1
|
Walsh D, Foster J. Understanding the public stigma of mental illness: a mixed-methods, multi-level, exploratory triangulation study. BMC Psychol 2024; 12:403. [PMID: 39033289 PMCID: PMC11265057 DOI: 10.1186/s40359-024-01887-3] [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: 01/22/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND This study examines the role of themata in understanding mental health-related stigma. It is motivated by the need for alternative theoretical-methodological approaches beyond the dominant frameworks in education and contact-based anti-stigma public health efforts, which have shown mixed effects. Specifically, it addresses the need for a more nuanced framework in stigma research, one that is sensitive to the dialogues through which people relate themselves to mental health and stigma in context. METHODS The research employs an exploratory mixed-methods approach, including the analysis of 529 news reports, 20 focus group discussions, and 19 one-to-one interviews, all concerning representations of shared living arrangements with someone perceived to have experiences of mental illness. Thematic analysis and natural language processing are used within a convergent triangulation design to analyze the data. RESULTS We found that mental health and illness were communicated through an overarching Self/Other thema and five subordinate themata: normal/abnormal, harm/non-harm, bounded/non-bounded, and moral/immoral. Despite familiarity with psychological distress and 'modern' explanations of mental illness, concerns about social identity motivated representations of mental illness as a predominantly permanent, negative form of personhood marked by abnormality, harm, distance, and immorality. Additionally, concerns about personal vulnerability, including historically rooted fears of contagion, motivated distancing representations of mental illness, rather than neutral portrayals. CONCLUSIONS Themata have under-developed theoretical and methodological potential for addressing mental health-related stigma, particularly in their ability to describe the dynamic ways in which culture motivates people to both resist and reproduce stigma, partly through ambivalences, absences, tensions, and ambiguities in representation. A critical discussion is provided on how themata may support ecological strategies in mental health campaigns over generic models, emphasizing the need to understand group knowledge and contact dynamics to mitigate adverse effects. Themata Public Health Unintended Consequences Mixed Methods Behaviour Change Natural Language Processing.
Collapse
Affiliation(s)
- Daniel Walsh
- Grenoble Alpes University, Bureau 49 Sciences Po/ Pacte, Grenoble, 38040, France.
| | - Juliet Foster
- King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
| |
Collapse
|
2
|
Amberson T, Heagele T, Wyte-Lake T, Couig MP, Bell SA, Mammen MJ, Wells V, Castner J. Social support, educational, and behavioral modification interventions for improving household disaster preparedness in the general community-dwelling population: a systematic review and meta-analysis. Front Public Health 2024; 11:1257714. [PMID: 38596429 PMCID: PMC11003604 DOI: 10.3389/fpubh.2023.1257714] [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] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/22/2023] [Indexed: 04/11/2024] Open
Abstract
Background The efficacy of household emergency preparedness interventions for community-dwelling, non-institutionalized people is largely unknown. Objective To ascertain the state of the science on social support, educational, and behavioral modification interventions to improve all-hazard household disaster preparedness. Design Systematic review and meta-analysis. Methods Databases, trial registers, reports, and websites were searched, and citation trails followed utilizing replicable methods. Individual, cluster, and cross-over randomized controlled trials of non-institutionalized, community-dwelling populations and non-randomized controlled trials, controlled before-after, and program evaluation studies were included. At least two review authors independently screened each potentially relevant study for inclusion, extracted data, and assessed the risk of bias. Risk of bias was assessed using Cochrane's RoB2 tool for randomized studies and ROBINS-I tool for nonrandomized studies. Meta-analyses were applied using a random-effects model. Where meta-analysis was not indicated, results were synthesized using summary statistics of intervention effect estimates and vote counting based on effect direction. The evidence was rated using GRADE. Results 17 studies were included with substantial methodological and clinical diversity. No intervention effect was observed for preparedness supplies (OR = 6.12, 95% 0.13 to 284.37) or knowledge (SMD = 0.96, 95% CI -0.15 to 2.08) outcomes. A small positive effect (SMD = 0.53, 95% CI 0.16 to 0.91) was observed for preparedness behaviors, with very low certainty of evidence. No studies reported adverse effects from the interventions. Conclusion Research designs elucidating the efficacy of practical yet complex and multi- faceted social support, educational, and behavioral modification interventions present substantial methodological challenges where rigorous study design elements may not match the contextual public health priority needs and resources where interventions were delivered. While the overall strength of the evidence was evaluated as low to very low, we acknowledge the valuable and informative work of the included studies. The research represents the seminal work in this field and provides an important foundation for the state of the science of household emergency preparedness intervention effectiveness and efficacy. The findings are relevant to disaster preparedness practice and research, and we encourage researchers to continue this line of research, using these studies and this review to inform ongoing improvements in study designs.
Collapse
Affiliation(s)
- Taryn Amberson
- Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Tara Heagele
- Hunter-Bellevue School of Nursing, Hunter College, The City University of New York, New York City, NY, United States
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center, Los Angeles, CA, United States
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Mary Pat Couig
- College of Nursing, University of New Mexico, Albuquerque, NM, United States
| | - Sue Anne Bell
- University of Michigan, Ann Arbor, MI, United States
| | | | - Valerie Wells
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Jessica Castner
- Castner Incorporated, Grand Island, NY, United States
- University at Albany School of Public Health, Albany, NY, United States
| |
Collapse
|
3
|
Wu J, Yang S, Wang W, Jaeger C. How effective are community-based disaster reduction strategies? Evidence from the largest-scale program so far. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:1667-1681. [PMID: 36347524 DOI: 10.1111/risa.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/27/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Strategies of community-based disaster risk reduction have been advocated for more than 2 decades. However, we still lack in-depth quantitative assessments of the effectiveness of such strategies. Our research is based on a national experiment in this domain: the "Comprehensive Disaster Reduction Demonstration Community" project, a governmental program running in China since 2007. Information on more than 11,000 demonstration communities was collected. Combined with the local disaster information and socioeconomic conditions, the spatiotemporal characteristics of these communities over 12 years and their differences in performance by region and income group were analyzed. We performed an attribution analysis for disaster risk reduction effectiveness. This is the first time a series of quantitative evaluation methods have been applied to verify the effectiveness of a large-scale community-based disaster risk reduction project, both from the perspective of demonstrative effects and loss reduction benefits. Here, we find that the project is obviously effective from these two perspectives, and the disaster loss reduction effectiveness illustrates clear regional differences, where the regional economic level and hazard severity act as important drivers. Significant differences of urban-rural and income call for matching fortification measures, and the dynamic management of demonstration community size is required, since the loss reduction benefit converges when the penetration rate of the demonstration community reaches approximately 4% in a province. These and further results provide diverse implications for community-based disaster risk reduction policies and practices.
Collapse
Affiliation(s)
- Jingyan Wu
- Key Laboratory of Environmental Change and Natural Disaster of Ministry of Education, Beijing Normal University, Beijing, China
- Academy of Disaster Reduction and Emergency Management, Faculty of Geographical Science, Beijing Normal University, Beijing, China
| | - Saini Yang
- Key Laboratory of Environmental Change and Natural Disaster of Ministry of Education, Beijing Normal University, Beijing, China
- Academy of Disaster Reduction and Emergency Management, Faculty of Geographical Science, Beijing Normal University, Beijing, China
- School of National Safety and Emergency Management, Beijing Normal University, Beijing, China
| | - Weiping Wang
- School of National Safety and Emergency Management, Beijing Normal University, Beijing, China
| | - Carlo Jaeger
- Global Futures Laboratory, Arizona State University, Tempe, Arizona, USA
- Global Climate Forum, Berlin, Germany
| |
Collapse
|
4
|
Sun L, Qi W. Tibetan Buddhist belief and disaster resilience: a qualitative exploration of the Yushu area, China. DISASTERS 2023; 47:788-805. [PMID: 36082482 DOI: 10.1111/disa.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The role of religious belief in disasters has attracted increased scholarly interest in recent years. This paper shows that religious belief can generate disaster resilience through the pathways of disaster framing, mental health, and disaster behaviours. Drawing on interviews conducted with Tibetan Buddhist believers in the Yushu earthquake area of China, this study indicates that notions of Tibetan Buddhism, as well as religious practices, helped locals to make sense of the 2010 event, obtain spiritual support in its aftermath, foster a sense of community, and develop a prosocial post-earthquake environment. These religious notions and practices also assisted in sustaining a faith-based network composed of two kinds of important local social relationships, layperson-layperson and layperson-monk, which increased local disaster resilience at the level of response behaviour. The findings enrich our understanding of the religious source of disaster resilience and yield insights into disaster risk reduction in religious regions, especially where Buddhist belief is prevalent.
Collapse
Affiliation(s)
- Lei Sun
- Assistant Professor, School of International Relations and Public Affairs, Fudan University, China
| | - Wenhua Qi
- Associate Professor, Institute of Geology, China Earthquake Administration, China
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Daniel Walsh
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK
| | | |
Collapse
|
6
|
Walsh D, Foster J. Where does research design fall short? Mental health related‐stigma as example. JOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR 2022. [DOI: 10.1111/jtsb.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel Walsh
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Juliet Foster
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| |
Collapse
|
7
|
Liu X, Sun L. Examining the impact of fatalism belief and optimism orientation on seismic preparedness: Considering their roles in the nexus between risk perception and preparedness. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2021. [DOI: 10.1111/1468-5973.12383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Xingyu Liu
- School of Public Policy and Management Tsinghua University Beijing PR China
| | - Lei Sun
- School of International Relations and Public Affairs Fudan University Shanghai PR China
| |
Collapse
|
8
|
Amberson T, Heagele T, Castner J, Wyte-Lake T, Couig MP, Bell SA, Mammen MJ, Wells V. Social support, educational, and behavioral modification interventions for improving household disaster preparedness in the general community-dwelling population. Hippokratia 2021. [DOI: 10.1002/14651858.cd014934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Tara Heagele
- Hunter-Bellevue School of Nursing, Hunter College; The City University of New York; New York New York USA
| | - Jessica Castner
- Castner Incorporated; Grand Island New York USA
- Journal of Emergency Nursing; Grand Island New York USA
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center; Los Angeles California USA
- Department of Family Medicine; Oregon Health & Science University; Portland Oregon USA
| | - Mary Pat Couig
- College of Nursing; University of New Mexico; Albuquerque New Mexico USA
| | | | - Manoj J Mammen
- State University of New York at Buffalo; Buffalo New York USA
| | - Valerie Wells
- MRC/CSO Social and Public Health Sciences Unit; University of Glasgow; Glasgow UK
| |
Collapse
|
9
|
Walsh DAB, Foster JLH. A Call to Action. A Critical Review of Mental Health Related Anti-stigma Campaigns. Front Public Health 2021; 8:569539. [PMID: 33490010 PMCID: PMC7820374 DOI: 10.3389/fpubh.2020.569539] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Using a knowledge-attitudes-behavior practice (KABP) paradigm, professionals have focused on educating the public in biomedical explanations of mental illness. Especially in high-income countries, it is now common for education-based campaigns to also include some form of social contact and to be tailored to key groups. However, and despite over 20 years of high-profile national campaigns (e.g., Time to Change in England; Beyond Blue in Australia), examinations suggest that the public continue to Other those with experiences of mental ill-health. Furthermore, evaluations of anti-stigma programs are found to have weak- to no significant long-term effects, and serious concerns have been raised over their possible unintended consequences. Accordingly, this article critically re-engages with the literature. We evidence that there have been systematic issues in problem conceptualization. Namely, the KABP paradigm does not respond to the multiple forms of knowledge embodied in every life, often outside conscious awareness. Furthermore, we highlight how a singular focus on addressing the public's perceived deficits in professionalized forms of knowledge has sustained public practices which divide between "us" and "them." In addition, we show that practitioners have not fully appreciated the social processes which Other individuals with experiences of mental illness, nor how these processes motivate the public to maintain distance from those perceived to embody this devalued form of social identity. Lastly, we suggest methodological tools which would allow public health professionals to fully explore these identity-related social processes. Whilst some readers may be frustrated by the lack of clear solutions provided in this paper, given the serious unintended consequences of anti-stigma campaigns, we caution against making simplified statements on how to correct public health campaigns. Instead, this review should be seen as a call to action. We hope that by fully exploring these processes, we can develop new interventions rooted in the ways the public make sense of mental health and illness.
Collapse
|
10
|
Massazza A, Brewin CR, Joffe H. Feelings, Thoughts, and Behaviors During Disaster. QUALITATIVE HEALTH RESEARCH 2021; 31:323-337. [PMID: 33228498 PMCID: PMC7753093 DOI: 10.1177/1049732320968791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Thoughts, feelings, and behaviors during traumatic events, that is, peritraumatic reactions, are key to post-trauma psychopathology development. Qualitative research is required to investigate whether existing quantitative methods capture the range and complexity of peritraumatic reactions as described by survivors. Semi-structured interviews were conducted with 104 earthquake survivors. Participants reported experiencing various peritraumatic reactions (M = 21, range = 6-43). The survivors' accounts confirmed presence and overall phenomenological characteristics of commonly studied peritraumatic reactions such as dissociation, distress, mental defeat, and immobility. In addition, novel and understudied reactions were identified: cognitive overload, hyperfocus, and emotion regulation, as well as positive affect. Finally, a number of cross-cutting phenomena were identified such as the social nature of many reactions and survivors evaluating their reactions as difficult to put into words. These findings have implications for the conceptualization of peritraumatic reactions, for trauma-focused psychotherapeutic interventions, and for the wellbeing of disaster survivors.
Collapse
Affiliation(s)
- Alessandro Massazza
- Research Department of Clinical,
Educational and Health Psychology, University College London, London, United
Kingdom
| | - Chris R. Brewin
- Research Department of Clinical,
Educational and Health Psychology, University College London, London, United
Kingdom
| | - Helene Joffe
- Research Department of Clinical,
Educational and Health Psychology, University College London, London, United
Kingdom
| |
Collapse
|
11
|
Sun L, Xue L. Does non‐destructive earthquake experience affect risk perception and motivate preparedness? JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2020. [DOI: 10.1111/1468-5973.12286] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lei Sun
- Center for Crisis Management Research (CCMR) School of Public Policy and Management Tsinghua University Beijing China
| | - Lan Xue
- Center for Crisis Management Research (CCMR) School of Public Policy and Management Tsinghua University Beijing China
| |
Collapse
|