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Kontos P, Grigorovich A, Dupuis SL, Colobong R, Gray J, Jonas-Simpson C, Serota A. Projecting a Critique of Stigma Associated With Dementia on Screen: The Impact of a Canadian Film on the Importance of Relational Caring in the Community. THE GERONTOLOGIST 2024; 64:gnad045. [PMID: 37067944 DOI: 10.1093/geront/gnad045] [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: 09/06/2022] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Relational caring has the capacity to reduce stigma associated with dementia by shifting the focus from dysfunction and behavior management, to attending to the interdependencies and reciprocities that underpin caring relationships, and making explicit the centrality of relationships to quality care, growth, and quality of life. Education, particularly arts-based approaches, has been identified as a key strategy to decrease stigma. Yet rarely are the arts utilized in educational initiatives, and particularly so in community care settings. With an interest in redressing this, our team evaluated the impact of a Canadian filmed research-based drama-Cracked: new light on dementia-about stigma associated with people living with dementia and their families. RESEARCH DESIGN AND METHODS We conducted interviews with family carers of people living with dementia and formal care providers affiliated with community-based dementia care, and also the general public at 3 and 8 months postscreening. RESULTS Our analysis of participants' perceptions/experiences illustrates the effectiveness of Cracked in reducing stigma by demonstrating changes in the understanding of dementia and changes in practice. Our analysis also includes attention to how the film, as a form of cultural production, deepened engagement and facilitated transformation. DISCUSSION AND IMPLICATIONS Our evaluation of Cracked demonstrates that it is an effective strategy for decreasing the stigma associated with dementia by promoting relational caring. It also importantly contributes to the theoretical literature that supports film-based approaches to stigma reduction.
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Affiliation(s)
- Pia Kontos
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alisa Grigorovich
- Department of Recreation and Leisure Studies, Recreation and Leisure Studies, Brock University, St. Catharines, Ontario, Canada
| | - Sherry L Dupuis
- Department of Recreation and Leisure Studies, Recreation and Leisure Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Romeo Colobong
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Julia Gray
- Department of Health and Society, University of Toronto-Scarborough, Scarborough, Ontario, Canada
| | | | - Alexine Serota
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Shi XL, Li LY, Fan ZG. Psychiatrists’ occupational stigma conceptualization, measurement, and intervention: A literature review. World J Psychiatry 2023; 13:298-318. [PMID: 37383285 PMCID: PMC10294130 DOI: 10.5498/wjp.v13.i6.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/19/2023] Open
Abstract
Psychiatrists require frequent contact with and treatment of patients with mental illnesses. Due to the influence of associative stigma, psychiatrists may also be targets of stigma. Occupational stigma warrants special consideration because it significantly affects psychiatrists' career advancement, well-being, and their patients’ health. Given that there is no complete summary of this issue, this study reviewed the existing literature on psychiatrists' occupational stigma to clearly synthesize its concepts, measurement tools, and intervention strategies. Herein, we emphasize that psychiatrists’ occupational stigma is a multifaceted concept that simultaneously encompasses physically, socially, and morally tainted aspects. Currently, standardized methods to specifically measure psychiatrists’ occupational stigma are lacking. Interventions for psychiatrists’ occupational stigma may consider the use of protest, contact, education, comprehensive and systematic methods, as well as the use of psychotherapeutic approaches. This review provides a theoretical basis for the development of relevant measurement tools and intervention practices. Overall, this review seeks to raise public awareness of psychiatrists' occupational stigma, thereby promoting psychiatric professionalism and reducing its stigma.
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Affiliation(s)
- Xiao-Li Shi
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Lu-Yao Li
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Zhi-Guang Fan
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
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Latifian M, Abdi K, Raheb G, Islam SMS, Alikhani R. Stigma in people living with bipolar disorder and their families: a systematic review. Int J Bipolar Disord 2023; 11:9. [PMID: 36805368 PMCID: PMC9941403 DOI: 10.1186/s40345-023-00290-y] [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: 01/03/2023] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Stigma affects different life aspects in people living with bipolar disorder and their families. This study aimed to examining the experience of stigma and evaluating predictors, consequences and strategies to combat stigma in people with bipolar disorder and their families. METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) in 2022. We extensively reviewed six online databases (PubMed, Scopus, Medline, EMBASE, Web of Science and Google Scholar). Articles published in the English language about stigma in people living with bipolar disorders and their families were included. RESULTS A total of 42,763 articles were retrieved, of which 40 articles from 14 countries were included in this study (n = 7417 participants). Of the 40 articles, 29 adopted quantitative methods (72.5%), two used mixed-methods (5%), eight used qualitative (20%) methods, and one was a case series (2.5%). The results of the studies were categorized into four themes: 1. Stigma experienced by people living with bipolar disorders and their families, 2. Predictors of stigma in people living with bipolar disorders and their families, 3. Consequences of stigma in people living with bipolar disorders and their families, 4. Effective interventions and strategies to reduce stigma in people living with bipolar disorders and their families. CONCLUSION The results of this study might be useful to design psychiatric cognitive interventions to reduce stigma in people living with bipolar disorders and their families and designing community-based interventions to normalize bipolar disorder at the community level.
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Affiliation(s)
- Maryam Latifian
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kianoush Abdi
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Ghoncheh Raheb
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sheikh Mohammed Shariful Islam
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Rosa Alikhani
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Khodabakhshi-Koolaee A, Manoochehri M. Improving resilience in mothers with schizophrenic sons: A group movie analysis. Int J Soc Psychiatry 2023; 69:63-69. [PMID: 34962176 DOI: 10.1177/00207640211067677] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have demonstrated the positive effects of film screening for raising awareness and improving treatment in various clinical groups. This study not only focused on film screening but also paid special attention to pre-screening group analysis to explore the effectiveness of group movie analysis on mothers with schizophrenic sons. METHODS The present study was conducted using a quasi-experimental design with pre-test and post-test and a control group. The research population included all mothers with schizophrenic sons who had enrolled in the Iranian Society Supporting Individuals with Schizophrenia in Tehran in 2021. The participants were 30 mothers with schizophrenic sons who were selected based on the inclusion criteria and were randomly assigned to intervention and control groups. The participants in the intervention group attended 12 film therapy analysis sessions (one session per week). The data were collected using the Connor-Davidson Resilience Scale (CD-RISC). Statistical analyses were performed using the analysis of covariance (ANCOVA). RESULTS The results showed a significant difference between the mean scores of resilience for the participants before (M = 28.89) and after the film therapy analysis intervention (M = 52.56, F = 6.15, p = .0001). CONCLUSION Film therapy analysis was effective in improving the resilience of mothers with schizophrenic sons. It seems that movie screening with the group analysis afterward contributed to sharing the experiences of caring for the sick child and creating a sense of empathy in mothers. Thus, group movie analysis can be used as a suitable option to reduce the psychological distress of mothers with schizophrenic sons and improve their quality of life.
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Affiliation(s)
| | - Mina Manoochehri
- Department of Psychology & Educational Sciences, Faculty of Humanities, Khatam University, Tehran, Iran
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5
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Zhuang J, Guidry A. Does Storytelling Reduce Stigma? A Meta-Analytic View of Narrative Persuasion on Stigma Reduction. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2022. [DOI: 10.1080/01973533.2022.2039657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
| | - Ashley Guidry
- The University of Texas at Austin, Moody College of Communication
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6
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Educational Programs and Teaching Strategies for Health Professionals Responding to Women With Complex Perinatal Mental Health and Psychosocial Concerns. A Scoping Review. Nurse Educ Pract 2022; 60:103319. [DOI: 10.1016/j.nepr.2022.103319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022]
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Carrara BS, Fernandes RHH, Bobbili SJ, Ventura CAA. Health care providers and people with mental illness: An integrative review on anti-stigma interventions. Int J Soc Psychiatry 2021; 67:840-853. [PMID: 33380251 DOI: 10.1177/0020764020985891] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health care providers are an important target group for anti-stigma interventions because they have the potential to convey stigmatizing attitudes towards people with mental illness. This can have a detrimental impact on the quality and effectiveness of care provided to those affected by mental illness. AIMS AND METHODS Whittemore & Knafl's integrative review method (2005) was used to analyze 16 studies investigating anti-stigma interventions targeting health care providers. RESULTS The interventions predominantly involved contact-based educational approaches which ranged from training on mental health (typically short-term), showing videos or films (indirect social contact) to involving people with lived experiences of mental illness (direct social contact). A few studies focused on interventions involving educational strategies without social contact, such as mental health training (courses/modules), distance learning via the Internet, lectures, discussion groups, and simulations. One study investigated an online anti-stigma awareness-raising campaign that aimed to reduce stigmatizing attitudes among health care providers. CONCLUSION Anti-stigma interventions that involve social contact between health care providers and people with mental illness, target specific mental illnesses and include long-term follow-up strategies seem to be the most promising at reducing stigma towards mental illness among health care providers.
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Affiliation(s)
- Bruna Sordi Carrara
- PAHO/WHO Collaborating Center for Nursing Research Development, University of Sao Paulo at Ribeirao Preto College Nursing, Brazil
| | | | - Sireesha Jennifer Bobbili
- University of Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Carla Aparecida Arena Ventura
- PAHO/WHO Collaborating Center for Nursing Research Development, University of Sao Paulo at Ribeirao Preto College Nursing, Brazil
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Gaiha SM, Salisbury TT, Usmani S, Koschorke M, Raman U, Petticrew M. Effectiveness of arts interventions to reduce mental-health-related stigma among youth: a systematic review and meta-analysis. BMC Psychiatry 2021; 21:364. [PMID: 34294067 PMCID: PMC8296649 DOI: 10.1186/s12888-021-03350-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Educational interventions engage youth using visual, literary and performing arts to combat stigma associated with mental health problems. However, it remains unknown whether arts interventions are effective in reducing mental-health-related stigma among youth and if so, then which specific art forms, duration and stigma-related components in content are successful. METHODS We searched 13 databases, including PubMed, Medline, Global Health, EMBASE, ADOLEC, Social Policy and Practice, Database of Promoting Health Effectiveness Reviews (DoPHER), Trials Register of Promoting Health Interventions (TRoPHI), EPPI-Centre database of health promotion research (Bibliomap), Web of Science, PsycINFO, Cochrane and Scopus for studies involving arts interventions aimed at reducing any or all components of mental-health-related stigma among youth (10-24-year-olds). Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Data were extracted into tables and analysed using RevMan 5.3.5. RESULTS Fifty-seven studies met our inclusion criteria (n = 41,621). Interventions using multiple art forms are effective in improving behaviour towards people with mental health problems to a small effect (effect size = 0.28, 95%CI 0.08-0.48; p = 0.007) No studies reported negative outcomes or unintended harms. Among studies using specific art forms, we observed high heterogeneity among intervention studies using theatre, multiple art forms, film and role play. Data in this review are inconclusive about the use of single versus multiple sessions and whether including all stigma components of knowledge, attitude and behaviour as intervention content are more effective relative to studies focused on these stigma components, individually. Common challenges faced by school-based arts interventions included lack of buy-in from school administrators and low engagement. No studies were reported from low- and middle-income countries. CONCLUSION Arts interventions are effective in reducing mental-health-related stigma to a small effect. Interventions that employ multiple art forms together compared to studies employing film, theatre or role play are likely more effective in reducing mental-health-related stigma.
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Affiliation(s)
- Shivani Mathur Gaiha
- Indian Institute of Public Health- Hyderabad, Public Health Foundation of India, Hyderabad, India. .,Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. .,Department of Pediatrics, Division of Adolescent Medicine, Stanford School of Medicine, Stanford University, Palo Alto, USA.
| | - Tatiana Taylor Salisbury
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Shamaila Usmani
- grid.8991.90000 0004 0425 469XCentre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirja Koschorke
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Usha Raman
- grid.18048.350000 0000 9951 5557Department of Communication, Sarojini Naidu School of Arts & Communication, University of Hyderabad, Hyderabad, India
| | - Mark Petticrew
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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9
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Van Alboom M, De Ruddere L, Kindt S, Loeys T, Van Ryckeghem D, Bracke P, Mittinty MM, Goubert L. Well-being and Perceived Stigma in Individuals With Rheumatoid Arthritis and Fibromyalgia: A Daily Diary Study. Clin J Pain 2021; 37:349-358. [PMID: 33734147 DOI: 10.1097/ajp.0000000000000929] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The presence or absence of clearly defined symptoms and underlying pathophysiology may be a crucial variable related to variability in well-being and stigmatization in individuals with chronic pain (ICPs). In the context of pain, absence of clearly defined symptoms and pathophysiology deviates from the widely endorsed biomedical model and as such, may lead to stigmatization, which in turn could be related to ICPs' well-being. OBJECTIVES The present study compared physical, psychological, social well-being, and perceived stigmatization in individuals with clearly defined symptoms and underlying pathophysiology (rheumatoid arthritis, RA) and individuals with less well understood symptoms and pathophysiology (fibromyalgia, FM) using daily diaries. Furthermore, the association between daily perceived stigmatization and daily well-being was examined. MATERIALS AND METHODS Seventy-nine participants with FM, 86 participants with RA, and 33 participants with both diagnoses completed a diary for 14 consecutive days. RESULTS Compared to individuals with RA, individuals with FM and individuals with both diagnoses reported worse daily well-being. After controlling for age, pain duration, and daily pain, differences between FM and RA remained significant for social well-being and completion of plans. Differences between RA and the dual diagnosis group remained significant for completion of plans, negative affect, and isolation. Furthermore, results suggested more stigmatization in individuals with FM than in individuals with RA. Individuals with both diagnoses reported equal stigmatization as individuals with FM, but more stigmatization than individuals with RA. Finally, increased levels of perceived stigma were associated with lower well-being. DISCUSSION Findings highlight that the absence of clearly defined symptoms and pathophysiology could be contributing to greater feelings of stigmatization, which may be detrimental for ICPs' well-being.
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Affiliation(s)
| | | | - Sara Kindt
- Department of Applied Health and Lifestyle Sciences, University of Applied Sciences, Bruges, Belgium
| | | | - Dimitri Van Ryckeghem
- Departments of Experimental-Clinical and Health Psychology
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | - Manasi M Mittinty
- Pain Management Research Institute, University of Sydney, Sydney, NSW, Australia
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10
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Rai SS, Peters RMH, Syurina EV, Irwanto I, Naniche D, Zweekhorst MBM. Intersectionality and health-related stigma: insights from experiences of people living with stigmatized health conditions in Indonesia. Int J Equity Health 2020; 19:206. [PMID: 33176809 PMCID: PMC7661268 DOI: 10.1186/s12939-020-01318-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background Health-related stigma is a complex phenomenon, the experience of which intersects with those of other adversities arising from a diversity of social inequalities and oppressive identities like gender, sexuality, and poverty – a concept called “intersectionality”. Understanding this intersectionality between health-related stigma and other forms of social marginalization can provide a fuller and more comprehensive picture of stigma associated with health conditions. The main objective of this paper is to build upon the concept of intersectionality in health-related stigma by exploring the convergence of experiences of stigma and other adversities across the intersections of health and other forms of social oppressions among people living with stigmatized health conditions in Indonesia. Methods This qualitative study interviewed 40 people affected by either of four stigmatizing health conditions (HIV, leprosy, schizophrenia, and diabetes) in Jakarta and West Java, Indonesia between March and June 2018. Data was analyzed thematically using an integrative inductive-deductive framework approach. Results The main intersectional inequalities identified by the participants were gender and socioeconomic status (n = 21), followed by religion (n = 13), age (n = 11), co-morbidity (n = 9), disability (n = 6), and sexuality (n = 4). Based on these inequalities/identities, the participants reported of experiencing oppression because of prevailing social norms, systems, and policies (macro-level), exclusion and discrimination from societal actors (meso-level), and self-shame and stigma (micro-level). While religion and age posed adversities that negatively affected participants in macro and meso levels, they helped mitigate the negative experiences of stigma in micro level by improving self-acceptance and self-confidence. Conclusion This study uncovered how the experience of health-related stigma intersects with other oppressions originating from the various social inequalities in an individual’s life. The findings highlight the importance of acknowledging and understanding the multi-dimensional aspect of lives of people living with stigmatized health conditions, and warrant integrated multi-level and cross-cutting stigma reduction interventions to address the intersectional oppressions they experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01318-w.
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Affiliation(s)
- Sarju Sing Rai
- Athena Institute, Faculty of Science, Vrije University Amsterdam, VU Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands. .,Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain.
| | - Ruth M H Peters
- Athena Institute, Faculty of Science, Vrije University Amsterdam, VU Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands
| | - Elena V Syurina
- Athena Institute, Faculty of Science, Vrije University Amsterdam, VU Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands
| | - Irwanto Irwanto
- Faculty of Psychology, Atma Jaya Catholic University, Jakarta, Indonesia
| | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Marjolein B M Zweekhorst
- Athena Institute, Faculty of Science, Vrije University Amsterdam, VU Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands
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11
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Hubley S, Moldow E, Robbins C, Harper B, Martin C, Zhou S. The Impact of Entertainment Education for Social and Emotional Learning in Elementary Schools. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1795751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Mamon D, Scoglio AAJ, Calixte RM, Tuval-Mashiach R, Patton B, Drebing CE. Connecting Veterans and Their Community Through Narrative: Pilot Data on a Community Strengthening Intervention. Community Ment Health J 2020; 56:804-813. [PMID: 31907805 DOI: 10.1007/s10597-019-00540-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Abstract
Military personnel transitioning to civilian life commonly report difficulty with establishing friendships, reconnecting with family, and a greater sense that they do not "fit in." Personal narrative interventions have the potential to increase the community's interest and understanding of Veterans' experience. This study examines the impact of a narrative intervention in which Veterans used film or verbal storytelling to describe their experience of being a Veteran to civilian audiences. A total 12 Veterans participated in at least one performance, and 88 community audience members attended one of six performances of the Veterans' narratives. Survey data indicate increase in positive attitudes towards Veterans, as well as a shift in the Veterans' perspective of civilians as receptive and supportive. These preliminary findings suggest that narrative interventions appear to have a positive impact on civilians' interest in Veterans and therefore, may be a valuable community reintegration intervention.
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Affiliation(s)
- Daria Mamon
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program and Harvard Medical School, Boston, MA, USA. .,The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA. .,One Constitution Wharf, Suite 140, Charlestown, MA, 02129, USA.
| | - Arielle A J Scoglio
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
| | - Rachelle M Calixte
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
| | | | | | - Charles E Drebing
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
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13
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Bresolin JZ, Dalmolin GDL, Vasconcellos SJL, Barlem ELD, Andolhe R, Magnago TSBDS. Depressive symptoms among healthcare undergraduate students. Rev Lat Am Enfermagem 2020; 28:e3239. [PMID: 32074209 PMCID: PMC7021484 DOI: 10.1590/1518-8345.3210.3239] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 09/23/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE to identify the intensity of depressive symptoms and their associated factors in healthcare undergraduate students. METHOD cross-sectional study developed with undergraduate health students from a public higher education institution using the Beck Depression Inventory-version II and a student characterization questionnaire. The study involved 792 participants. For data analysis, we used descriptive statistics, chi-squared test and Poisson regression. RESULTS the intensity of depressive symptoms was moderate to severe in 23.6% of the students, associated with the non-performance of physical and leisure activities and with speech therapy and nursing courses. CONCLUSION several factors may be associated with depression, thus, further investigation into the related factors that cause its emergence in this period of life is necessary, as well as raising institutional awareness and developing strategies at the personal and group level to promote well-being, improve time management and interpersonal relationships, in order to achieve better academic results and personal development.
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Affiliation(s)
- Julia Zancan Bresolin
- Prefeitura Municipal de Santa Maria, Secretaria Municipal de Saúde,
Santa Maria, RS, Brazil
| | | | | | | | - Rafaela Andolhe
- Universidade Federal de Santa Maria, Departamento de Enfermagem,
Santa Maria, RS, Brazil
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14
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Rao D, Elshafei A, Nguyen M, Hatzenbuehler ML, Frey S, Go VF. A systematic review of multi-level stigma interventions: state of the science and future directions. BMC Med 2019; 17:41. [PMID: 30770756 PMCID: PMC6377735 DOI: 10.1186/s12916-018-1244-y] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Researchers have long recognized that stigma is a global, multi-level phenomenon requiring intervention approaches that target multiple levels including individual, interpersonal, community, and structural levels. While existing interventions have produced modest reductions in stigma, their full reach and impact remain limited by a nearly exclusive focus targeting only one level of analysis. METHODS We conducted the first systematic review of original research on multi-level stigma-reduction interventions. We used the following eligibility criteria for inclusion: (1) peer-reviewed, (2) contained original research, (3) published prior to initiation of search on November 30, 2017, (4) evaluated interventions that operated on more than one level, and (5) examined stigma as an outcome. We stratified and analyzed articles by several domains, including whether the research was conducted in a low-, middle-, or high-income country. RESULTS Twenty-four articles met the inclusion criteria. The articles included a range of countries (low, middle, and high income), stigmatized conditions/populations (e.g., HIV, mental health, leprosy), intervention targets (e.g., people living with a stigmatized condition, health care workers, family, and community members), and stigma reduction strategies (e.g., contact, social marketing, counseling, faith, problem solving), with most using education-based approaches. A total of 12 (50%) articles examined community-level interventions alongside interpersonal and/or intrapersonal levels, but only 1 (4%) combined a structural-level intervention with another level. Of the 24 studies, only 6 (25%) were randomized controlled trials. While most studies (17 of 24) reported statistically significant declines in at least one measure of stigma, fewer than half reported measures of practical significance (i.e., effect size); those that were reported varied widely in magnitude and were typically in the small-to-moderate range. CONCLUSIONS While there has been progress over the past decade in the development and evaluation of multi-level stigma interventions, much work remains to strengthen and expand this approach. We highlight several opportunities for new research and program development.
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Affiliation(s)
- Deepa Rao
- Department of Global Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Campus Mailbox 357965, Harris Hydraulics Building, 1705 NE Pacific Street, Seattle, WA, 98195-7175, USA.
| | - Ahmed Elshafei
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Minh Nguyen
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah Frey
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
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Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, Mitchell EMH, Nelson LRE, Sapag JC, Siraprapasiri T, Turan J, Wouters E. Stigma in health facilities: why it matters and how we can change it. BMC Med 2019; 17:25. [PMID: 30764806 PMCID: PMC6376713 DOI: 10.1186/s12916-019-1256-2] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.
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Affiliation(s)
- Laura Nyblade
- RTI International, 701 13th ST NW, Suite 750, Washington, DC, USA
| | - Melissa A. Stockton
- Epidemiology Department, UNC Gillings School of Global Public Health, 2103 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599 USA
| | - Kayla Giger
- RTI International, 701 13th ST NW, Suite 750, Washington, DC, USA
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, Zambart, P.O. Box 50697, Lusaka, Zambia
| | - Maria L. Ekstrand
- Division of Prevention Science, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549 USA
- St John’s Research Institute, St John’s National Academy of Health Sciences, Bengaluru, India
| | - Roger Mc Lean
- Health Economics Unit, Centre for Health Economics, Faculty of Social Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Ellen M. H. Mitchell
- International Institute for Social Studies, Erasmus University, Kortenaerkade 12, 2518 AX The Hague, Netherlands
| | - La Ron E. Nelson
- University of Rochester School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642 USA
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, M5T 1B8 Canada
| | - Jaime C. Sapag
- Departments of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Office of Transformative Global Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Ontario, Canada
| | - Taweesap Siraprapasiri
- Department of Disease Control, Ministry of Public Health of the Government of Thailand, Tivanond Road, Nonthaburi, 11000 Thailand
| | - Janet Turan
- Department of Health Care Organization and Policy, Maternal and Child Health Concentration, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
- Behavioral and Community Sciences Core, UAB Center for AIDS Research (CFAR), Birmingham, USA
| | - Edwin Wouters
- Centre for Longitudinal & Life Course Studies, University of Antwerp, Sint-Jacobstraat 2, B-2000 Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, PO Box 399, Bloemfontein, 9300 South Africa
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Quality of life in stabilized outpatients with bipolar I disorder: Associations with resilience, internalized stigma, and residual symptoms. J Affect Disord 2018; 238:399-404. [PMID: 29909303 DOI: 10.1016/j.jad.2018.05.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/07/2018] [Accepted: 05/28/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Improving Quality of Life (QoL) is an important objective in the treatment of bipolar disorder. The aim of the current study was to examine to which extent resilience, internalized stigma, and psychopathology are correlated to QoL. METHODS We recruited 60 outpatients diagnosed with bipolar I disorder according to DSM-IV criteria and 77 healthy control subjects from the general community. In patients, symptoms were quantified by the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS) and internalized stigma by the Internalized Stigma of Mental Illness (ISMI) scale. In order to assess QoL and resilience, the Berliner Lebensqualitätsprofil (BELP) and the Resilience Scale (RS-25) were used in both patients and control subjects. RESULTS Despite presenting with a very mild symptom level and relatively low internalized stigma, patients with bipolar I disorder indicated significantly lower QoL and resilience as compared to healthy control subjects. In patients, QoL correlated significantly with resilience, internalized stigma, and residual symptoms of depression. No significant correlations were observed between QoL and residual manic symptoms. LIMITATIONS The cross-sectional design and the relatively small sample size limit the generalizability of our results. Furthermore, levels of resilience and internalized stigma may change over the course of the illness and have different impacts on the long-term outcome of patients with bipolar disorder. CONCLUSION Our results show that QoL of patients suffering from bipolar I disorder, even when only mildly ill, is strongly associated with the degree of resilience and internalized stigma, and that particularly residual depressive symptoms have a negative impact on QoL. In addition to drug treatment, psychotherapeutic approaches should be applied to strengthen resilience, to reduce internalized stigma, and, ultimately, to improve quality of life.
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Ng YP, Rashid A, O’Brien F. Determining the effectiveness of a video-based contact intervention in improving attitudes of Penang primary care nurses towards people with mental illness. PLoS One 2017; 12:e0187861. [PMID: 29131841 PMCID: PMC5683645 DOI: 10.1371/journal.pone.0187861] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/28/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mental illness-related stigma is common, and is associated with poorer outcomes in people with mental illness. This study evaluated the attitudes of primary care nurses towards people with mental illness and its associated factors; and the effectiveness of a short video-based contact intervention (VBCI) in improving these attitudes using a Malay version of the 15-item Opening Minds Stigma Scale for Healthcare Providers (OMS-HC-15-M). METHODS A 5-minute VBCI was developed comprising elements of psychoeducation and interviews of people with mental illness and the people they interact with, relating to experience of mental illness and recovery. A pre-post cross-sectional study was conducted on 206 randomly selected primary care nurses in Penang, Malaysia. The OMS-HC-15-M questionnaire was administered before and immediately after participants viewed the VBCI. The difference in mean pre-post VBCI scores using paired t-tests, effect size and standardised response mean (SRM) were obtained. Factors correlating to attitudes were obtained using univariate and multivariate regression analyses. RESULTS Differences in pre-post VBCI score were statistically significant (p<0.001) with a 14% score reduction, a moderate effect size and SRM at 0.97 (0.85-0.11) and 1.1 (0.97-1.2) respectively. By factoring in the Minimal Detectable Change statistic of 7.76, the VBCI produced a significant improvement of attitudes in 30% of the participants. Factors associated with less stigmatising attitudes at baseline were previous psychiatry-related training, desiring psychiatric training, and positive contact with people with mental illness. CONCLUSIONS This is the first study in Malaysia to show that a brief VBCI is effective in improving attitudes of primary care nurses towards people with mental illness in the immediate term. Further studies are needed to determine if these results can be sustained in the longer term and generalizable to other health care professionals. Qualitative studies are warranted to provide insight to the factors correlating to these attitudes. (300 words).
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Affiliation(s)
- Yin Ping Ng
- Department of Psychiatry, Penang Medical College, Penang, Malaysia
- * E-mail:
| | - Abdul Rashid
- Department of Public Health, Penang Medical College, Penang, Malaysia
| | - Finian O’Brien
- Department of Psychiatry, Penang Medical College, Penang, Malaysia
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Yamauchi T, Takeshima T, Hirokawa S, Oba Y, Koh E. An Educational Program for Nursing and Social Work Students Using Artwork Created by People with Mental Health Problems. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9716-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Guruge S, Wang AZY, Jayasuriya-Illesinghe V, Sidani S. Knowing so much, yet knowing so little: a scoping review of interventions that address the stigma of mental illness in the Canadian context. PSYCHOL HEALTH MED 2016; 22:507-523. [PMID: 27264792 DOI: 10.1080/13548506.2016.1191655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Stigma can have detrimental effects on the health and wellbeing of individuals living with a mental illness. This scoping review describes the nature, range, and extent of intervention research aimed at reducing public and self-stigma of mental illness in the Canadian context. The review was guided by Arksey and O'Malley's framework. A search of databases and relevant websites identified 35 primary studies. Most studies used quantitative research methods and included predominantly youth or middle-aged adults, women, and white Canadian-born people. Guided by different conceptualizations of stigma, direct or indirect contact, education, and advocacy-focused interventions, aimed to provide information, and/or develop skills to address self and public stigma. Most studies evaluated interventions' effectiveness short-term. Of the few studies that followed-up participants long-term, some were able to reduce stigmatizing attitudes post-intervention, however, these targeted only specific groups such as students or health care professionals. Lack of diversity among the samples, and limited evidence of long-term effectiveness of interventions, were some of the studies' limitations. What is currently known about interventions aimed at reducing the stigma of mental illness in the Canadian context is not informed by research among vulnerable groups, such as people living with a mental illness, older adults, immigrants, and people of diverse ethnic backgrounds. Interventions that are informed by clear conceptualizations of stigma and rigorously evaluated in a range of ethno-cultural groups would create a knowledge base that is useful for policy-makers, community leaders, and agencies serving various ethnic communities in Canada.
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Affiliation(s)
- Sepali Guruge
- a Daphne Cockwell School of Nursing , Ryerson University , Toronto
| | | | | | - Souraya Sidani
- a Daphne Cockwell School of Nursing , Ryerson University , Toronto
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Characteristics, correlates and outcomes of perceived stigmatization in bipolar disorder patients. J Affect Disord 2016; 194:196-201. [PMID: 26845046 DOI: 10.1016/j.jad.2016.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 11/11/2015] [Accepted: 01/11/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to elucidate the characteristics, correlates and outcomes of perceived stigmatization in patients with Bipolar Disorder (BD). METHODS At baseline 50 remitted BD patients completed the Stigma Questionnaire (SQ), the Work and Social Adjustment Scale (WSAS), and the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Auto-Questionnaire - Short Version (TEMPS-A). The BD patients were followed for 24 months as part of their ongoing treatment. Information on illness course and treatments was obtained at baseline and at follow-up through medical records and interviews. RESULTS The prevalence of perceived stigmatization ranged from 37% to 57% across the areas measured by the SQ. The areas with most perceived stigmatization were work-ability and psychiatric hospitalization. Psychoeducation and affective temperaments emerged as significant independent predictors of perceived stigmatization. Perceived stigmatization was not related to affective recurrences. LIMITATIONS The follow-up period might have been too short to measure the long-term impact of perceived stigmatization. CONCLUSIONS The findings suggest that BD patients consider issues concerning work-ability and psychiatric hospitalizations to be particularly affected by stigmatization. Psychoeducation and affective temperaments were, furthermore, identified as factors implicated in perceived stigmatization in this population.
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Yoshii H, Mandai N, Saito H, Akazawa K. Reliability and validity of the workplace social distance scale. Glob J Health Sci 2014; 7:46-51. [PMID: 25948436 PMCID: PMC4802059 DOI: 10.5539/gjhs.v7n3p46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/17/2014] [Indexed: 11/12/2022] Open
Abstract
Self-stigma, defined by a negative attitude toward oneself combined with the consciousness of being a target of prejudice, is a critical problem for psychiatric patients. Self-stigma studies among psychiatric patients have indicated that high stigma is predictive of detrimental effects such as the delay of treatment and decreases in social participation in patients, and levels of self-stigma should be statistically evaluated. In this study, we developed the Workplace Social Distance Scale (WSDS), rephrasing the eight items of the Japanese version of the Social Distance Scale (SDSJ) to apply to the work setting in Japan. We examined the reliability and validity of the WSDS among 83 psychiatric patients. Factor analysis extracted three factors from the scale items: "work relations," "shallow relationships," and "employment." These factors are similar to the assessment factors of the SDSJ. Cronbach's alpha coefficient for the WSDS was 0.753. The split-half reliability for the WSDS was 0.801, indicating significant correlations. In addition, the WSDS was significantly correlated with the SDSJ. These findings suggest that the WSDS represents an approximation of self-stigma in the workplace among psychiatric patients. Our study assessed the reliability and validity of the WSDS for measuring self-stigma in Japan. Future studies should investigate the reliability and validity of the scale in other countries.
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Michalak EE, Livingston JD, Maxwell V, Hole R, Hawke LD, Parikh SV. Using theatre to address mental illness stigma: a knowledge translation study in bipolar disorder. Int J Bipolar Disord 2014; 2:1. [PMID: 25505692 PMCID: PMC4215813 DOI: 10.1186/2194-7511-2-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reduction of the stigma of mental illness is an international priority; arts- and contact-based approaches represent a promising mode of intervention. This project was designed to explore the impact of a one-woman theatrical performance on attitudes towards bipolar disorder (BD) on people with BD and healthcare providers. METHODS A playwright and actress who lives with BD developed a stage performance - 'That's Just Crazy Talk' - targeting stigmatizing attitudes towards BD. Prospective, longitudinal and sequential mixed methods were used to assess the impact of the performance on people with BD (n = 80) and healthcare providers (n = 84). Qualitative interviews were conducted with 33 participants (14 people with BD and 19 healthcare providers). RESULTS AND DISCUSSION Quantitatively, healthcare providers showed significantly improved attitudes immediately post-performance, but this change was not maintained over time; people with BD showed little quantitative change. Qualitatively, both people with BD and BD healthcare providers showed enduring and broadly positive changes. A theatrical presentation designed to reduce stigma produced immediate impact on healthcare providers quantitatively and significant qualitative impact on people with BD and healthcare providers. Additionally, the utility of using mixed-method approaches in mental health research was demonstrated.
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Affiliation(s)
- Erin E Michalak
- Division of Mood Disorders, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, V6T 2A1 Canada
| | - James D Livingston
- Saint Mary's University, 923 Robie St, Halifax, Nova Scotia B3H 3C3 Canada
| | - Victoria Maxwell
- Crazy for Life Co., P.O. Box 1354, Sechelt, British Columbia V0N 3A0 Canada
| | - Rachelle Hole
- School of Social Work, University of British Columbia, ARTS Bldg, 3333 University Way, Kelowna, British Columbia V1V 1V7 Canada
| | - Lisa D Hawke
- Université de Saint-Boniface, 200 Avenue de la Cathedrale, Winnipeg, MB R2H 0H7 Canada
| | - Sagar V Parikh
- University of Toronto, 399 Bathurst Street, Toronto, Ontario M5T 2S8 Canada ; University Health Network, 190 Elizabeth Street, Toronto, Ontario M5G 2C4 Canada
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