“Why am I like this?” Consumers discuss their causal beliefs and stigma

Examining illness perceptions over time: an exploratory prospective analysis of causal attributions in individuals with depressive symptoms

BACKGROUND

According to the Common-Sense Model of Illness Representations, illness beliefs, such as causal attributions, can influence the way people assess and cope with their illness and vice versa. To date, causal attributions in people with depressive symptoms have been studied mainly cross-sectionally, quantitatively and independently. The purpose of this study is to examine the causal attributions of people with depressive symptoms in terms of their stability over time, dependence on treatment experience, and differentiation of causal concepts.

METHODS

In a population-based prospective sample, people with at least mild depressive symptoms (PHQ-9 Score ≥ 5) were interviewed via telephone at T0 and twelve months later (T1). Causal attributions were assessed using the Brief Illness Perception Questionnaire. After the open responses were qualitatively analysed using a deductive-inductive approach, stability over time was assessed for causal attributions and concepts by comparing answers between the two time points. Subsequent exploratory quantitative analyses were conducted using chi-square tests, t-tests, and logistic regression analyses.

RESULTS

A total of 471 individuals (age M = 53.9, 53.6% female) with a mean PHQ-9 Score of 8.4 were included in the analyses. Causal attributions related to participants' social environment, workplace, and past are the most stable over time. However, individuals with and without a time-stable causal concept showed no differences in terms of sociodemographic characteristics, severity of depressive symptoms, risk of comorbidity, and treatment experiences. Overall, the causal concepts of people with depressive symptoms appear to be very diverse. Those with treatment experience (M = 2.21, SD = 0.80) named significantly more causal attributions compared to people without treatment experience (M = 1.98, SD = 0.81, t(471) = -3.060, p < 0.01). In addition, logistic regression analyses revealed that treatment-experienced respondents were more likely to attribute "childhood/youth/parental home" and "predisposition".

CONCLUSIONS

Our study reveals that people with treatment experience tend to report treatment-congruent causal attributions, such as childhood and family environment, as well as predisposition, more frequently. Understanding how causal attributions and concepts are formed and change can be helpful for addressing causal attributions in treatment. Future studies should take into account the benefits of employing qualitative survey methods for exploring causal attributions.

Consumer attitudes and preferences toward psychiatric genetic counselling and educational resources: A scoping review

INTRODUCTION

The etiology of psychiatric disorders is multifactorial including genomic and environmental risk factors. Psychiatric genetic counseling is an emerging field that may promote processes of adaptation to, and the management of, psychiatric disorders. Many countries lack dedicated services leading to a gap in care. This scoping review will inform the development of psychiatric genetics-based educational resources.

OBJECTIVES

To explore individuals with a psychiatric disorder and their relatives' attitudes and beliefs toward psychiatric genetics, genetic counseling, and genetics-based education. To evaluate how best to convey education to consumers.

METHOD

Database literature searches occurred on May 2nd, 2023, using PubMed, Medline, and PsycINFO. Reviews, letters to the editor, case reports, and publications before 2003 were excluded.

RESULTS

Twenty-four papers met the inclusion criteria. Results suggest individuals with a psychiatric disorder and their relatives tended to overestimate risk, and express concern about reproductive decision- making. Genetic counseling and educational resources were perceived to be useful and empowering.

CONCLUSION

Affected individuals and relatives are interested in gaining greater insight into their own and/or their relative's psychiatric disorder, management strategies, and understanding familial risks.

PRACTICE IMPLICATIONS

The evidence from this review may inform the development of genetics-based educational resources or guide future research.

Anxiety Disorders: The Relationship between Insight and Metacognition

BACKGROUND

The exploration of metacognition in relation to anxiety has received considerable attention in recent decades. Research indicates that it plays a role in the development and maintenance of anxiety disorders while also providing benefits, including the ability to assess situations, modify behaviors, and make informed decisions.

SUMMARY

We propose that having an awareness of a disorder, also known as insight, is related to metacognition in anxiety. This relationship stems from the ability it provides individuals to recognize their mental state through reflection on personal experiences. We discuss the impact of insight and metacognition on decision-making, treatment-seeking behaviors, and coping strategy selection.

KEY MESSAGES

Understanding the concept of insight in anxiety disorders, as compared to other mental disorders like psychosis, requires exploring its complexities while carefully considering the balance of harms and benefits. While the medicalization of symptoms in psychosis is widely regarded as clearly beneficial, evaluating the role of insight in anxiety disorders demands a more nuanced understanding. Gaining a fuller perspective on patients' beliefs can impact their behaviors and decision-making. Clinicians can achieve this by encouraging active self-reflection to increase awareness, which includes evaluating both severity and impact on daily functioning. This also involves expressing experiences and exploring attributions of anxiety. This practical approach enables clinicians to understand engagement and treatment-seeking behaviors, allowing them to tailor treatment plans and develop effective coping and management strategies. Ultimately, this knowledge promotes a deeper comprehension of insight into anxiety disorders.

Explanatory models of mental illness among working professionals diagnosed with bipolar or depression in the United States

BACKGROUND

People diagnosed with mental illness develop a variety of explanatory models of their conditions in the face of uncertainty. Explanatory models matter because they are associated with internalized stigma and illness behaviors such as treatment preferences.

AIMS

This paper explores how working professionals in the United States draw on biological and/or environmental factors to explain the cause(s) of their diagnoses of bipolar or depression.

METHOD

Findings are derived from an analysis of transcripts of in-depth interviews with 52 individuals from across the United States who were invited to participate in a study of working professionals diagnosed with mental illness. About 25 self-identified as having bipolar disorder and 27 as having major depression. Transcript data were analyzed following the principles of flexible coding with the goal of establishing a typology of explanatory models of self-identified bipolar versus depression.

RESULTS

Six types of explanatory models emerged from the analysis. One was exclusively biological, a second was exclusively environmental, and the remaining four combined biological and environmental factors in different ways. Quotations from the interviews are provided to illustrate each type, and comparisons between types are made based on primary diagnosis (bipolar vs. depression), and self-reports of trauma and stressful experiences.

CONCLUSION

Implications for the future research on explanatory models and how they may impact people who are diagnosed with a mental illness across multiple dimensions of their lives are presented.

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

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

Subjective experience of the origin and development of avoidant personality disorder

OBJECTIVE

To better understand how persons diagnosed with avoidant personality disorder (AVPD) make sense of the origin and development of their current everyday struggles.

METHODS

Persons with AVPD (N = 15) were interviewed twice using semi-structured qualitative interviews, which were analyzed through interpretative-phenomenological analysis. Persons with the first-hand experience of AVPD were included in the research.

RESULTS

The superordinate theme, "a story of becoming forlorn," encompassed three main themes: "it goes all the way back to when I was little," "there was a distance between others and me," and "transitions made it worse."

CONCLUSIONS

Though the results are not necessarily specific to AVPD, the findings clarify how people with AVPD can make sense of their current struggles by constructing developmental life stories in the interplay between themselves as persons and the growing demands of their social world. Furthermore, childhood relational vulnerabilities may challenge the ongoing development of social cognition and skills.

"The Less I Think About It, the Better I Feel": A Thematic Analysis of the Subjective Experience of Malignant Mesothelioma Patients and Their Caregivers

Aim: A cancer diagnosis-and in particular a Malignant Mesothelioma (MM) one-breaks the somatopsychic balance of the individual, compromising the quality of residual life and giving rise to many negative emotions difficult to integrate and to elaborate (such as depression, fears, anxieties, hopelessness, guilt, shame, and rage). Several national and international guidelines acknowledged the importance of evaluating psychological and socio-relational features in MM patients and their caregiver. However, only few studies have investigated the subjective experience of MM patients and even less research has focused on the caregivers' experience. Thus, the aim of the present study is to investigate the lived experience of both MM patients and their caregivers, providing an in-depth comprehension of the psychological sequelae of the disease. Materials and Methods: Within a psychoanalytically-informed conceptual framework, open-ended interviews were conducted with 10 MM patients and 9 caregivers. Thematic analysis was employed: interviews were audio-recorded, transcribed verbatim, and coded in order to identify the main recurring themes across the narratives. Results: We detected four different themes: (1) bodily symptoms and embodied emotions; (2) living in or near a National Priority Contaminated Site (NCPS); (3) "nothing is like it was" (that is, the impact of the diagnosis on everyday life, the changes it causes in the family relationships, the things that are still possible to do, the mourning process); (4) "what will become of us?" (that is, worries about the impact of the diagnosis on the beloved ones, death and legacy). Discussion: MM patients and caregivers seem to be stuck in a concrete mental functioning focused on symptoms and they find it difficult to openly think and talk about the affective and emotional consequences of the diagnosis. Alongside this, they express the need to find new and less conflictual ways to stay together and talk to each other during the period of active treatments for the illness (i.e., chemotherapy, radiotherapy, etc) and the end-of-life. The results of this study have important implications for the clinical management of MM and can help develop multi-professional specialist interventions addressed to both patients and caregivers.

"It's often liberating": consumers discuss causal beliefs in the treatment process

Background: Causal beliefs are thought to influence consumers' perceptions of their mental illness and self-stigma, and may impact treatment and recovery. Understanding consumers' perspective on causes being addressed in treatment is vital to help guide future research and improve services. Aim: This study aimed to explore consumers' views on causes of mental illness being addressed in treatment, along with their subjective experiences of how causes were focused on in their treatment. Methods: Using a qualitative approach, semi-structured interviews were conducted with 23 consumers who self-identified as having a mental illness. A thematic analytic framework was used to identify and analyse themes that emerged within the data. Results: Consumers believed that causes were important and should be addressed in treatment, and identified several associated benefits including increased insight/personal understanding of their illness, symptom management and relapse prevention and reduced self-blame. Negative consequences and considerations were also identified. Conclusion: Causes help consumers make sense of their illness, and consumers would like causes to be addressed in treatment. More research is needed on how mental health professionals can address causes effectively as consumers are currently dissatisfied with how causes were discussed in their treatment.