nairobi, the stigma related knowledge score was higher in the post campaign sample (β = 0.21, 95% CI = 0.07 to 0.34, p = 0.003). Conclusion The increase in intended contact in the absence of other changes seen in Ghana, is consistent with the early results for Time to Change England. The estimate for the magnitude of this change is the same as Time to Change England for the general population between 2009 and 19, a very promising result for a short term public mental health campaign. The different results observed between sites may be due to campaign as well as population differences. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10966-8.
Collapse
Affiliation(s)
- Laura C Potts
- Department of Biostatistics & Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK.
| | - Claire Henderson
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| |
Collapse
|
16
|
Wong EC, Collins RL, McBain RK, Breslau J, Burnam MA, Cefalu MS, Roth E. Racial-Ethnic Differences in Mental Health Stigma and Changes Over the Course of a Statewide Campaign. Psychiatr Serv 2021; 72:514-520. [PMID: 33691488 PMCID: PMC8500546 DOI: 10.1176/appi.ps.201900630] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The authors examined whether shifts in mental health-related stigma differed across racial-ethnic groups over the course of a California statewide antistigma campaign and whether racial-ethnic disparities were present at the beginning of the campaign and 1 year later. METHODS Participants had taken part in the 2013 and 2014 California Statewide Surveys (CASSs), a longitudinal, random-digit-dialing telephone survey of California adults ages ≥18 years (N=1,285). Surveys were administered in English, Spanish, Mandarin, Cantonese, Vietnamese, Khmer, and Hmong. RESULTS Compared with Whites, Latino and Asian respondents who preferred to take the survey in their native language had higher levels of mental health-related stigma on several domains of the 2013 CASS. Specifically, Latino and Asian respondents who completed the survey in their native language were more likely than White respondents to report social distance, prejudice, and perceptions of dangerousness toward people with mental illness. These racial-ethnic disparities persisted 1 year later on the 2014 CASS. Latino-Spanish respondents experienced significant decreases in social distance over the course of the campaign but not to a degree that eliminated disparities on the 2014 CASS. Of note, perceptions of dangerousness of people with mental illness significantly increased among Latino-Spanish respondents between the 2013 and 2014 CASSs. CONCLUSIONS Future research is needed to better understand which components of antistigma campaigns are effective across racial-ethnic minority groups and whether more targeted efforts are needed, especially in light of the persistent and growing racial-ethnic disparities in mental health care.
Collapse
Affiliation(s)
- Eunice C Wong
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Rebecca L Collins
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Ryan K McBain
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Joshua Breslau
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - M Audrey Burnam
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Matthew S Cefalu
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Elizabeth Roth
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| |
Collapse
|
17
|
Quirke E, Klymchuk V, Suvalo O, Bakolis I, Thornicroft G. Mental health stigma in Ukraine: cross-sectional survey. Glob Ment Health (Camb) 2021; 8:e11. [PMID: 34026241 PMCID: PMC8127637 DOI: 10.1017/gmh.2021.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/03/2021] [Accepted: 02/25/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND STUDY OBJECTIVES This study aimed to assess among Ukrainian adults: (1) knowledge of mental disorders; (2) attitudes towards people with mental health disorders, and to the delivery of mental health treatment within the community; and (3) behaviours towards people with mental disorders. METHODOLOGY A cross-sectional survey of Ukrainian adults aged 18-60 was conducted. Stigma-related mental health knowledge was measured using the mental health knowledge schedule. Attitude towards people with mental health disorders was assessed using the Community Attitudes towards Mental Illness scale. The Reported and Intended Behaviour scale was used to assess past and future intended behaviour towards people with mental health disorders. RESULTS Associations between gender, age, and educational level and the knowledge and attitudes measures were identified. There was evidence of a positive association between being male and positive intended behaviours towards people with mental health disorders [mean difference (MD) = 0.509, 95% confidence interval (CI) 0.021-0.998]. Older age was negatively associated with positive intended behaviours towards people with mental health disorders (MD = -0.017, 95% CI 0.0733 to -0.001). Higher education was positively associated with stigma-related mental health knowledge (MD = 0.438, 95% CI 0.090-0.786), and negatively associated with authoritarian (MD = 0.755, 95% CI 0.295-1.215) attitudes towards people with mental health problems. CONCLUSION Overall, the findings indicate a degree of awareness of, and compassion towards, people with mental illness among Ukrainian adults, although this differed according to gender, region, and education level. Results indicate a need for the adoption and scaling-up of anti-stigma interventions that have been demonstrated to be effective.
Collapse
Affiliation(s)
- Eleanor Quirke
- Hamburg University of Applied Sciences, Hamburg, Germany
| | - Vitalii Klymchuk
- Institute for Social and Political Psychology of National Academy of Educational Sciences, Kyiv, Ukraine
| | - Orest Suvalo
- Institute of Mental Health of Ukrainian Catholic University, Lviv, Ukraine
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics & Health Services and Population Research Department, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|
18
|
Walsh DAB, Foster JLH. A Call to Action. A Critical Review of Mental Health Related Anti-stigma Campaigns. Front Public Health 2021; 8:569539. [PMID: 33490010 PMCID: PMC7820374 DOI: 10.3389/fpubh.2020.569539] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Using a knowledge-attitudes-behavior practice (KABP) paradigm, professionals have focused on educating the public in biomedical explanations of mental illness. Especially in high-income countries, it is now common for education-based campaigns to also include some form of social contact and to be tailored to key groups. However, and despite over 20 years of high-profile national campaigns (e.g., Time to Change in England; Beyond Blue in Australia), examinations suggest that the public continue to Other those with experiences of mental ill-health. Furthermore, evaluations of anti-stigma programs are found to have weak- to no significant long-term effects, and serious concerns have been raised over their possible unintended consequences. Accordingly, this article critically re-engages with the literature. We evidence that there have been systematic issues in problem conceptualization. Namely, the KABP paradigm does not respond to the multiple forms of knowledge embodied in every life, often outside conscious awareness. Furthermore, we highlight how a singular focus on addressing the public's perceived deficits in professionalized forms of knowledge has sustained public practices which divide between "us" and "them." In addition, we show that practitioners have not fully appreciated the social processes which Other individuals with experiences of mental illness, nor how these processes motivate the public to maintain distance from those perceived to embody this devalued form of social identity. Lastly, we suggest methodological tools which would allow public health professionals to fully explore these identity-related social processes. Whilst some readers may be frustrated by the lack of clear solutions provided in this paper, given the serious unintended consequences of anti-stigma campaigns, we caution against making simplified statements on how to correct public health campaigns. Instead, this review should be seen as a call to action. We hope that by fully exploring these processes, we can develop new interventions rooted in the ways the public make sense of mental health and illness.
Collapse
|
19
|
Relationships between types of UK national newspapers, illness classification, and stigmatising coverage of mental disorders. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1527-1535. [PMID: 33481044 PMCID: PMC8429387 DOI: 10.1007/s00127-021-02027-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Media coverage on mental health problems has been found to vary by newspaper type, and stigma disproportionately affects people with mental illness by diagnosis. OBJECTIVE This study investigated the relationships between types of UK national newspaper (tabloid vs. broadsheet), illness classification (SMI-severe mental illnesses vs. CMD-common mental disorders), and stigmatising coverage of mental disorders, and whether these relationships changed over the course of the Time to Change anti-stigma programmes in England and Wales. METHODS Secondary analysis of data from a study of UK newspaper coverage of mental illness was performed. Relevant articles from nine UK national newspapers in 2008-11, 2013, 2016 and 2019 were retrieved. A structured coding framework was used for content analysis. The odds an article was stigmatising in a tabloid compared to a broadsheet, and about SMI compared to CMD, were calculated. Coverage of CMD and SMI by newspaper type was compared using the content elements categorised as stigmatising or anti-stigmatising. RESULTS 2719 articles were included for analysis. Articles in tabloids had 1.32 times higher odds of being stigmatising than articles in broadsheet newspapers (OR 1.32, 95% CI 1.12-1.55). Odds of stigmatising coverage was 1.72 times higher for articles on SMI than CMD (OR 1.72, 95% CI 1.39-2.13). Different patterns in reporting were observed when results were stratified by years for all analyses. A few significant associations were observed for the portrays of stigmatising elements between tabloid and broadsheet newspapers regarding SMI or CMD. CONCLUSIONS Tailored interventions are needed for editors and journalists of different newspaper types, to include specific strategies for different diagnoses.
Collapse
|
20
|
Sampogna G, Gehlen L, Giallonardo V, Robinson EJ, Thornicroft G, Henderson C. Mental health service users' responses to anticipated discrimination and the Time to Change program in England. Eur Psychiatry 2020; 64:e5. [PMID: 33342457 PMCID: PMC8057446 DOI: 10.1192/j.eurpsy.2020.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Responses to anticipateddiscrimination are common among mental health service users and can have adetrimental impact on their recovery. Since 2009, the Time to Change (TTC)anti-stigma program in England has aimed to improve service users’ empowerment,reducing public stigma and discrimination. In this paper, we aim to evaluatewhether service users’ awareness of TTC is associated with fewer responses toanticipated discrimination. Methods We used data collected for the evaluation of TTC from samples of mental health service users interviewed by telephone in annual surveys 2009-2014. Results Five thousand and nine hundredand twenty-three participants completed the survey, mainly suffering from mooddisorders (depression, 28.4%, n = 1,681) and schizophrenia related disorders(15.4%, n = 915). In 23.2% of cases,participants were aware of any aspects of the TTC program, while participationin TTC was reported by 2.6%. Being aware of the TTC program was notsignificantly associated with responses to anticipated discrimination, exceptfor those participating in the TTC campaign in 2013. Stopping oneself fromapplying for work was significantly associated with experienced discriminationin both finding (p < 0.001) and keeping (p < 0.001) a job.Concealing mental health problems was associated with a general experience ofbeing shunned (p < 0.001). Conclusions Awareness of a nationalanti-stigma program may not be sufficient to encourage people to seek work/educationor to be open about their illness in situations in which they currentlyanticipate discrimination. There is the need to identify new multi-levelstrategies for challenging anticipated discrimination, even focusing ondifferent target groups.
Collapse
Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli,"Naples, Italy
| | | | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli,"Naples, Italy
| | - Emily J Robinson
- Biostatistics & Health Informatics Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Claire Henderson
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
21
|
Manescu EA, Robinson EJ, Henderson C. Attitudinal and demographic factors associated with seeking help and receiving antidepressant medication for symptoms of common mental disorder. BMC Psychiatry 2020; 20:579. [PMID: 33272233 PMCID: PMC7711251 DOI: 10.1186/s12888-020-02971-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/17/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite the increased attention given to improvement of mental health-related knowledge and attitudes, rates of help-seeking for mental illness remain low even in countries with well-developed mental health services. This study examines the relationships between attitudes to mental illness, symptoms of common mental disorder and seeking-help and receiving medication for a mental health problem. METHODS We used data from the nationally representative Health Survey for England 2014 to design three logistic regression models to test for the effects of attitudes to mental illness (measured by a shortened version of the Community Attitudes toward the Mentally Ill, CAMI scale) on: recent contact with a doctor for a mental health problem; use of any type of mental health service in the last 12 months; and having antidepressants currently prescribed, while controlling for symptoms of common mental disorder (measured by the General Health Questionnaire, GHQ). We also tested for an interaction between attitudes to mental illness and symptoms of common mental disorder on the outcomes. RESULTS A significant but very small effect of CAMI score was found on 'antidepressants currently prescribed' model (OR = 1.01(1.00, 1.02) but not on the two indicators of help-seeking. We also found a significant but very small interaction between CAMI and GHQ scores on recent contact with a doctor (OR = 0.99, 95% CI (0.990, 0.998); adjusted Wald test P = 0.01)). Knowing someone with a mental illness had a significant positive effect on help-seeking indicated by: (a) recent contact with a doctor (2.65 (1.01, 6.98)) and (b) currently prescribed antidepressant (2.67 (1.9, 3.75)) after controlling for attitudes to mental illness. CONCLUSIONS Our results suggest that knowing someone with a mental health problem seems to have a further positive effect on help-seeking, beyond improving attitudes to mental illness. Furthermore, multiple different types and aspects of stigma may contribute to help-seeking behaviours, consequently multi-faceted approaches are likely to be most efficient.
Collapse
Affiliation(s)
- Elena A Manescu
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
- Psychiatry Department, University of Medicine, Pharmacy, Science and Technology, Tirgu-Mures, Romania.
| | - Emily J Robinson
- Research Data & Statistics Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Claire Henderson
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|
22
|
Improvement for most, but not all: changes in newspaper coverage of mental illness from 2008 to 2019 in England. Epidemiol Psychiatr Sci 2020; 29:e177. [PMID: 33148367 PMCID: PMC7681112 DOI: 10.1017/s204579602000089x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS Time to Change, an anti-stigma programme in England, has worked to reduce stigma relating to mental illness in many facets of life. Newspaper reports are an important factor in shaping public attitudes towards mental illnesses, as well as working as a barometer reflecting public opinion. This study aims to assess the way that coverage of mental health topics and different mental illnesses has changed since 2008. METHOD Articles covering mental health in 18 different newspapers were retrieved using keyword searches on two randomly chosen days of each month in 2008, 2009, 2010, 2011, 2013, 2014, 2016 and 2019. A content analysis approach using a structured coding framework was used to extract information from the articles. Logistic regression models were used to estimate the change in odds of each hypothesised stigmatising or anti-stigmatising element occurring in 2019 compared to 2008 and 2016 with a Wald test to assess the overall significance of year as a predictor in the model. Further logistic regression models were used to assess the association between the diagnosis that an article was about and the odds that it was stigmatising, and whether this relationship is moderated by year of publication. RESULTS A total of 6731 articles were analysed, and there was a significant increase in anti-stigmatising articles in 2019 compared to 2008 (OR 3.16 (2.60-3.84), p < 0.001) and 2016 (OR 1.40 (1.16-1.69), p < 0.001). Of the 5142 articles that specified a diagnosis, articles about schizophrenia were 6.37 times more likely to be stigmatising than articles about other diagnoses (OR 6.37 (3.05-13.29) p < 0.001), and there was evidence that the strength of this relationship significantly interacted with the year an article was published (p = 0.010). Articles about depression were significantly less likely to be stigmatising (OR 0.59 (0.69-0.85) p = 0.018) than those about other diagnoses, while there was no difference in coverage of eating disorders v. other diagnoses (OR 1.37 (0.67-2.80) p = 0.386); neither of these relationships showed an interaction with the year of publication. CONCLUSION Anti-stigma programmes should continue to work with newspapers to improve coverage of mental illness. However, interventions should consider providing specific guidance and promote awareness of rarer mental illnesses, such as schizophrenia, and evaluation should examine whether reductions in stigma extend to people with all mental illness diagnoses.
Collapse
|
23
|
Lee CF, Lin YH, Chi LK, Lin HM, Huang JP. The Evidence Base in Exercise Knowledge of Pregnant Women: A Latent Class Analysis. Worldviews Evid Based Nurs 2020; 17:437-447. [PMID: 33085219 DOI: 10.1111/wvn.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exercise has many benefits for women with uncomplicated pregnancies. However, poor exercise knowledge may contribute to problems or barriers that reduce a woman's level of exercise after becoming pregnant. AIM This study was performed to identify pregnancy exercise knowledge among pregnant women using latent class analysis and to examine the relationship between pregnancy exercise knowledge patterns and sociodemographic characteristics. DESIGN A descriptive, cross-sectional approach was used in this study. METHODS Participants were recruited from the prenatal outpatient departments of two hospitals and a certified prenatal center in Taipei, Taiwan. A total of 618 participants completed a pregnancy exercise knowledge test. The data were analyzed using WINMIRA and SPSS 20.0 software. RESULTS Two latent classes were identified based on exercise knowledge among pregnant women. The Accurate Knowledge group (n = 543, 87.9%), which had a higher latent trait for exercise knowledge (M = 1.31, SD = 0.94), was larger than the Limited Knowledge group (n = 75, 12.1%), which had a lower latent trait (M = -0.22, SD = 1.14). The principles of exercise for pregnant women, particularly the appropriate intensity and duration, may be difficult items for women in the Limited Knowledge group to understand. Women with Limited Knowledge had significantly lower education levels and greater rates of unemployment, multiparity, and miscarriage than women in the Accurate Knowledge group. LINKING EVIDENCE TO ACTION A two-class system for interpreting exercise knowledge among pregnant women is statistically supported. We believe that this study has evidence-based potential to help healthcare providers improve pregnant women's exercise knowledge as part of routine prenatal care to promote exercise.
Collapse
Affiliation(s)
- Ching-Fang Lee
- Department of Nursing, Mackay Medical College, New Taipei, Taiwan
| | - Yuan-Horng Lin
- Department of Mathematics Education, National Taichung University of Education, Taichung City, Taiwan
| | - Li-Kang Chi
- Department of Physical Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsien-Ming Lin
- Section of Obstetrics, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
24
|
Mennigen E, Bearden CE. Psychosis Risk and Development: What Do We Know From Population-Based Studies? Biol Psychiatry 2020; 88:315-325. [PMID: 32061373 PMCID: PMC7305046 DOI: 10.1016/j.biopsych.2019.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 12/23/2022]
Abstract
Recent years have seen an advent in population-based studies in children, adolescents, and adults that examine the prevalence, etiology, and developmental trajectories of diverse subclinical psychopathological symptoms that pose a risk for the later development of severe mental illnesses. It is increasingly recognized that most categorically defined psychiatric disorders occur on a spectrum or continuum, show high heterogeneity and symptom overlap, and share genetic and environmental risk factors. We discuss neurodevelopmental underpinnings of psychosis spectrum symptoms and review brain morphometric and functional alterations as well as genetic liability for psychosis in individuals experiencing psychotic symptoms (PSs) in the general population. With regard to brain structure and function, findings of qualitatively similar alterations in individuals experiencing subthreshold PSs and individuals with overt psychotic disorders support the notion of a psychosis continuum. However, genetic and epidemiological studies have emphasized the overlap of PSs and other psychiatric illnesses. In particular, PSs during adolescence appear to be a nonspecific precursor of different psychopathological outcomes. Given the evidence presented in this review, we argue that findings from population-based studies are appropriate to guide policy-making to further emphasize public health efforts. Broadly accessible mental health programs are promising to make a difference in the field of adolescent mental health. However, the specific efficacy of these programs warrants further study, and caution is advised to not overpathologize potentially transient occurrence of mental health problems.
Collapse
Affiliation(s)
- Eva Mennigen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Department of Psychology, University of California, Los Angeles, Los Angeles, California.
| |
Collapse
|
25
|
Potts LC, Henderson C. Moderation by socioeconomic status of the relationship between familiarity with mental illness and stigma outcomes. SSM Popul Health 2020; 11:100611. [PMID: 32715077 PMCID: PMC7378684 DOI: 10.1016/j.ssmph.2020.100611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/30/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Multiple studies suggest response to mental health treatment is worse for people of lower socioeconomic status, a group who also express more mental illness stigma. Worse response to treatment may lead to greater therapeutic pessimism, an important component of stigma. However, familiarity with mental illness is associated with lower levels of stigma. This study therefore examines whether, among the general public, socioeconomic status moderates the relationships between familiarity and stigma related outcomes: knowledge; attitudes; and desire for social distance. Methods We carried out secondary analysis of data from the Attitudes to Mental Illness survey, collected annually from different general population samples from 2009-17, and every two years from 2017-19. Three separate multiple linear regression models examined factors associated with each outcome, with interaction tests between socioeconomic status and familiarity. Stigma related knowledge was measured using the Mental Health Knowledge Schedule (MAKS), which includes items on treatment effectiveness and recovery, thus addressing aspects of therapeutic pessimism. Attitudes were measured using the Community Attitudes towards the Mentally Ill Scale; and desire for social distance using the Reported and Intended Behaviour scale. Results In lower socioeconomic groups, personal experience was more frequent, while familiarity with someone else was less frequent. Interaction tests were significant for stigma related knowledge (p<0.0001) and desire for social distance (p=0.0118), but not for attitudes (p=0.057). The direction of the interaction differed between knowledge and the other outcomes. In lower socioeconomic groups the positive effect of familiarity on knowledge was weaker, as hypothesised, but for attitudes and desire for social distance, its effect was stronger. Conclusions Our results support the promotion of familiarity through encouraging discussion of mental health problems within social networks. However, lower stigma related knowledge among people with personal experience in lower socioeconomic groups suggests different responses to mental illness among these groups are needed. Familiarity with mental illness is associated with lower levels of stigma. Different experiences of familiarity may lead to moderation by socioeconomic group. The effect of familiarity on knowledge is weaker in lower socioeconomic groups. The results suggest more therapeutic pessimism in lower socioeconomic groups.
Collapse
Affiliation(s)
- Laura C. Potts
- Biostatistics and Health Informatics Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
- Corresponding author. Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Claire Henderson
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| |
Collapse
|
26
|
Walsh D, Foster J. A Contagious Other? Exploring the Public's Appraisals of Contact with 'Mental Illness'. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2005. [PMID: 32197437 PMCID: PMC7142778 DOI: 10.3390/ijerph17062005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022]
Abstract
Mental illness has recurrently been found to be Othered by the lay public, although few researchers have examined the affective and implicit processes involved. To explore this, we triangulated facial electromyography (EMG), self-reports, and individual interview data, finding participants to Other mental illness, a process that involved disgust, fear and pity. Furthermore, mental illness was considered to have the potential to permeate, posing a contagious threat. This research highlights the need to fully explore the forms of understanding, which maintain mental-health related stigma, including beliefs about contamination, and the implications this may have for the design of anti-stigma campaigns.
Collapse
Affiliation(s)
- Daniel Walsh
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
| | | |
Collapse
|
27
|
Time to Change's social marketing campaign for a new target population: results from 2017 to 2019. BMC Psychiatry 2019; 19:417. [PMID: 31881957 PMCID: PMC6933720 DOI: 10.1186/s12888-019-2415-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Since 2009 Time to Change has included among its strategies a social marketing campaign to tackle the stigma surrounding mental health problems. At the start of its third phase (2016-2021) the target group of the campaign was kept as people aged between mid-twenties and mid-forties but changed to middle-low income groups and the content was focused on men. METHODS Participants (n = 3700) were recruited through an online market research panel, before and after each burst of the campaign. They completed an online questionnaire evaluating knowledge (Mental Health Knowledge Schedule, MAKS); attitudes (Community Attitudes toward Mental Illness, CAMI); and desire for social distance (Intended Behaviour subscale of the Reported and Intended Behaviour Scale, RIBS). Socio-demographic data and awareness of the campaign were also collected. RESULTS For each of the 3 bursts, significant pre-post awareness differences were found (OR = 2.83, CI = 1.90-4.20, p < 0.001; OR = 1.72, CI = 1.22-2.42, p = 0.002; OR = 1.41, CI = 1.01-1.97, p = 0.043), and awareness at the end of the third burst was 33%. Demographic factors associated with awareness for one or more bursts included having children, familiarity with mental illness, male sex, being Black, Asian or other ethnic minorities and living in London or the East Midlands regions. An improvement across bursts in the "living with" subscale item of the RIBS, and in the "recover" and "advice to a friend" MAKS items were found. Familiarity with mental illness had the strongest association with all outcome measures, while the awareness of the campaign was also related with higher scores in MAKS and RIBS. CONCLUSIONS These interim results suggest that the campaign is reaching and having an impact on its new target audience to a similar extent as did the TTC phase 1 campaign. While over the course of TTC we have found no evidence that demographic differences in stigma have widened, and indeed those by age group and region of England have narrowed, those for socioeconomic status, ethnicity and sex have so far remained unchanged. By targeting a lower socioeconomic group and creating relatively greater awareness among men and in Black and ethnic minority groups, the campaign is showing the potential to address these persistent differences in stigma.
Collapse
|
28
|
Lien YY, Lin HS, Tsai CH, Lien YJ, Wu TT. Changes in Attitudes toward Mental Illness in Healthcare Professionals and Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234655. [PMID: 31766689 PMCID: PMC6926665 DOI: 10.3390/ijerph16234655] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022]
Abstract
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.
Collapse
|
29
|
Ingram E, Jones R, Schofield P, Henderson C. Small area deprivation and stigmatising attitudes towards mental illness: a multilevel analysis of Health Survey for England (2014) data. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1379-1389. [PMID: 31055630 DOI: 10.1007/s00127-019-01722-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/25/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to explore how small area deprivation is associated with attitudes towards mental illness in a large sample of individuals living in private households in England. METHOD Cross-sectional data from Health Survey for England (2014) were analysed using multilevel models. The exposure of interest was the deprivation level of the small area in which an individual resides as measured by Index of Multiple Deprivation (IMD) score. The primary outcome was an individual's overall attitude towards mental illness, measured using a 12 item version of the Community Attitudes toward the Mentally Ill (CAMI) scale. Further outcomes were the two subscales of the CAMI, reflecting attitudes of (1) prejudice and exclusion and (2) tolerance and support. Individuals were nested within household and small geographical area. RESULTS 5820 participants were included. Results from unadjusted models found strong evidence that individuals residing in the most deprived areas of England have worse attitudes towards mental illness compared to individuals living in the least deprived areas (estimated difference = - 3.5 points; 95% CI - 4.8 to - 2.2; P < 0.001). After adjusting for age, sex, education level, ethnicity and weekly income there was no longer evidence for this association (adjusted difference = - 0.1 points, 95% CI - 1.3 to 1.2; P = 0.931). Similar patterns of results were found for the CAMI subscales. CONCLUSIONS The relationship between small area-level deprivation and attitudes towards mental illness is no longer observed when controlling for certain individual-level characteristics.
Collapse
Affiliation(s)
- Elizabeth Ingram
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London, UK.
| | - Rebecca Jones
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London, UK
| | - Peter Schofield
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House, Guy's Campus, London, UK
| | - Claire Henderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| |
Collapse
|
30
|
Niedzwiedz CL. How does mental health stigma get under the skin? Cross-sectional analysis using the Health Survey for England. SSM Popul Health 2019; 8:100433. [PMID: 31312714 PMCID: PMC6609872 DOI: 10.1016/j.ssmph.2019.100433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/04/2022] Open
Abstract
Despite increased awareness of mental health problems, stigma persists. Little research has examined potential health and wellbeing outcomes associated with stigma. The aim of this study was to investigate relationships between mental health stigma, metabolic and cardiovascular biomarkers, as well as wellbeing and quality of life among people with no mental disorder, common mental disorders and severe mental illness. Data were taken from adults aged 16 + years participating in the Health Survey for England in 2014 (N = 5491). Mental health stigma was measured using the 12-item Community Attitudes towards the Mentally Ill (CAMI) scale, intended to measure attitudes around prejudice and exclusion, and tolerance and support for community care. Individuals were divided into six groups based on their mental health (no mental disorder, common mental disorder, severe mental illness) and whether they exhibited more (≤25th percentile) or less (>25th percentile) stigmatising attitudes. Metabolic and cardiovascular biomarker outcomes included systolic and diastolic blood pressure; total cholesterol; high-density lipoprotein (HDL) cholesterol; glycated haemoglobin, body mass index (BMI), waist-hip ratio and resting pulse rate. Biomarkers were analysed individually and as an allostatic load score. Wellbeing was measured using Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and quality of life via Euro-QoL-5D (EQ-5D). Linear regression models were calculated adjusted for confounders. Compared to individuals with less stigmatising attitudes, results suggested that those with more negative attitudes exhibited poorer wellbeing and quality of life across all mental disorder/stigma groups, including those with no mental disorder (WEMWBS (range 14–70): b = -1.384, 95% CI: -2.107 to -0.661). People with severe mental illness generally had unhealthier biomarker profiles and allostatic load scores, but results were inconsistent for any additional influence of mental health stigma. Reducing stigma may be beneficial for population wellbeing, but further research is needed to clarify whether stigma contributes to adverse biomarkers amongst people with mental illness. Few studies have researched the consequences of mental health stigma. More stigmatising attitudes relate to poorer wellbeing amongst all groups. People with severe mental illness had more adverse biomarker profiles. Results were inconclusive for any additional influence of mental health stigma.
Collapse
Affiliation(s)
- C L Niedzwiedz
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom
| |
Collapse
|