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Stracke M, Dobener LM, Christiansen H. Children of parents with a mental illness - stigma questionnaire: validation and revision. Front Psychiatry 2024; 15:1376627. [PMID: 38952634 PMCID: PMC11215172 DOI: 10.3389/fpsyt.2024.1376627] [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: 01/25/2024] [Accepted: 05/13/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction Mental disorders are often stigmatized in society. The stigma of mental illness affects people with a mental illness themselves as well as their family members-a phenomenon called stigma by association (SBA). Children of parents with a mental illness (COPMI) are a particular vulnerable group for SBA. In our systematic review, experienced SBA, anticipated SBA, affiliate SBA, and structural discrimination were identified as relevant stigma dimensions for children of parents with a mental illness. To assess SBA in adolescents who grow up with a parent with a mental illness, the COPMI-SQ was developed. Methods N = 930 adolescents completed the study. Of those, N = 380 adolescents (sample 1; 72.6% female, mean age 17.12 (SD = 2.01) years) reported growing up with at least one parent with a mental illness. Using confirmatory (CFA) and exploratory factor analyses (EFA) as well as standard item and reliability analyses, we analyzed and revised the COPMI-SQ in the first sample. To validate the factorial structure of the revised COPMI-SQ, CFA was also conducted in the independent sample of the other N = 550 adolescents (sample 2; 80.0% female, mean age 16.36 (SD = 1.98) years) who reported not growing up with a parent with a mental illness. To test four measurement invariance, a multiple-group CFA was conducted in the combined sample of adolescents who reported growing up with and without a parent with a mental illness (sample 1 and sample 2). Results CFA in sample 1 resulted in an inadequate model fit for the theoretically assumed four-factor structure (CFI = .687; RMSEA = .064 (90% CI = .062-.066); SRMR = .092; AIC = 229 155.63). Following EFA and item and reliability analyses in sample 1, the COPMI-SQ was reduced to four scales ("Experienced SBA," "Affiliate SBA," "Shame," and "Anticipated SBA") and two additional screening scales ("Healthcare" and "Social support"). To facilitate questionnaire use, only the three best items were retained in each scale, reducing the total item number to 12 plus five additional screener items. CFA in sample 2 also resulted in an inadequate model fit for the theoretically assumed four factor structure (CFI = .667; RMSEA = .065 (90% CI = .063-.066); SRMR = .101; AIC = 335 651.99). In comparison, the final version of the COPMI-SQ-r showed the best model fit (CFI = .945; RMSEA = .062 (90% CI = .052-.072); SRMR = .049; AIC = 60 008.05). In the multiple-group CFA (sample 1 and sample 2), metric invariance was established (χ2 (208) = 481.58, p < .001; CFI = .939; RMSEA = .053 (90% CI = .047-.059); SRMR = .056). In sample 2, internal consistency was found to be good for the total scale (α = .84) and almost acceptable to almost good for the subscales (α = .64 to.78). Discussion The revised version of the COPMI-SQ (COPMI-SQ-r) is a reliable and economic questionnaire to assess SBA in adolescents who grow up with a parent with a mental illness. The COPMI-SQ-r can be used to help develop and evaluate anti-stigma and general interventions for affected adolescents.
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Affiliation(s)
- Markus Stracke
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- German Center for Mental Health, Philipps University Marburg, Marburg, Germany
| | - Lisa-Marie Dobener
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- German Center for Mental Health, Philipps University Marburg, Marburg, Germany
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Chen X, Wang S, Liao X, Li Y, Leung SF, Bressington DT. Interventions to decrease health students' stigma toward schizophrenia: A scoping review. Int J Nurs Stud 2024; 158:104837. [PMID: 38936243 DOI: 10.1016/j.ijnurstu.2024.104837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Schizophrenia is heavily stigmatized among health professionals. Given that health professional students are future members of the workforce and will provide care for people with schizophrenia, it is essential to implement interventions aimed at reducing stigma among this group. OBJECTIVE This scoping review aimed to identify and synthesize existing literature on interventions to decrease schizophrenia stigma among health professional students, and to determine the possible gaps in the literature. DESIGN Nine electronic databases and gray literature were searched, including PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure, WanFang, and Google on 5 May 2023. Two researchers independently conducted data screening, data extraction, and assessed study risks. A most updated search was also done on 22 May 2024. The Cochrane risk of bias tool version 2 for randomized trials and Risk of Bias in Non-randomized Studies were used to assess the studies' risk of bias. Data synthesis and analysis were conducted by two reviewers using a narrative approach. Reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. RESULTS This review included twenty-one studies with 2520 health professional students. The majority of included studies were non-randomized controlled trials (38 %) and pre-post studies (52 %). Most of the included studies were conducted in the United States (24 %). The participants in ten (48 %) studies were medical students. The number of intervention sessions ranged from one to 13, with an average of three. Seven (33 %) studies had an intervention duration of less than four weeks and 16 (76 %) studies had no follow-up. Various scales were used to assess the outcomes of schizophrenia stigma. Only two studies (10 %) indicated the intervention's ineffectiveness, with the majority of interventions led by psychiatry department faculty and individuals with schizophrenia. CONCLUSIONS Most studies (90 %) utilized various approaches, including face-to-face or online education, direct contact with individuals with schizophrenia, or a combination thereof, to diminish stigma among health professional students. However, none addressed cultural and empathy factors in their intervention designs, and the included studies lacked theoretical guidance. The review only comprised English quantitative studies with significant heterogeneity, with 17 studies (81 %) displaying serious or high risk of bias, limiting comprehensive discussions. These findings offer valuable insights for future systematic review. Tweetable abstract Studies on reducing health professional students' schizophrenia stigma need to address cultural and empathy factors.
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Affiliation(s)
- Xi Chen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoli Liao
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Daniel Thomas Bressington
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; Faculty of Health, Charles Darwin University, Casuarina, NT 0810, Australia
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Albery IP, Long N, Kelly I, Frings D, Morris J. Does identity as a drinker predict problem recognition motivation in harmful drinkers? Soc Sci Med 2024; 351:116967. [PMID: 38761456 DOI: 10.1016/j.socscimed.2024.116967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/16/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
Harmful drinking is associated with significant negative health and social outcomes, but drinkers are reticent to recognise personal drinking problems, hindering natural recovery or help-seeking. Recent evidence suggests that social identity as a drinker is associated with various drinking-related factors but has not been examined in relation to likelihood of problem recognition. In a group of ninety-six harmful drinkers (61 females, M age = 34 years) we explored how identity components associated with ingroup self-investment and ingroup self-definition in combination with implicit identity as a drinker accounted for degrees of problem recognition. In addition to demographic information, addiction experience and drinking behaviour (AUDIT), respondents completed measures of ingroup self-investment (identity centrality, solidarity, and satisfaction), ingroup self-definition (ingroup homogeneity and self-stereotyping), a "self as drinker" identity implicit association test and problem recognition (four items from the Stages of Change Readiness and Treatment Eagerness Scale). After controlling for possible covariates (age, gender and alcohol addiction experience) increased problem recognition was accounted for by explicit and not implicit identity components. More specifically, increasing perceived chronic saliency of one's drinker identity (self-investment in the drinker ingroup) and not an implicit association between the self and being a drinker was related to increased likelihood of problem recognition. This suggests that how chronically and explicitly accessible the identity of the drinker is for individuals might operate to stimulate the willingness or motivation to recognise potential drinking related harm.
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Affiliation(s)
- Ian P Albery
- Centre for Addictive Behaviours Research, London South Bank University, London, United Kingdom.
| | - Natalie Long
- Centre for Addictive Behaviours Research, London South Bank University, London, United Kingdom
| | - Isabelle Kelly
- Centre for Addictive Behaviours Research, London South Bank University, London, United Kingdom
| | - Daniel Frings
- Centre for Addictive Behaviours Research, London South Bank University, London, United Kingdom
| | - James Morris
- Centre for Addictive Behaviours Research, London South Bank University, London, United Kingdom
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Ohayon S, Goldzweig G, Vilchinsky N, Hasson-Ohayon I. The Associations Among Observers' Openness to Experience and Agreeableness With Social Distance: The Moderating Role of Disability Type. J Nerv Ment Dis 2024; 212:325-331. [PMID: 38810095 DOI: 10.1097/nmd.0000000000001775] [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: 05/31/2024]
Abstract
ABSTRACT Despite abundant literature on personality and stigma, the role of disability type in this relationship has remained unaddressed. In the current study, we examined whether the relationship between observers' openness to experience and agreeableness on the one hand, and social distance on the other, was moderated by the target person's type of disability (psychiatric vs. physical). One hundred thirty-nine participants were randomly assigned to complete a social distance questionnaire referring to a vignette of a person in three conditions (physical disability, psychiatric disability, and control). A main effect of openness on social distance was found. Additionally, we found an interaction effect of agreeableness and the type of disability. Namely, the relationship between agreeableness and social distance was significant only in the physical disability condition but not in the other two conditions. To conclude, the current study emphasizes the role of personality traits in social distance toward individuals with disabilities.
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Affiliation(s)
- Shay Ohayon
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Gil Goldzweig
- Department of Behavioral Science, The Academic College of Tel Aviv-Yafo, Israel
| | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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Grohmann E, Al-Addous A, Sander C, Dogan-Sander E, Baumann E, Angermeyer MC, Schomerus G. Changes in the ability to correctly identify schizophrenia and depression: results from general population surveys in Germany over 30 years. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02660-y. [PMID: 38583103 DOI: 10.1007/s00127-024-02660-y] [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: 10/10/2023] [Accepted: 03/10/2024] [Indexed: 04/08/2024]
Abstract
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.
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Affiliation(s)
- Elise Grohmann
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Germany.
| | - Amani Al-Addous
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Germany
| | - Ezgi Dogan-Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Germany
| | - Eva Baumann
- Department of Journalism and Communication Research, Hannover University of Music, Drama, and Media, Hannover, Germany
| | | | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Germany
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Shillington KJ, Vanderloo LM, Burke SM, Ng V, Tucker P, Irwin JD. Factors that contributed to Ontario adults' mental health during the first 16 months of the COVID-19 pandemic: a decision tree analysis. PeerJ 2024; 12:e17193. [PMID: 38563002 PMCID: PMC10984169 DOI: 10.7717/peerj.17193] [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: 12/14/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
The COVID-19 pandemic has negatively impacted the mental health of individuals globally. However, less is known about the characteristics that contributed to some people having mental health problems during the pandemic, while others did not. Mental health problems can be understood on a continuum, ranging from acute (e.g., depression following a stressful event) to severe (e.g., chronic conditions that disrupt everyday functioning). Therefore, the purpose of this article was to generate profiles of adults who were more or less at risk for the development of mental health problems, in general, during the first 16-months of the COVID-19 pandemic in Ontario, Canada. Data were collected via online surveys at two time points: April-July 2020 and July-August 2021; 2,188 adults (Mage = 43.15 years; SD = 8.82) participated. Surveys included a demographic questionnaire and four previously validated tools to measure participants' mental health, subjective wellbeing, physical activity and sedentary behaviour, and sleep. A decision tree was generated at each time point for those with mental health problems, and those with no mental health problems. Results showed that subjective wellbeing was the biggest contributor to mental health status. Characteristics associated with no mental health problems among adults included having good wellbeing, being a good sleeper (quantity, quality, and patterns of sleep), and being over the age of 42. Characteristics associated with mental health problems included having poor wellbeing and being a poor sleeper. Findings revealed that specific characteristics interacted to contribute to adults' mental health status during the first 16 months of the COVID-19 pandemic. Given that wellbeing was the biggest contributor to mental health, researchers should focus on targeting adults' wellbeing to improve their mental health during future health crises.
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Affiliation(s)
- Katie J Shillington
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- Department of Neurobiology, University of California San Diego, San Diego, California, United States
- Center for Empathy and Social Justice in Human Health, T. Denny Sanford Institute for Empathy and Compassion, University of California San Diego, San Diego, California, United States
| | - Leigh M Vanderloo
- Child Health Evaluative Science, The Hospital for Sick Children, Toronto, Ontario, Canada
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Shauna M Burke
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Victor Ng
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Division of Professional Development and Practice Support, College of Family Physicians of Canada, Mississauga, Ontario, Canada
| | - Patricia Tucker
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Jennifer D Irwin
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
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da Cunha Koch C, Coughlan H, Cannon M. Representations of hallucinations and dissociation in young adult literature: using literature to challenge stigma about psychosis. Ir J Psychol Med 2024; 41:125-131. [PMID: 36189612 DOI: 10.1017/ipm.2022.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This paper explores the role that sensitively portrayed literary representations of hallucinations and dissociation may have in counteracting stigma associated with these experiences. In it, we focus on narratives of young people experiencing hallucinatory and dissociative phenomena in two award-winning, young adult novels: How It Feels to Float by Helena Fox and A Monster Calls by Patrick Ness. We identify and discuss three literary devices in these two novels that promote empathy for the characters and their experiences. The narrative accounts in both novels challenge conceptions of hallucinations and dissociation as unknowable and unrelatable experiences with their empathic portrayals of relatable characters that create comprehensible accounts of adolescents grappling with their sense of reality. Importantly, they highlight the potential role that literature can play in stigma reduction by positively shaping young peoples' understandings of unfamiliar mental health experiences.
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Affiliation(s)
- C da Cunha Koch
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - H Coughlan
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - M Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
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Stricker J, Hasenburg L, Jakob L, Weigl T, Pietrowsky R. Public Stigma and Continuum Beliefs Across Personality Disorder Severity Levels. J Pers Disord 2024; 38:75-86. [PMID: 38324251 DOI: 10.1521/pedi.2024.38.1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Stigmatizing attitudes toward persons with personality disorders are common. Preliminary evidence suggests that continuum beliefs (the view that presented symptoms lie on a continuum with normality) are associated with reduced personality disorder stigma. This study aimed to evaluate whether this association holds across the entire spectrum of personality disorder severity and whether greater personality disorder severity is linked to higher stigma. A general population sample (N = 848) completed questions about a vignette depicting mild, moderate, or severe personality disorder severity. Higher continuum beliefs were associated with a lower desire for social distance from persons with mild, moderate, or severe personality disorder. In addition, continuum beliefs were higher, and the desired social distance was lower toward a person with mild than a person with moderate or severe personality disorder. Thus, fostering continuum beliefs might aid in combating personality disorder stigma, including toward severely affected persons who experience strong stigmatization.
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Affiliation(s)
- Johannes Stricker
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Laureen Hasenburg
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Louisa Jakob
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Weigl
- Psychology School, Fresenius University of Applied Sciences, Düsseldorf, Germany
| | - Reinhard Pietrowsky
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Railey AF, Greene A. Stigma as a local process: Stigma associated with opioid dependency in a rural-mixed Indiana county. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104327. [PMID: 38237430 DOI: 10.1016/j.drugpo.2024.104327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/29/2023] [Accepted: 01/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Because the nature and magnitude of stigmatizing views associated with opioid dependency vary by social, cultural, and structural factors, strategies to reduce public stigma towards opioid dependency should vary by context. We leverage a unique dataset with evidence of multiple stigmatizing views to understand how to target interventions to reduce stigma in a state disproportionately impacted by the opioid epidemic, with a specific focus on a rural-mixed county. METHODS Data come from the representative Person-to-Person Health Study (2018-2020) of 2,050 Indiana residents, 224 from the rural-mixed Fayette County. Bivariate statistics and multivariate regression analyses were used to evaluate the association between Fayette County and measures of stigma (e.g., desire for social distance, prejudice, causal attributions) relative to the rest of Indiana. RESULTS Fayette County statistically differed from the rest of Indiana on most demographic characteristics and measures of stigmatizing views. Multivariate regressions revealed that compared to the rest of Indiana, residence in Fayette County was associated with a higher desire for social distance, perceptions of unpredictability, and attributing opioid dependency to genetics and the way the person was raised. CONCLUSION Our results contribute to growing evidence supporting the need for local approaches to address stigma. Stigma in Fayette County primarily reflects concerns about how people manage their opioid dependency. Strategies focusing on treatment and recovery potential, accompanied by extending the influence of supportive stakeholders and policies, will become important to address this stigma.
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Affiliation(s)
- Ashley F Railey
- Department of Sociology, Oklahoma State University, United States; Irsay Institute, Indiana University Bloomington, United States.
| | - Alison Greene
- School of Public Health-Bloomington, Indiana University, United States
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Nagel LC, Tesky VA, Schall A, Müller T, König J, Pantel J, Stangier U. Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study. Heliyon 2024; 10:e23379. [PMID: 38148800 PMCID: PMC10750160 DOI: 10.1016/j.heliyon.2023.e23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Objectives Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified. Methods Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral. Results Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008). Conclusion Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.
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Affiliation(s)
| | | | - Arthur Schall
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Tanja Müller
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Jochem König
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Johannes Pantel
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology, Goethe University, Frankfurt, Germany
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Morris J, Boness CL, Burton R. (Mis)understanding alcohol use disorder: Making the case for a public health first approach. Drug Alcohol Depend 2023; 253:111019. [PMID: 37952353 PMCID: PMC11061885 DOI: 10.1016/j.drugalcdep.2023.111019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
'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.
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Affiliation(s)
- James Morris
- London South Bank University, Centre for Addictive Behaviours Research, UK.
| | - Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, USA
| | - Robyn Burton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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McLaren T, Peter LJ, Tomczyk S, Muehlan H, Schomerus G, Schmidt S. The effects of causal and self-efficacy beliefs on help-seeking for people with depressive complaints: a quasi-experimental online study. Front Psychiatry 2023; 14:1232848. [PMID: 38098625 PMCID: PMC10720663 DOI: 10.3389/fpsyt.2023.1232848] [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: 06/01/2023] [Accepted: 10/23/2023] [Indexed: 12/17/2023] Open
Abstract
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.
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Affiliation(s)
- Thomas McLaren
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Lina-Jolien Peter
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Samuel Tomczyk
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Holger Muehlan
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Silke Schmidt
- Institute of Psychology, University of Greifswald, Greifswald, Germany
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13
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Medero K, Hovick S. Narratives and Mental Illness: Understanding the Factors That Impact Stigmatizing Attitudes and Behavioral Intentions. JOURNAL OF HEALTH COMMUNICATION 2023; 28:768-776. [PMID: 37855132 DOI: 10.1080/10810730.2023.2267498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Entertainment television has been explored to reduce stigmatizing attitudes toward mental illness by incorporating positive stories about characters with mental illness. Guided by mediated contact theory and the extended elaboration likelihood model, this study examines whether exposure and engagement with entertainment narratives, featuring characters with mental illnesses of varying levels of public stigma, impacts stigmatizing attitudes and intentions to interact with individuals with mental illness generally. Participants (n = 234) were randomized to one of the three conditions: (1) a more stigmatized mental illness (schizophrenia), (2) a less stigmatized mental illness (depression), or (3) a non-mental illness control (cancer). Participants in the more stigmatized condition reported significantly less identification with characters than those in the less stigmatized condition, and greater identification with the characters were associated with more positive attitudes and behavioral intentions. Narrative counterarguing was associated with less positive attitudes and intentions toward people with mental illness. Implications based on these findings include identifying ways to increase engagement with less familiar mental illnesses to optimize the positive outcomes associated with narrative engagement.
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Affiliation(s)
| | - Shelly Hovick
- Communication, The Ohio State University, Columbus, USA
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14
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Warbrick LA, Dunn BD, Moran PA, Campbell J, Kessler D, Marchant K, Farr M, Ryan M, Parkin M, Sharpe R, Turner K, Sylianou M, Sumner G, Wood E. Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol. Pilot Feasibility Stud 2023; 9:170. [PMID: 37798752 PMCID: PMC10552316 DOI: 10.1186/s40814-023-01394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The NHS Talking Therapies for Anxiety and Depression programme ('TTad'; formerly Improving Access to Psychological Therapies 'IAPT') delivers high-intensity cognitive behavioural therapy (CBT) to over 200,000 individuals each year for common mental health problems like depression and anxiety. More than half of these individuals experience comorbid personality difficulties, who show poorer treatment outcomes. TTad therapists report feeling unskilled to work with clients with personality difficulties, and enhancing the training of TTad therapists may lead to improved treatment outcomes for individuals presenting with secondary personality difficulties alongside depression and anxiety. METHODS This is a pre-post non-randomised mixed-method feasibility study, exploring the feasibility and acceptability of a 1-day training workshop for high-intensity (HI) CBT therapists. The workshop is focused on understanding and assessing personality difficulties and adapting HICBT treatments for anxiety and depression to accommodate client needs. The feasibility and acceptability of the workshop and the evaluation procedures will be investigated. It will be examined to what extent the workshop provision leads to improvements in therapist skills and confidence and explored to what extent the training has the potential to enhance clinical outcomes for this client group. DISCUSSION This feasibility study will provide data on the acceptability and feasibility of delivering brief therapist training to adapt usual HICBT to optimise care for individuals with secondary personality difficulties seeking treatment in TTad services for a primary problem of depression and/or anxiety. The study will also evaluate proof of concept that such an approach has the potential to improve clinical outcomes for those with secondary personality difficulties and report any possible harms identified. The study will inform the design of a future randomised controlled trial designed to test the effectiveness and cost-effectiveness of the training. TRIAL REGISTRATION ISRCTN81104604 . Submitted on 6th June 2022. Registration date: 3rd January 2023.
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Affiliation(s)
- Laura A Warbrick
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK.
- College of Medicine and Health, University of Exeter, Exeter, UK.
| | - Barnaby D Dunn
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Paul A Moran
- Bristol Medical School, University of Bristol, Bristol, UK
| | - John Campbell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David Kessler
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Marchant
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Michelle Farr
- Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Mary Ryan
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Megan Parkin
- Royal Devon University Healthcare NHS Foundation Trust, Tiverton, UK
| | | | - Katrina Turner
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Gemma Sumner
- Everyturn Mental Health, Newcastle Upon Tyne, UK
| | - Emma Wood
- Everyturn Mental Health, Newcastle Upon Tyne, UK
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15
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Bach B, Beghi M. Editorial: Reviews in psychiatry 2022: personality disorders. Front Psychiatry 2023; 14:1279335. [PMID: 37732084 PMCID: PMC10507361 DOI: 10.3389/fpsyt.2023.1279335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Massimiliano Beghi
- Department of Mental Health and Addictions, Azienda Unità Sanitaria Locale (AUSL) della Romagna, Cesena, Italy
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16
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Stricker J, Jakob L, Pietrowsky R. Associations of continuum beliefs with personality disorder stigma: correlational and experimental evidence. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02543-8. [PMID: 37548924 DOI: 10.1007/s00127-023-02543-8] [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: 10/30/2022] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE A pervasive and deeply entrenched stigma of personality disorders exists. For other mental disorders, a large body of research suggests that continuum beliefs (i.e., the endorsement of continuum perspectives on mental health and psychopathology) stimulate more favorable attitudes toward affected persons. Additionally, mental disorder classification systems increasingly incorporate continuous personality disorder models. Yet, it is unclear how continuum beliefs are related to personality disorder stigma. This study evaluated the link of continuum beliefs with personality disorder stigma based on correlational and experimental data. METHODS A large general population sample (N = 848) completed self-report measures of continuum beliefs regarding personality disorders, desired social distance, and prejudice toward persons with personality disorders. Additionally, participants were randomly presented with information supporting a continuous or a dichotomous view of personality disorders. RESULTS Continuum beliefs were associated with lower desired social distance (r = - 0.19) and prejudice (r = - 0.22). Additionally, the brief continuum intervention was associated with increased continuum beliefs (d = 0.99) and decreased desired social distance (d = - 0.14) and prejudice (d = - 0.17). Finally, the intervention effects on desired social distance and prejudice were mediated by continuum beliefs. CONCLUSION This study suggests that highlighting continuum views on personality disorders in public communication and interventions might reduce personality disorder stigma.
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Affiliation(s)
- Johannes Stricker
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - Louisa Jakob
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Reinhard Pietrowsky
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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17
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Wallhed Finn S, Mejldal A, Nielsen AS. The associations between public stigma and support for others' help-seeking for alcohol use disorder: a cross sectional study in the general Danish population. Addict Sci Clin Pract 2023; 18:46. [PMID: 37542352 PMCID: PMC10403820 DOI: 10.1186/s13722-023-00400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND A minority of all individuals with alcohol use disorders (AUD) seek treatment, where stigma is one prominent barrier. Social support is important to facilitate health and increase treatment-seeking. Whether there is an association between stigma and attitudes towards others' help-seeking for AUD is unknown. The aim of this study was to investigate the associations between stigma and support towards others' help-seeking for AUD, also to explore possible gender differences. METHOD Cross-sectional study, n = 2895, including Danish adults aged 30-65 in the general population. Year 2020, an online questionnaire was administrated, which covered demographics, attitudes towards others' help-seeking for AUD, and stigma measured with the Difference, Disdain & Blame Scales. Analyses were performed with Restricted Cubic Spline models, and odds ratios were calculated. RESULTS Lower level of stigma was associated with a higher probability for endorsing an "active support strategy". Level of stigma was not associated with "not knowing what to say or do" or "sharing my concern with others". There were few gender differences: among men, higher level of stigma was associated with a higher probability of "avoidance". Among women, lower level of stigma was associated with a lower probability of "avoidance". CONCLUSION There is a clear association between stigma and attitudes towards supporting others' help-seeking for AUD. The results highlight the need to reduce stigma and promote engagement towards others' treatment-seeking.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, 5000, Odense, Denmark.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, 5000, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, 5000, Odense, Denmark
- Psychiatric Hospital, University Function, Region of Southern Denmark, Odense, Denmark
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18
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Scholze K, Reich H, Passow P, Sander C, Czaplicki A, Hegerl U. Lifestyle causal beliefs are associated with higher personal and perceived stigma regarding depressive disorders: results from a representative population survey. BMC Psychiatry 2023; 23:414. [PMID: 37291498 PMCID: PMC10249268 DOI: 10.1186/s12888-023-04907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/27/2023] [Indexed: 06/10/2023] Open
Abstract
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.
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Affiliation(s)
- Katharina Scholze
- Depression Research Centre, German Depression Foundation, Leipzig, Germany
| | - Hanna Reich
- Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Phyllis Passow
- Depression Research Centre, German Depression Foundation, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Andreas Czaplicki
- Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Ulrich Hegerl
- Johann Christian Senckenberg Distinguished Professorship, Goethe-University, Frankfurt am Main, Germany
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19
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Finn SW, Mejldal A, Nielsen AS. Perceived barriers to seeking treatment for alcohol use disorders among the general Danish population - a cross sectional study on the role of severity of alcohol use and gender. Arch Public Health 2023; 81:65. [PMID: 37087483 PMCID: PMC10122805 DOI: 10.1186/s13690-023-01085-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND A minority of all individuals with alcohol use disorders (AUD) seek treatment. Since the suffering from AUD has severe consequences for both the individual and for society, it is important to improve the understanding of barriers to seeking treatment. Most studies of barriers thus far have been conducted in the United States of America or the United Kingdom. There is a need for studies from other contexts. The overall aim is to investigate barriers to treatment seeking for AUD. The specific aims are to: 1) describe barriers to AUD treatment at different levels of alcohol use. 2) compare gender differences regarding barriers to AUD treatment. METHODS Study design: Cross-sectional. PARTICIPANTS 1594 representative Danish adults from the general population aged 30-65 years. An online questionnaire was administrated by a market research company. The questionnaire covered demographic data, barriers to treatment and level of alcohol use. Analyses were performed by means of chi-2 test and logistic regression. RESULTS The most common barriers were related to stigma and shame: admitting to others of having a problem, being labelled, fear of the consequences and that others would find out. Participants with higher severity of alcohol use were more likely to endorse a wish to handle alcohol problems themselves and to report barriers related to treatment services. Women with high severity of alcohol use, endorsed higher level of fear of the consequences than men. CONCLUSIONS There is an urgent need to reduce stigma around AUD. Individuals with higher severity of alcohol use report a lower willingness to seek professional treatment if a problem occurs. Especially among individuals with high severity of alcohol use there is a need to address gender specific barriers.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
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20
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Bryant E, Touyz S, Maguire S. Public perceptions of people with eating disorders: Commentary on results from the 2022 Australian national survey of mental health-related stigma and discrimination. J Eat Disord 2023; 11:62. [PMID: 37062849 PMCID: PMC10108519 DOI: 10.1186/s40337-023-00786-z] [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: 11/22/2022] [Accepted: 04/12/2023] [Indexed: 04/18/2023] Open
Abstract
Mental illness is highly prevalent in the community. As such, significant attention has been paid in recent years to raising awareness of the mental health disorders (including eating disorders). This includes efforts to normalise help-seeking, campaigns to reduce stigma and discrimination, targeted research funding and advocacy for improved and accessible mental health service provision. But have these initiatives changed public attitude? The 2022 National Survey of Mental Health-Related Stigma and Discrimination is the first of four national surveys canvassing the general public's perceptions of people with mental health disorders (including stigmatising and discriminatory beliefs) conducted since 1995 to include eating disorders. It finds significant prejudice against those with mental health disorders still exists within the community, particularly among younger Australians. For eating disorders, this is primarily related to attributions of blame and personal weakness. Findings from the survey are discussed in this commentary.
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Affiliation(s)
- E Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.
| | - S Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - S Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
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21
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Buckwitz V, Juergensen V, Göbel M, Schomerus G, Speerforck S. Roles of perception of similarities, continuum beliefs, and social distance toward a person with schizophrenia: a German sample study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:681-684. [PMID: 36709224 PMCID: PMC10066069 DOI: 10.1007/s00127-023-02423-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/12/2023] [Indexed: 01/30/2023]
Abstract
Continuum beliefs (CB) interventions aim to reduce the stigma of schizophrenia by stating that people with and without schizophrenia exist on one mental health-illness continuum. The current study examines the interrelation between perception of similarities (PoS), CB and desire for social distance (SD) in a German population sample (N = 760). Applying linear regression models: PoS and CB were significantly associated with lower SD explaining about 12% variance and PoS was significantly associated with higher CB. CB partially mediated the relation of PoS and SD. Upcoming mental illness stigma interventions applying CB interventions should also aim to increase PoS.
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Affiliation(s)
- V Buckwitz
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany.
- Department of Psychology, University of California-Berkeley, Berkeley, USA.
| | - V Juergensen
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
| | - M Göbel
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
| | - G Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
| | - S Speerforck
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
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22
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
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.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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23
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Horwood G, Augoustinos M, Due C. “It’s important to manage our stress”: Mental health advice in the Australian print news media during the COVID-19 pandemic. SSM - MENTAL HEALTH 2023; 3:100204. [PMID: 36974336 PMCID: PMC10029348 DOI: 10.1016/j.ssmmh.2023.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 03/24/2023] Open
Abstract
The COVID-19 pandemic has heightened existing concerns about mental health and illness in Australia. The news media is an important source of health information, but there has been little research into how advice about mental health is communicated to the public via the news media. In this study, we examined how advice about building and maintaining mental health was discursively constructed in the news media during the COVID-19 pandemic. A discourse analytic approach informed by critical discursive psychology was employed to analyse 436 articles published in daily newspapers in Australia between 1 January and 31 December 2020, which contained references to mental health and the COVID-19 pandemic. Three main interpretative repertoires were identified – negative emotions are a risk to mental health and must be managed; risky emotions should be managed by being controlled (based around a ‘border control’ metaphor); and risky emotions should be managed by being released (based around a ‘pressure cooker’ metaphor). This study demonstrates that, amid the COVID-19 pandemic, advice constructed negative emotions as risky and problematic; and normalized the habitual management of emotions by individuals through strategies of control and release. Potential implications of such discourses for goals of improving population mental health are discussed.
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Affiliation(s)
- Grace Horwood
- School of Psychology, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
| | - Martha Augoustinos
- School of Psychology, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
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24
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Tomczyk S, Heineck S, McLaren T, Peter LJ, Schomerus G, Schmidt S, Muehlan H. Yes, I can! Development and validation of the self-efficacy for self-help scale. J Affect Disord 2023; 331:279-286. [PMID: 36933667 DOI: 10.1016/j.jad.2023.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Self-help interventions for health complaints promise alleviation, for instance, of depressive symptoms, and have become increasingly popular. However, despite constant progress regarding digitally supported self-help, real-world uptake is low and motivational processes, like task-specific self-efficacy, are rarely investigated. Therefore, this study developed and tested the Self-Efficacy for Self-Help Scale (SESH). METHODS In a randomized controlled trial of a positive psychological online intervention to foster self-help, 344 adults (mean age = 49.26 years, SD = 27.85; 61.9 % female) completed SESH at three time points (pretest, posttest, 2-week follow-up). Psychometric testing included factorial validity, reliability (internal consistency, split-half), convergent validity (via depression coping self-efficacy), discriminant validity (via depression severity, depression literacy), sensitivity to change (due to the intervention), and predictive validity (via a theory of planned behavior questionnaire on self-help). RESULTS The unidimensional scale showed excellent reliability, construct validity, and predictive validity regarding self-help (the theory of planned behavior explained 49 % of variance in self-help intentions). The analysis did not clearly support sensitivity to change, however, as SESH scores did not change in the intervention group but were lower in the control group at posttest. LIMITATIONS The study was not representative of the population, and the intervention was not previously tested. Studies with longer follow-ups and more diverse samples are needed. CONCLUSIONS This study closes a gap in current self-help research by presenting a psychometrically sound measure to capture self-efficacy for self-help that can be used in epidemiological studies as well as clinical practice.
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Affiliation(s)
- Samuel Tomczyk
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany.
| | - Sascha Heineck
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Thomas McLaren
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Lina-Jolien Peter
- University of Leipzig Medical Center, Department of Psychiatry and Psychotherapy, Germany
| | - Georg Schomerus
- University of Leipzig Medical Center, Department of Psychiatry and Psychotherapy, Germany
| | - Silke Schmidt
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Holger Muehlan
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
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25
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Monaghan C, Bizumic B. Dimensional models of personality disorders: Challenges and opportunities. Front Psychiatry 2023; 14:1098452. [PMID: 36960458 PMCID: PMC10028270 DOI: 10.3389/fpsyt.2023.1098452] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual's personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.
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Affiliation(s)
- Conal Monaghan
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
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26
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Weissinger GM, Evans L, Van Fossen C, Winston-Lindeboom P, Ruan-Iu L, Rivers AS. Parent experiences during and after adolescent suicide crisis: A qualitative study. Int J Ment Health Nurs 2023; 32:917-928. [PMID: 36882964 DOI: 10.1111/inm.13137] [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: 09/16/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
Parents of adolescents who have suicide crises (i.e. suicide attempt and/or significant ideation) are often highly involved in the care management, treatment and preventing future suicides of their children. How they experience these suicide crises, and the period afterward, has not been well studied. The purpose of this study was to understand parents' (defined in this study as any legal guardian of an adolescent taking on a parental role) experience of adolescent suicide crises and its impact on themselves and the family system. Semi-structured interviews were conducted with parents (N = 18) of adolescents who had a suicide crisis in the past 3 years. Thematic analysis was used with a combined inductive-deductive coding approach, drawing from Diamond's conceptualization of family treatment engagement for suicidal youth and iterative close readings of transcripts. Five themes emerged related to parent experience: Trauma of the Experience (subtheme: Feelings of Failure); Living in Fear; Alone and Seeking Connection; Lasting Impact; and A New Normal (subtheme: Turn the Pain to Purpose). Parents experienced these events as traumatic, damaging their sense of self. They experienced long periods of time where fear and loneliness dominated their lives. Recovery was both an individual and a family process, occurring in tandem with, but distinct from, adolescent experiences. Descriptions and illustrative quotes illustrate parent experiences and their understanding of the impact on the family system. Results highlighted that parents require support both for themselves and as caregivers for adolescents around an adolescent's suicide crisis and that family-focused services are vital.
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Affiliation(s)
- Guy M Weissinger
- Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Lili Evans
- Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Catherine Van Fossen
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Payne Winston-Lindeboom
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Linda Ruan-Iu
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Alannah Shelby Rivers
- Department of Psychology and Philosophy, Texas Woman's University, Denton, Texas, USA
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Examining the impact of experiencing auditory verbal hallucinations from a first-person perspective on the degree of empathy and stigmatization in a group of psychology students: A study using 360° immersive videos. Compr Psychiatry 2023; 123:152379. [PMID: 36870090 DOI: 10.1016/j.comppsych.2023.152379] [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: 10/14/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Stigmatization toward psychosis is persistent among mental health professionals (MHPs) and negatively impacts the patients' outcomes. One suggested way of reducing stigmatization is to expose MHPs to simulations of psychotic symptoms. This approach has been associated with an increase in empathy, but also with an increase in the desire of social distance. The addition of an empathic task (ET) has been suggested to neutralize this effect on social distance. The present study aims to (1) examine the effect of a remotely administered 360° immersive video (360IV) simulation on empathy and stigma among psychology students and (2) replicate the neutralizing effect of an ET on social distance. Finally, the potential role of immersive properties on changes will also be explored. METHODS A 360IV simulating auditory hallucinations was constructed in collaboration with patient partners. 121 psychology students were allocated to one of three conditions: (i) exposure to the 360IV, (ii) exposure to the 360IV and to an ET (360IV + ET), and (iii) no exposure (control). Measures of empathy and stigma (stereotypes and social distance) were collected before and after the interventions. RESULTS An increase of empathy was observed in the 360IV and 360IV + ET conditions compared to the control condition. There was an increase of stereotypes in all conditions and no effect on social distance. CONCLUSIONS This study confirms the effectiveness of a 360IV simulation intervention in increasing empathy in psychology students but questions its efficacy in reducing stigma.
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Jahn I, Jelinek L, Moritz S, Stengler K. [Psychological Burden in Relatives of People with Mental Illness During the COVID-19 Pandemic]. PSYCHIATRISCHE PRAXIS 2023. [PMID: 36791788 DOI: 10.1055/a-1997-9592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
CONCERN The COVID-19 pandemic is a burden for most people - particular for those with mental illness and their families. The aim of the present study was to investigate specific burdens as well as coping strategies among relatives of people with mental illness. METHODS A questionnaire to assess Corona pandemic-related influences on burdens of relatives of people with mental illness was developed. A total of 228 relatives participated in the survey between March and June 2021. RESULTS More than 87% of the relatives surveyed reported that they were burdened by the mental illness of their ill relatives. Many of the respondents subjectively described helpful coping strategies such as appreciation of healthy parts. CONCLUSION In times of crisis, such as the COVID-19 pandemic, care structures and support services should also be sensitively aligned and continuously provided for relatives of people with mental illness.
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Affiliation(s)
- Ina Jahn
- Zentrum für Seelische Gesundheit, HELIOS Park-Klinikum Leipzig, Leipzig, Germany
| | - Lena Jelinek
- Zentrum für Psychosoziale Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Zentrum für Psychosoziale Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Katarina Stengler
- Zentrum für Seelische Gesundheit, HELIOS Park-Klinikum Leipzig, Leipzig, Germany
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Cavelti M, Sharp C, Chanen AM, Kaess M. Commentary: Commentary on the Twitter comments evoked by the May 2022 debate on diagnosing personality disorders in adolescents. Child Adolesc Ment Health 2023; 28:186-191. [PMID: 36478638 DOI: 10.1111/camh.12618] [Citation(s) in RCA: 5] [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] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
The debate about the value and utility of personality disorder (PD) diagnosis in adolescence published in the May 2022 issue of CAMH generated fervent Twitter discussion. This commentary addresses some points raised in the Twitter discussion that represent important social and/or cultural beliefs that are often presented in day-to-day practice but are rarely tested in the context of scientific evidence. This includes, in particular, the assertion that symptoms used to diagnose personality disorder are better described as sequelae of trauma, and the assertion that effective treatment for PD is possible without a diagnosis. The call for a fundamental transformation of mental health services that currently do not meet the needs of people with PD and for the involvement of people with lived experience as equal partner in this process is supported by evidence and might represent common ground among those clinician-scientist advocating for early intervention for PD and those expressing their concerns about this issue.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Andrew M Chanen
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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30
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Fernandez DK, Singh S, Deane FP, Vella SA. Exploring Continuum and Categorical Conceptualisations of Mental Health and Mental Illness on Australian Websites: A Systematic Review and Content Analysis. Community Ment Health J 2023; 59:275-289. [PMID: 35994182 PMCID: PMC9859906 DOI: 10.1007/s10597-022-01005-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/27/2022] [Indexed: 01/25/2023]
Abstract
It is important to explore the types of conceptualisations and causes presented in online mental health promotion given the implications that these presentations may have on mental health stigma. This study systematically reviewed 92 Australian webpages focused on either mental health, mental illness, depression, or schizophrenia, to explore the types of conceptualisations and aetiologies presented. A minority of mental health and mental illness webpages (n = 8, 8.70%) explicitly presented continuum conceptualisations, with none providing explicit categorical conceptualisations. No depression or schizophrenia webpages presented explicit conceptualisations of any kind. All four webpage foci had a greater proportion of continuum than categorical conceptualisations. Moreover, both depression and schizophrenia webpages presented many mixed conceptualisations which included both continuum and categorical messaging. Most webpages mentioned biological and social causes equally across webpage foci. These findings suggest that Australian mental health websites predominantly present continuum conceptualisations of mental health and mental illness.
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Affiliation(s)
- Dominic K. Fernandez
- School of Psychology, University of Wollongong, North Wollongong, NSW 2522 Australia
| | - Saniya Singh
- School of Psychology, University of Wollongong, North Wollongong, NSW 2522 Australia
| | - Frank P. Deane
- School of Psychology, University of Wollongong, North Wollongong, NSW 2522 Australia
| | - Stewart A. Vella
- School of Psychology, University of Wollongong, North Wollongong, NSW 2522 Australia
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Finn SW, Mejldal A, Nielsen AS. Public stigma and treatment preferences for alcohol use disorders. BMC Health Serv Res 2023; 23:76. [PMID: 36694198 PMCID: PMC9872434 DOI: 10.1186/s12913-023-09037-y] [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: 08/01/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Alcohol use disorders (AUD) are among the most highly stigmatized medical conditions. Only a minority of individuals with AUD seek treatment, and stigma is one of the most prominent barriers to treatment-seeking. However, there is a lack of knowledge about the associations between stigma and preferences for help-seeking, and the associations between stigma and preferences for treatment seeking. AIM to investigate the associations between stigma and preferences for where to seek help and treatment for AUD. As sub-analyses, associations between stigma, level of alcohol use and preferences for help-seeking and treatment preferences will be analyzed. METHOD Cross-sectional design, including n = 3037 participants aged 30 - 65 years, living in Denmark. DATA In 2020, an online questionnaire was administered by a market research company. The questionnaire covered demographics, preferences for help-seeking and treatment for AUD, stigma measured with the Difference, Disdain & Blame Scales for Public Stigma, and alcohol use measured with the Alcohol Use Disorder Test (AUDIT). ANALYSES restricted cubic spline models were applied to model outcomes. Odds ratios were calculated. RESULTS A lower level of stigma was associated with a higher probability of preferring formal and informal help-seeking for AUD. Both high and low levels of stigma were associated with a higher probability of preferring to consult general practitioners. Stigma was not associated with other preferences for treatment-seeking, nor trying to change oneself or a passive strategy. The sub-analyses, grouped by level of alcohol use, showed similar results. CONCLUSION Stigma is associated with lower preferences for formal and informal help-seeking, however not type of treatment preferred. Future studies should address stigma in relation to other factors of the treatment-seeking process.
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Affiliation(s)
- Sara Wallhed Finn
- grid.10825.3e0000 0001 0728 0170Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, Entrance. 220 B, 5000 Odense, Denmark ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mejldal
- grid.10825.3e0000 0001 0728 0170Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, Entrance. 220 B, 5000 Odense, Denmark
| | - Anette Søgaard Nielsen
- grid.10825.3e0000 0001 0728 0170Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, Entrance. 220 B, 5000 Odense, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Hospital, University Function, Region of Southern Denmark, Odense, Denmark
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McLaren T, Peter LJ, Tomczyk S, Muehlan H, Schomerus G, Schmidt S. The Seeking Mental Health Care model: prediction of help-seeking for depressive symptoms by stigma and mental illness representations. BMC Public Health 2023; 23:69. [PMID: 36627597 PMCID: PMC9831378 DOI: 10.1186/s12889-022-14937-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Only about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy). METHOD All variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R). RESULTS Altogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16). CONCLUSION The Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses. TRIAL REGISTRATION German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111-1264-9954. Registered 16 February 2021.
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Affiliation(s)
- Thomas McLaren
- grid.5603.0Department of Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum Str. 13, 17489 Greifswald, Germany
| | - Lina-Jolien Peter
- grid.9647.c0000 0004 7669 9786Department of Psychiatry and Psychotherapy, Medical Faculty, University Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Samuel Tomczyk
- grid.5603.0Department of Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum Str. 13, 17489 Greifswald, Germany
| | - Holger Muehlan
- grid.5603.0Department of Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum Str. 13, 17489 Greifswald, Germany
| | - Georg Schomerus
- grid.9647.c0000 0004 7669 9786Department of Psychiatry and Psychotherapy, Medical Faculty, University Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Silke Schmidt
- grid.5603.0Department of Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum Str. 13, 17489 Greifswald, Germany
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Ponew A, Brieger A, Lust C, Speerforck S, von Peter S, Stuetzle S. Lived experiences matter: The role of mental health professionals' psychological crises and vulnerability in shaping their health beliefs and concepts. Front Psychiatry 2023; 14:1114274. [PMID: 36761862 PMCID: PMC9905638 DOI: 10.3389/fpsyt.2023.1114274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Angel Ponew
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Anna Brieger
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Christian Lust
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Stefan Stuetzle
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany.,Evangelische Hochschule Dresden, University of Applied Sciences for Social Work, Education and Care, Dresden, Germany
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Tomczyk S, Schlick S, Gansler T, McLaren T, Muehlan H, Peter LJ, Schomerus G, Schmidt S. Continuum beliefs of mental illness: a systematic review of measures. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1-16. [PMID: 35927343 PMCID: PMC9845169 DOI: 10.1007/s00127-022-02345-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/19/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The continuum of mental health/illness has been subject to scientific debate for decades. While current research indicates that continuum belief interventions can reduce mental health stigma and improve treatment seeking in affected populations, no study has yet systematically examined measures of continuum beliefs. METHODS This preregistered systematic review summarizes measures of continuum beliefs. Following the PRISMA statement, three scientific databases (PubMed, PsycInfo and PsycArticles via EBSCOhost, Web of Science) are searched, instruments are described and discussed regarding their scope, and methodological quality. RESULTS Overall, 7351 records were identified, with 35 studies reporting relevant findings on 11 measures. Most studies examined general population samples and used vignette-based measures. Schizophrenia and depression were most commonly examined, few studies focused on dementia, ADHD, OCD, eating disorders, and problematic alcohol use, or compared continuum beliefs across disorders. Validity was very good for most measures, but reliability was rarely tested. Measures mostly assessed beliefs in the normality of mental health symptoms or the normality of persons with such symptoms but rarely nosological aspects (i.e., categorical v continuous conceptualization of mental disorders). CONCLUSIONS Current research provides psychometrically sound instruments to examine continuum beliefs for a variety of mental disorders. While studies suggest utility for general population samples and mental health professionals, more research is necessary to corroborate findings, for instance, regarding age (e.g., in adolescents), gender, or type of mental disorder. Future research should also compare self-report ratings, and vignette-based measures, include measures of nosological concepts to fully grasp the continuum concept of mental illness. PREREGISTRATION PROSPERO: CRD42019123606.
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Affiliation(s)
- S. Tomczyk
- grid.5603.0Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, 17489 Greifswald, Germany
| | - S. Schlick
- grid.5603.0Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, 17489 Greifswald, Germany
| | - T. Gansler
- grid.5603.0Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, 17489 Greifswald, Germany
| | - T. McLaren
- grid.5603.0Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, 17489 Greifswald, Germany
| | - H. Muehlan
- grid.5603.0Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, 17489 Greifswald, Germany
| | - L.-J. Peter
- grid.9647.c0000 0004 7669 9786Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - G. Schomerus
- grid.9647.c0000 0004 7669 9786Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - S. Schmidt
- grid.5603.0Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, 17489 Greifswald, Germany
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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.
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Yip CCH, Fung WTW, Leung DCK, Chan KKS. The impact of stigma on engaged living and life satisfaction among people with mental illness in Hong Kong. Qual Life Res 2023; 32:161-170. [PMID: 36056192 DOI: 10.1007/s11136-022-03218-8] [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: 07/24/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE The present study aimed to investigate how the interpersonal (experienced discrimination) and intrapersonal (anticipated stigma and internalized stigma) manifestations of psychiatric stigma may affect engaged living and life satisfaction among people with mental illness. In this study, we developed and evaluated a conceptual model to clarify how experienced discrimination may lead to anticipated stigma and internalized stigma and thereby impede engaged living and reduce life satisfaction. METHODS A total of 205 Hong Kong Chinese people with mental illness completed standardized questionnaire measures of experienced discrimination, anticipated stigma, internalized stigma, engaged living, and life satisfaction. The associations among these variables were analyzed using path analyses and bootstrap analyses. RESULTS Path analyses showed that experienced discrimination was related to higher levels of anticipated stigma and internalized stigma, which were, in turn, linked to lesser engaged living and consequently lower life satisfaction. Bootstrap analyses further revealed that experienced discrimination had significant indirect effects on life satisfaction via anticipated stigma and engaged living and via internalized stigma and engaged living. CONCLUSIONS Theoretically, our study uncovers how the interpersonal and intrapersonal manifestations of psychiatric stigma may adversely affect engaged living and life satisfaction among people with mental illness. Practically, our study points to the importance of developing and implementing stigma-related interventions at societal and individual levels in order to enable people with mental illness to live fulfilling and satisfying lives.
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Affiliation(s)
| | - Winnie Tsz Wa Fung
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Donald Chi Kin Leung
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Kevin Ka Shing Chan
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong. .,Centre for Psychosocial Health, The Education University of Hong Kong, Tai Po, Hong Kong.
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Dave B, O'Connor C. A systematic review of the antecedents, correlates, and consequences of continuum beliefs about depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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38
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Hinshaw SP. Psychological problems, biomedical models, and stigma: A commentary on Lahey et al. (2022). JCPP ADVANCES 2022. [DOI: 10.1002/jcv2.12119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Stephen P. Hinshaw
- University of California Berkeley California USA
- University of California, San Francisco San Francisco California USA
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Leonhard A, Leonhard C, Sander C, Schomerus G. The effect of alcohol use disorder symptom and recovery narratives on problem-recognition: A randomized online trial. Addict Behav 2022; 134:107426. [PMID: 35870440 DOI: 10.1016/j.addbeh.2022.107426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Anya Leonhard
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany.
| | - Christoph Leonhard
- The Chicago School of Professional Psychology at Xavier University of Louisiana, 1 Drexel Dr, New Orleans, LA 70125, USA
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany
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40
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Chan KKS, Fung WTW, Leung DCK, Tsui JKC. The impact of perceived and internalised stigma on clinical and functional recovery among people with mental illness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6102-e6111. [PMID: 36254881 DOI: 10.1111/hsc.14047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/16/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
The present study aimed to develop and validate a conceptual model linking public and internalised stigma to recovery attitudes, processes and outcomes among people with mental illness. Specifically, we sought to examine whether perceptions of public stigma (i.e., perceived stigma) would affect experiences of internalised stigma (i.e., self-stigma) and thereby influence recovery attitudes (i.e., recovery orientation), recovery processes (i.e., service engagement) and recovery outcomes (i.e., clinical recovery and functional recovery). A total of 205 people with mental illness from Hong Kong, China, completed questionnaire measures on perceived stigma, self-stigma, recovery orientation, service engagement, clinical recovery and functional recovery. The associations among these variables were analysed using path analyses and bootstrap analyses. Path analyses showed that perceived stigma was related to greater self-stigma, which was, in turn, linked to lower recovery orientation and then lesser service engagement and ultimately poorer clinical recovery and functional recovery. Bootstrap analyses further demonstrated that perceived stigma had significant indirect effects on recovery orientation via self-stigma, on service engagement via self-stigma and recovery orientation and on clinical recovery and functional recovery via self-stigma, recovery orientation and service engagement. Theoretically, our findings reveal how public and internalised stigma may adversely affect recovery attitudes, processes and outcomes among people with mental illness. Practically, our findings point to the vital and urgent need to develop effective interventions to mitigate stigma and self-stigma at community and individual levels in order to reduce the deleterious impact of stigma on recovery.
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Affiliation(s)
- Kevin Ka Shing Chan
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
- Centre for Psychosocial Health, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Winnie Tsz Wa Fung
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Donald Chi Kin Leung
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Jack Ka Chun Tsui
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
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Okoli CZ. Board of Directors' Column: Novel IDEAS Moving Whole Health Forward. J Am Psychiatr Nurses Assoc 2022; 28:488-490. [PMID: 36267003 DOI: 10.1177/10783903221130034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chizimuzo Zim Okoli
- Chizimuzo (Zim) Okoli, PhD, MPH, MSN, PMHNP-BC, FAAN, American Psychiatric Nurses Association, Falls Church, VA, USA
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Thornicroft G, Sunkel C, Alikhon Aliev A, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC, Guerrero Z, Gurung D, Habtamu K, Hanlon C, Heim E, Henderson C, Hijazi Z, Hoffman C, Hosny N, Huang FX, Kline S, Kohrt BA, Lempp H, Li J, London E, Ma N, Mak WWS, Makhmud A, Maulik PK, Milenova M, Morales Cano G, Ouali U, Parry S, Rangaswamy T, Rüsch N, Sabri T, Sartorius N, Schulze M, Stuart H, Taylor Salisbury T, Vera San Juan N, Votruba N, Winkler P. The Lancet Commission on ending stigma and discrimination in mental health. Lancet 2022; 400:1438-1480. [PMID: 36223799 DOI: 10.1016/s0140-6736(22)01470-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK.
| | | | - Akmal Alikhon Aliev
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Sue Baker
- Mind international, London, UK; Changing Minds Globally, London, UK
| | - Elaine Brohan
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | - Kelly Davies
- Centre for Implementation Science, King's College London, London UK
| | - Mekdes Demissie
- College of Health Sciences and Medicine, School of Nursing and Midwifery, Haramaya University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | | | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Zoe Guerrero
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Dristy Gurung
- Centre for Implementation Science, King's College London, London UK; Transcultural Psychosocial Organization (TPO), Kathmandu Nepal
| | - Kassahun Habtamu
- Addis Ababa University, School of Psychology, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; WHO Collaborating Centre for Mental Health Research and Training, King's College London, London UK; Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Heim
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | - Claire Henderson
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | | | - Nadine Hosny
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | | | | | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington DC, USA
| | - Heidi Lempp
- Institute of Psychiatry, Psychology and Neuroscience, and Academic Department of Rheumatology, King's College London, London UK
| | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ning Ma
- Institute of Mental Health, Peking University, Beijing, China
| | - Winnie W S Mak
- Department of Psychology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, NSW, Australia
| | - Maria Milenova
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | | | - Uta Ouali
- Razi Hospital and El Manar Medical School, University of Tunis, La Manouba, Tunisia
| | - Sarah Parry
- South London and the Maudsley NHS Foundation Trust, London, UK
| | | | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Taha Sabri
- Taskeen Health Initiative, Karachi, Pakistan
| | - Norman Sartorius
- Association for the Improvement of Mental health Programs, Geneva, Switzerland
| | | | | | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | - Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London UK
| | - Nicole Votruba
- and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Petr Winkler
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
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Saguem BN, Ouanes S, Rhouma A, Nakhli J. Effectiveness of an educational program for reducing mental illness stigma targeting family medicine trainees in Tunisia: A quasi-experimental study. Appl Psychol Health Well Being 2022; 15:686-704. [PMID: 36178042 DOI: 10.1111/aphw.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/18/2022] [Indexed: 11/29/2022]
Abstract
Reducing stigma among mental health and health professionals has been an ultimate priority in many countries worldwide. This study aimed to evaluate the effectiveness of a four-session educational intervention for reducing stigma of mental illness targeting family medicine trainees in Tunisia. A quasi-experimental design was adopted with an intervention group (N = 51) and a control group (N = 56). Pre-intervention data were collected using an online survey. A four-session seminar series was implemented and organized. Post-intervention data were collected immediately after the end of the intervention then 2 months thereafter. Instruments included Attribution Questionnaire (AQ-27), Self-Determination Scale (SDS), Empowerment Scale (ES), and Recovery Scale (RS). Repeated measures analysis of covariance and multiple analysis of covariance tests were carried out. Results revealed that the intervention had moderate effects on the AQ-27 score and on six of its stigma factors including factors of the dangerousness model. The intervention improved SDS score, but not ES or RS scores. Positive effects were observed immediately after the intervention and 2 months thereafter. Regular implementation of educational programs in clinical practice would be beneficial. Developing other anti-stigma methods is needed to address the concepts of recovery and responsibility of patients with mental illness.
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Affiliation(s)
- Bochra Nourhène Saguem
- Research Laboratory LR12ES04, Farhat Hached Hospital, Department of Psychiatry, University of Sousse, Sousse, Tunisia
| | - Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Amal Rhouma
- Research Laboratory LR12ES04, Farhat Hached Hospital, Department of Psychiatry, University of Sousse, Sousse, Tunisia
| | - Jaâfar Nakhli
- Research Laboratory LR12ES04, Farhat Hached Hospital, Department of Psychiatry, University of Sousse, Sousse, Tunisia
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Ooi LQR, Chen J, Zhang S, Kong R, Tam A, Li J, Dhamala E, Zhou JH, Holmes AJ, Yeo BTT. Comparison of individualized behavioral predictions across anatomical, diffusion and functional connectivity MRI. Neuroimage 2022; 263:119636. [PMID: 36116616 DOI: 10.1016/j.neuroimage.2022.119636] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 10/31/2022] Open
Abstract
A fundamental goal across the neurosciences is the characterization of relationships linking brain anatomy, functioning, and behavior. Although various MRI modalities have been developed to probe these relationships, direct comparisons of their ability to predict behavior have been lacking. Here, we compared the ability of anatomical T1, diffusion and functional MRI (fMRI) to predict behavior at an individual level. Cortical thickness, area and volume were extracted from anatomical T1 images. Diffusion Tensor Imaging (DTI) and approximate Neurite Orientation Dispersion and Density Imaging (NODDI) models were fitted to the diffusion images. The resulting metrics were projected to the Tract-Based Spatial Statistics (TBSS) skeleton. We also ran probabilistic tractography for the diffusion images, from which we extracted the stream count, average stream length, and the average of each DTI and NODDI metric across tracts connecting each pair of brain regions. Functional connectivity (FC) was extracted from both task and resting-state fMRI. Individualized prediction of a wide range of behavioral measures were performed using kernel ridge regression, linear ridge regression and elastic net regression. Consistency of the results were investigated with the Human Connectome Project (HCP) and Adolescent Brain Cognitive Development (ABCD) datasets. In both datasets, FC-based models gave the best prediction performance, regardless of regression model or behavioral measure. This was especially true for the cognitive component. Furthermore, all modalities were able to predict cognition better than other behavioral components. Combining all modalities improved prediction of cognition, but not other behavioral components. Finally, across all behaviors, combining resting and task FC yielded prediction performance similar to combining all modalities. Overall, our study suggests that in the case of healthy children and young adults, behaviorally-relevant information in T1 and diffusion features might reflect a subset of the variance captured by FC.
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Affiliation(s)
- Leon Qi Rong Ooi
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore; Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore, Singapore
| | - Jianzhong Chen
- Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore, Singapore
| | - Shaoshi Zhang
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore; Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore, Singapore
| | - Ru Kong
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore; Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore, Singapore
| | - Angela Tam
- Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore, Singapore
| | - Jingwei Li
- Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Elvisha Dhamala
- Yale University, Departments of Psychology and Psychiatry, New Haven, CT, United States; Kavli Institute for Neuroscience, Yale University, New Haven, CT, United States
| | - Juan Helen Zhou
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore; Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Avram J Holmes
- Yale University, Departments of Psychology and Psychiatry, New Haven, CT, United States; Wu Tsai Institute, Yale University, New Haven, CT, United States
| | - B T Thomas Yeo
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore; Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore, Singapore.
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Walsh D, Foster J. Charting an Alternative Course for Mental Health-Related Anti-Stigma Social and Behaviour Change Programmes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10618. [PMID: 36078334 PMCID: PMC9518073 DOI: 10.3390/ijerph191710618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Mental health-related anti-stigma strategies are premised on the assumption that stigma is sustained by the public's deficiencies in abstract professional knowledge. In this paper, we critically assess this proposition and suggest new directions for research. Our analysis draws on three data sets: news reports (N = 529); focus groups (N = 20); interviews (N = 19). In each social context, we explored representations of mental health and illness in relation to students' shared living arrangements, a key group indicated for mental health-related anti-stigma efforts. We analysed the data using term-frequency inverse-document frequency (TF-IDF) models. Possible meanings indicated by TF-IDF modelling were interpreted using deep qualitative readings of verbatim quotations, as is standard in corpus-based research approaches to health and illness. These results evidence the flawed basis of dominant mental health-related anti-stigma campaigns. In contrast to deficiency models, we found that the public made sense of mental health and illness using dynamic and static epistemologies and often referenced professionalised understandings. Furthermore, rather than holding knowledge in the abstract, we also found public understanding to be functional to the social context. In addition, rather than being agnostic about mental health-related knowledge, we found public understandings are motivated by group-based identity-related concerns. We will argue that we need to develop alternative anti-stigma strategies rooted in the public's multiple contextualised sense-making strategies and highlight the potential of engaging with ecological approaches to stigma.
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Affiliation(s)
- Daniel Walsh
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK
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Hazell CM, Fixsen A, Berry C. Is it time to change the approach of mental health stigma campaigns? An experimental investigation of the effect of campaign wording on stigma and help-seeking intentions. PLoS One 2022; 17:e0273254. [PMID: 35980988 PMCID: PMC9387789 DOI: 10.1371/journal.pone.0273254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Mental health stigma causes a range of diverse and serious negative sequelae. Anti-stigma campaigns have largely aligned with medical theories and categorical approaches. Such campaigns have produced some improvements, but mental health stigma is still prevalent. The effect of alternative theoretical perspectives on mental health within anti-stigma campaigns has not been tested. Moreover, we do not know their effect on help-seeking intentions. Methods We conducted an online experimental pre-post study comparing the effects of two anti-stigma campaign posters on mental health stigma and help-seeking intentions. One poster adhered to the medical, categorical approach to mental health, whereas the other poster portrayed mental health problems in line with a non-categorical, continuous perspective. Results After controlling for familiarity with the campaign poster, country of residence and pre-test scores, we found no significant between-group differences in terms of help-seeking intentions and all stigma attitudes except for danger-related beliefs. That is, those who viewed the non-categorical poster reported an increased perception that people with mental health problems are dangerous. Discussion Our largely null findings may suggest the equivalence of these posters on stigma and help-seeking intentions but may also reflect the brevity of the intervention. Our findings concerning danger beliefs may reflect a Type I error, the complexities of stigma models, or the adverse effects of increased perceived contact. Further research is needed to test the effects of differing mental health paradigms on stigma and help-seeking intentions over a longer duration.
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Affiliation(s)
- Cassie M. Hazell
- School of Social Sciences, University of Westminster, London, United Kingdom
- * E-mail:
| | - Alison Fixsen
- School of Social Sciences, University of Westminster, London, United Kingdom
| | - Clio Berry
- Brighton and Sussex Medical School and School of Psychology, University of Sussex, Falmer, Brighton, United Kingdom
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Schomerus G, Leonhard A, Manthey J, Morris J, Neufeld M, Kilian C, Speerforck S, Winkler P, Corrigan PW. The stigma of alcohol-related liver disease and its impact on healthcare. J Hepatol 2022; 77:516-524. [PMID: 35526787 DOI: 10.1016/j.jhep.2022.04.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.
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Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany.
| | - Anya Leonhard
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Jakob Manthey
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - James Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - Maria Neufeld
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sven Speerforck
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Buckwitz V, Bommes JN, Hinshaw SP, Schomerus G. Continuum beliefs and the perception of similarities and differences to a person with depression. Compr Psychiatry 2022; 116:152314. [PMID: 35489309 DOI: 10.1016/j.comppsych.2022.152314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/21/2022] [Accepted: 04/09/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Both continuum beliefs (i.e., that mental disorder exists on a spectrum of normative behavior patterns) and the perception of similarities to a person with schizophrenia have shown mixed effects on reducing mental illness stigma. To our knowledge, this is the first study to address continuum beliefs and the perception of similarities to a person with depression in the context of depression-related stigma. METHODS This work is based on an online intervention study in an ethnically diverse sample recruited on Amazon MTurk including previously unanalyzed qualitive responses. Within this cross-sectional, mixed-methods online investigation (N = 304), we examined the relation of perceived similarities to continuum beliefs, social distance, and negative stereotypes in relation to a vignette about depression. A randomly assigned continuum beliefs intervention attempted to induce continuum beliefs about depression. An open-writing task asked participants to describe similarities and/or differences between themselves and the person depicted in the vignette. RESULTS The continuum beliefs intervention was associated to a greater number of perceived similarities to and fewer perceived differences from the target vignette. Moreover, perceived similarities were associated with increased continuum beliefs, less social distance, and less-negative stereotypes. Perceived differences from a person with depression were associated with increased social distance. LIMITATIONS Even though the continuum beliefs intervention did not significantly alter stigma measures directly, expressed continuum beliefs were associated to decreased mental illness stigma. CONCLUSIONS The findings emphasize that perceived similarities to an outgroup member (i.e., a person with depression) might augment the stigma-reducing mechanism of continuum beliefs.
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Affiliation(s)
- V Buckwitz
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany; Department of Psychology, University of California-Berkeley, Berkeley, USA.
| | - J N Bommes
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - S P Hinshaw
- Department of Psychology, University of California-Berkeley, Berkeley, USA; Department of Psychiatry and Behavioral Sciences, University of California-San Francisco, San Francisco, USA
| | - G Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
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Horwood G, Augoustinos M. 'It's more than sadness': The Discursive Construction of Depression on Australian Depression Websites. QUALITATIVE HEALTH RESEARCH 2022; 32:1185-1196. [PMID: 35583299 DOI: 10.1177/10497323221102240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Depression has been the subject of increased awareness and concern in Australia, but there has been little research into how depression is constructed on mental health websites, which have become a major resource for mental health information among the general public. In this study, critical discursive psychology was employed to analyse the informational content of eight major Australian mental health websites concerning depression. Four interpretative repertoires were identified - a biomedical, a self-optimization, a normal-natural and a societal-structural repertoire. The biomedical and self-optimization repertoires were the most prevalent, constructing depression as an illness within an individual occurring as a result of a biological or psychological deficit. Whilst previous studies have identified the predominance of a biomedical repertoire of depression on official websites, this study highlights the growing prominence of a self-optimization repertoire alongside the biomedical. Whilst it appeared that the aim of the websites was to challenge stigma and encourage help-seeking, it is argued that this way of understanding depression may have counter-productive effects in that the problem is located within the individual rather than with society, and individuals may be positioned as responsible for managing their own mental health, under the guidance of experts. The implications of understanding depression in this way, and not in alternative ways, are discussed.
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Affiliation(s)
- Grace Horwood
- School of Psychology, 1066University of Adelaide, Adelaide, SA, Australia
| | - Martha Augoustinos
- School of Psychology, 1066University of Adelaide, Adelaide, SA, Australia
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Sheehan L, Gaurean B, Corrigan PW. Debate: Stigma implications for diagnosing personality disorders in adolescents. Child Adolesc Ment Health 2022; 27:203-205. [PMID: 35293096 DOI: 10.1111/camh.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
Diagnosing personality disorders (PDs) in adolescence is a complex and often controversial decision. While early diagnosis provides a pathway to treatment, stigmatizing labels might unintentionally increase prejudice and discrimination for youth and their families, resulting in harm and treatment avoidance. In this paper, we outline stigma-related considerations for diagnosing PDs in adolescence, including types of stigma (public stigma, self-stigma, associative stigma) and moderators of stigma (continuum beliefs, biogenetic attributions, PD sub-diagnosis). Research indicates that PDs are among the most stigmatizing diagnoses in adults, particularly among healthcare providers. Experiences with stigma may differentially impact adolescents, who are undergoing rapid changes in identity development and profound influences from educational systems, peers, and social media. Youth who receive mental health services (especially those embedded in schools) worry about whether and how to talk about a diagnosis. However, adolescents with significant behavioral symptoms are often seen as different from their peers even prior to a formal diagnosis. Systematic efforts are needed to anticipate and mitigate stigma-related impacts on adolescents who might be diagnosed with PDs.
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