Psychiatric stigma: past, passing and to come

Advocating, Unlearning, Tearing It All Down? How BIPOC Young Adults with Mental Health Concerns Perceive and Engage with the Media

The COVID-19 pandemic has increased the salience of issues related to social justice, mental health, and health equity. During this time, the media have been instrumental in amplifying social movements but also in spreading mis/disinformation, violence, and hatred. Among communities who have been affected heavily during this time are Black, Indigenous, and People of Color (BIPOC) young adults who have a mental illness/significant mental health concerns. As frequent engagers and creators of media, their perspectives are critical to informing what aspects of the media should be leveraged to promote the health, well-being, and safety of people who have been marginalized. Thus, our study asks: How do BIPOC young adults (in the United States) who have a behavioral health diagnosis or significant mental health concerns perceive the media? Guided by intersectionality and grounded theory, we conducted in-depth interviews with 20 participants. The results reveal participants' 1) deep recognition of how the media uphold oppressive structures and 2) identification of ways that people have used and can use the media to fight those same structures. Researchers and media leaders should listen to, center the experiences of, collaborate with, and follow the lead of people who have been marginalized. This is critical to transforming the media such that they promote the well-being of all people.

Disease-Related Stigma, Stigmatizers, Causes, and Consequences: A Systematic Review

Background

Stigma is a sociological concept that is important in medicine and health because it threatens health as much as the disease itself. We aimed to explore the causes, stigmatizers, consequences and coping strategies related to the stigma of diseases by systematically analyzing relevant literature.

Methods

This systematic review examined 65 articles on Disease-Related Stigma by searching Noormags, Magiran, SID, Google Scholar, and PubMed databases. The articles were published in Persian and English between 2001 and 2022 and conducted in Iran. We used a three-step systematic review process to select articles that met the research criteria.

Results

Conflict in society, lack of knowledge, specific characteristics of the disease, and the contagious nature of disease are the main causes of stigma, leading to stigmatization by different groups such as significant others, generalized others, institutional others, and macro others. Patients experiencing stigma face various psychological, physical, and social complications, and they may use concealment as a coping strategy, which can pose a potential threat to society's general health.

Conclusion

By knowing the causes and stigmatizers of disease-related, it is possible to reduce stigma with less cost and time.

"You are Not Alone": Linking Peer Support to Information and Resources for Mental Health Concerns in Advocacy Groups' Social Media Messaging

The pervasive stigmatization of mental health concerns has caused a public health crisis in the United States, as it prevents individuals from seeking treatment for such concerns. Grassroots mental health advocacy groups working to mitigate this stigma and promote treatment largely do so through social media messaging strategies to provide audiences with information, resources, and peer support. Yet, scholars have not fully explicated what constitutes information, resources, or support. Further, little is known about mental health advocacy groups' goals for and perceived effectiveness of these strategies or how audience members understand these messaging strategies. By employing a case study approach with two grassroots mental health advocacy groups, this study provides a nuanced understanding of the strategies involved in providing information, resources, and peer support in social media messaging. This study also demonstrates that both content creators and audience members agree on the importance of linking support strategies - specifically peer support - with information and resources to achieve the organizations' primary goals. Theoretical and practical implications for the strategies used by both organizations are discussed.

Mental Health Services and Personal Recovery in California: A Population-Based Analysis

OBJECTIVE

Personal recovery measures have been examined among treatment-seeking individuals enrolled in high-quality care. The authors examined whether utilization of mental health services as typically delivered is associated with personal recovery among adults with clinically significant psychological distress.

METHODS

The Kessler Psychological Distress Scale (K-6) measured respondents' (N=1,954) psychological distress level. The authors also assessed five dimensions of personal recovery-hope, life satisfaction, empowerment, connectedness, and internalized stigma. Multivariable linear regression analyses were used to examine relationships between personal recovery and treatment, self-reported treatment completion, provider type, and adequacy of care, adjusting for covariates including K-6 score.

RESULTS

Participants who received care >12 months prior to the survey reported lower levels of hope (95% confidence interval [CI]=-0.36, -0.06, p<0.01), empowerment (95% CI=-0.26, -0.02, p<0.05), and connectedness (95% CI=-0.37, -0.06, p<0.01) than those who had not received treatment. Those who received care in the past 12 months reported lower levels of hope (95% CI=-0.47, -0.14, p<0.001) and life satisfaction (95% CI=-0.42, -0.05, p<0.01). However, treatment completion was associated with higher levels of empowerment (95% CI=0.02, 0.56, p<0.05) and hope (95% CI=0.04, 0.62, p<0.05) and lower levels of stigma (95% CI=-1.21, -0.21, p<0.01) compared with noncompletion. Differences according to provider type and adequacy of care were nonsignificant.

CONCLUSIONS

Utilization of mental health services was associated with lower levels of personal recovery, which may indicate that care-as typically utilized and received-does not promote personal recovery. Longitudinal research is needed to determine causal relationships underlying these associations.

Coping, Community and Fighting Stereotypes: An Exploration of Multidimensional Social Capital in Personal Blogs Discussing Mental Illness

Social capital has been identified as one of the ways in which mental health concerns may be mitigated - by ensuring that systems are in place at the micro (cognitive), meso (social interaction), and macro (institutional) levels to support individuals as they seek assistance with and recovery from mental health concerns. One area that deserves further research, however, is how social capital is created communicatively online for these purposes. This study outlines the creation of social capital through interviews with five personal bloggers, analysis of six additional personal blogs with mental health content, and analysis of 878 reader comments to blog posts. Social capital creation is found in three levels, with: (1) coping with mental illness present at the cognitive level, (2) fostering supportive community at the social interaction level, and (3) fighting against stereotypes at the institutional level.

The (Surprising) Impact of Televised Antidepressant Direct-to-Consumer Advertising on the Stigmatization of Mental Illness

This study tests the effect of pharmaceutical Direct-to-Consumer Advertising (DTCA) for antidepressants on perceived stigma surrounding mental disorders. We randomly assigned participants into one of three experimental conditions: antidepressant DTCA with portrayals of discrimination, cognitive separation, and stereotyping (DCSS), antidepressant DTCA without these representations, or a no-exposure control. Contrary to study hypotheses, participants who viewed ads containing portrayals of DCSS were significantly less likely to want to socially distance themselves from those with mental illnesses than those assigned to the no-exposure control condition, even when controlling for demographics and personal experience with mental illness. We discuss plausible explanations for the unexpected pattern of effects and resulting implications for future research on the topic.

Stigma of mental illness and help-seeking intention in university students

Aims and method

A cross-sectional study to ascertain levels of personal and perceived public mental illness stigma in a university student population and the association between the respective levels of stigma and help-seeking intention. An adaptation of the Discrimination-Devaluation scale was used.

Results

A total of 735 students participated in the study (response rate 77%). There were higher mean perceived public stigma levels than personal stigma levels. Perceived public stigma was not significantly associated with future non-help-seeking intention (odds ratio (OR) = 0.871, P = 0.428). Personal stigma was significantly associated with a decreased likelihood of future help-seeking intention (OR = 1.44, P = 0.043). Being younger than 25, having no history of or treatment for mental illness and having no personal contact with someone with a history of mental illness were all associated with higher personal stigma levels.

Clinical implications

This study indicates that personal stigma as distinct from perceived public stigma is a significant barrier to mental health utilisation for a student population and future stigma reduction campaigns could strategically focus on this.

Young people, mental illness and stigmatisation

In a recent review of the literature, Hayward & Bright (1997) offer four possible answers to the question of “What is the root cause of an unfavourable view of ‘mental illness’?” First, dangerousness: people fear the mentally ill because they believe them to be prone to violence. Second, attribution of responsibility: sufferers of mental/behavioural problems are seen as more responsible for their condition, implying a belief that the mentally ill ‘choose’ to behave as they do. Third, conditions perceived as being chronic, difficult to treat and having a poor prognosis are more stigmatised, and fourth, the cause for stigma lies in the disruption of normal social interactions based on social role.

Stigma of mental illness and ways of diminishing it

Stigma is defined as a sign of disgrace or discredit, which sets a person apart from others. The stigma of mental illness, although more often related to context than to a person's appearance, remains a powerful negative attribute in all social relations. Sociological interest in psychiatric stigma was given added vigour with the publication of Stigma – Notes on the Management of Spoiled Identity (Goffman, 1963). More recently, psychiatrists have begun to re-examine the consequences of stigma for their patients. In 1989, the American Psychiatric Association's annual meeting's theme ‘overcoming stigma’ was subsequently published as a collection of articles (Fink & Tasman, 1992), and last year saw the launch of the Royal College of Psychiatrists' five-year Changing Minds anti-stigma campaign.

The schizophrenia stigma and mass media: a search for news published by wide circulation media in Brazil

Schizophrenia is the most common illness used today as a metaphor in the media and routinely appears associated with crime and violence with no medical or scientific rigor, reinforcing the stigma against this disorder. Evaluation of the presence of structural stigma in the Brazilian media by means of a survey of printed news and the Internet using the term schizophrenia and its correlates under three aspects: (a) medical and scientific uses, (b) assigning a diagnosis of schizophrenia to crime suspects with little or no medical or scientific rigor, and (c) the metaphorical use. The study was conducted in three stages: search for publications, classification of items found and analysis of the context in which they were published. The survey was conducted in two periods: 2008 and 2011, the first being restricted to the newspaper Folha de S. Paulo and the second extended to the homepage of the main Brazilian print media. We found 229 texts, distributed as follows: 89 (39%) records as science and health, with a tendency to impersonality; 62 (27%) records as crime and violence, in which the 'diagnosis' of schizophrenia is given by lay people and 'supported' by an archeology of the life of the suspect which enlists all sorts of non-standard behavior; and 78 (34%) records of metaphorical use, always with a negative meaning. Most of the texts found (a) does not give voice to people with schizophrenia and their suffering, (b) trivializes the use of this psychiatric illness out of context to describe contradictory or of dubious character political and economic decisions, and

Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries

This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.

An experimental Investigation of the Impact of Personality Disorder Diagnosis on Clinicians: Can We See Past the Borderline?

Background: There is concern that diagnostic labels for psychiatric disorders may invoke damaging stigma, stereotypes and misunderstanding. Aims: This study investigated clinicians’ reactions to diagnostic labelling by examining their positive and negative reactions to the label borderline personality disorder (BPD). Method: Mental health professionals (n = 265) viewed a videotape of a patient suffering from panic disorder and agoraphobia undergoing assessment. Prior to viewing the videotape, participants were randomly allocated to one of three conditions and were given the following information about the patient: (a) general background information; (b) additional descriptive information about behaviour corresponding to BPD; and (c) additional descriptive information about behaviour corresponding to BPD, but explicitly adding BPD as a possible comorbid diagnostic label. All participants were then asked to note things they had seen in the videotape that made them feel optimistic or pessimistic about treatment outcome. Results: Participants in the group that were explicitly informed that the patient had a BPD diagnostic label reported significantly fewer reasons to be optimistic than the other two groups. Conclusions: Diagnostic labels may negatively impact on clinicians’ judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.

The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: executive summary of an American College of Physicians position paper

Behavioral health care includes care for patients around mental health and substance abuse conditions, health behavior change, life stresses and crises, and stress-related physical symptoms. Mental and substance use disorders alone are estimated to surpass all physical diseases as a major cause of worldwide disability by 2020. The literature recognizes the importance of the health care system effectively addressing behavioral health conditions. Recently, there has been a call for the use of the primary care delivery platform and the related patient-centered medical home model to effectively address these conditions. This position paper focuses on the issue of better integration of behavioral health into the primary care setting. It provides an environmental scan of the current state of conditions included in the concept of behavioral health and examines the arguments for and barriers to increased integration into primary care. It also examines various approaches of integrated care delivery and offers a series of policy recommendations that are based on the reviewed information and evidence to inform the actions of the American College of Physicians and its members regarding advocacy, research, and practice.

Is premenstrual dysphoric disorder really a disorder?

Premenstrual dysphoric disorder (PMDD) was recently moved to a full category in the DSM-5 (the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders). It also appears set for inclusion as a separate disorder in the ICD-11 (the upcoming edition of the World Health Organization's International Statistical Classification of Diseases and Related Health Problems). This paper argues that PMDD should not be listed in the DSM or the ICD at all, adding to the call to recognise PMDD as a socially constructed disorder. I first present the argument that PMDD pathologises understandable anger/distress and that to do so is potentially dangerous. I then present evidence that PMDD is a culture-bound phenomenon, not a universal one. I also argue that even if (1) medication produces a desired effect, (2) there are biological correlates with premenstrual anger/distress, (3) such anger/distress seems to occur monthly, and (4) women are more likely than men to be diagnosed with affective disorders, none of these factors substantiates that premenstrual anger/distress is caused by a mental disorder. I argue that to assume they do is to ignore the now accepted role that one's environment and psychology play in illness development, as well as arguments concerning the social construction of mental illness. In doing so, I do not claim that there are no women who experience premenstrual distress or that their distress is not a lived experience. My point is that such distress can be recognised and considered significant without being pathologised and that it is unethical to describe premenstrual anger/distress as a mental disorder. Further, if the credibility of women's suffering is subject to doubt without a clinical diagnosis, then the way to address this problem is to change societal attitudes towards women's suffering, not to label women as mentally ill. The paper concludes with some broader implications for women and society of the change in status of PMDD in the DSM-5 as well as a sketch of critical policy suggestions to address these implications.

Suggested avenues to reduce the stigma of mental illness in the Middle East

BACKGROUND

Stigma toward mentally ill individuals acts as a barrier to accessing care and receiving treatment.

AIM

To review current evidence pertaining to stigma toward mental illness in the Middle East in order to inform effective and sustainable interventions in this region.

METHODS

We conducted a systematic literature search using the PubMed database and evaluated all identified studies according to specific inclusion criteria.

RESULTS

Stigma toward individuals with mental illness does exist in the Middle East. Stigmatizing attitudes are particularly high toward culturally proscribed mental illnesses like alcohol abuse and lower for other disorders such as depression and psychosis.

CONCLUSIONS

We propose the following initiatives to reduce stigma toward mental illness in the Middle East: (a) educate families to enable them to support their affected relatives, (b) increase cooperation between psychiatrists and faith healers and (c) educate young people in schools to increase their awareness and understanding of mental illnesses and to combat negative stereotypes.

Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry

CONTEXT

Attitude of fresh graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS.

AIMS

(1) To compare the attitude of medical students and interns in a medical college toward mental illness and psychiatry. (2) To assess the impact of psychiatric training on attitude toward the mentally ill person and mental illness.

SETTINGS AND DESIGN

Cross-sectional, single assessment study conducted at a tertiary hospital.

SUBJECTS AND METHODS

Participants consisted of medical students of 1(st) and 2(nd) year who didn't have any exposure to psychiatry and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma, General Health Questionnaire-12 (GHQ-12), opinion about mental illness (OMI) scale, and attitude to psychiatry-29 (ATP-29) scale.

STATISTICAL ANALYSIS

Standard descriptive statistics (mean, percentage), Chi-square test.

RESULTS

A total of 135 participants formed the study sample, with 48, 47, and 40 participants from 1(st) year, 2(nd) year and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns toward psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude toward mental illness and psychiatry was reflected.

CONCLUSIONS

Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in OMI and psychiatry.

Spanish medical students' attitudes and views towards mental health and psychiatry: a multicentric cross-sectional study

OBJECTIVE

The aim of this study is to investigate the attitudes towards mental illness and psychiatry among fifth year Spanish medical students.

METHODS

The study included 171 students from three medical schools located in different areas of Spain: Cádiz; UCA (n = 113), Madrid; San Pablo-CEU (n = 22), and Barcelona; UAB (n = 36). They responded, prior to their undergraduate medical course in psychiatry, to the AMI questionnaire to measure the attitudes towards mental illness and to Balon's adapted questionnaire to investigate their view towards psychiatry.

RESULTS

The students (93.4 %) had a positive attitude towards mental illness (AMI). Attitudes towards psychiatry were fairly positive with a few negative views, specifically regarding the role of psychiatrists (items 11 and 13) and the prestige of the specialty (item 16). There were some statistically significant differences between the three medical schools in the perception of psychiatry as a medical discipline. A better attitude towards mental illness was associated with a better view of the overall merits of psychiatry.

CONCLUSIONS

Findings suggest that Spanish medical students do not have a negative attitude towards mental illness and they have a good perception of psychiatry, although there are still some misconceptions about this specialty. These student's attitudes could favor an appropriate management of patients suffering from mental illness.

Speaking to a Wider Audience about the Positive Contributions of Psychiatry

We live in a world that is increasingly complex, intense, and stressful. Most people, at some time or other in their lives, can make good use of psychiatry as they map their course and steer their way through it. While this holds true, there also exists a very disturbing trend. No other branch of medicine suffers a similar, constant criticism, scrutiny and quite often downright vehement protest. Even the service users, who have been greatly benefitted, choose to stay mum for fear of stigmatization that may follow if they admit to have undergone therapy. The onus lies on both, the service users and providers alike, to take the positive contributions of psychiatry to the masses at large. All of us, especially medical professionals, need to consider our own attitudes and awareness. The recognition that anyone will break down if mental stress is high enough should help free us from a 'them and us' attitude. Reading about people's own experience of mental illness can promote understanding: Examples include a successful actress and a prize-winning author. For mental health practitioners, enabling service users to influence service development is another strong anti-stigma move. A cognitive behavior therapy approach can help individuals overcome the stigma felt and also cope better with discrimination. Also, we need to stand up against mental health discrimination wherever it is encountered.

Health insurance and treatment of adolescents with co-occurring major depression and substance use disorders

OBJECTIVE

The goals of this study were to identify treatment rates among adolescents with co-occurring major depressive episode (MDE) and substance use disorder (SUD), and to examine the role of health insurance in the treatment of these disorders.

METHOD

Seven years of cross-sectional data (2004-2010) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 2,111 adolescents who had both a past-year MDE and SUD and whose insurance status was known. The associations of public and private insurance with MDE and SUD treatment were examined using multinomial logistic regressions that controlled for health status and sociodemographic variables.

RESULTS

Less than one-half (48%) of adolescents received any form of MDE treatment in the past year, and only 10% received any form of SUD treatment. Only 16% of adolescents who received MDE treatment also received SUD treatment. Relative to no insurance, public insurance was associated with an increased likelihood of receiving MDE treatment alone, but not with an increased likelihood of receiving both MDE and SUD treatment. Involvement in the criminal justice system was the major factor affecting the likelihood that an adolescent would receive both MDE and SUD treatment, as opposed to either no treatment or treatment for MDE alone.

CONCLUSIONS

Exceptionally low rates of SUD treatment were observed in this high-risk sample. Study findings highlight a missed opportunity to assess and to treat SUD among adolescents with co-occurring MDE and SUD who have received some form of MDE treatment in the past year.

Mental health literacy about depression and schizophrenia among adolescents in Sweden

BACKGROUND

Mental health literacy (MHL) refers to an individual's knowledge of mental disorders, including the ability to recognize psychopathology and being aware of help options. Most studies of MHL have focused on adults.

OBJECTIVE

The purpose of this study was to examine levels of MHL among adolescents.

METHODS

MHL was examined using two pre-established vignettes that presented an adolescent with symptoms of either depression or schizophrenia. The respondents were 426 adolescents (age mean=16). Vignette data were analyzed both qualitatively and quantitatively.

RESULTS

The data showed that 42.7% and 34.7% of the respondents identified depression and schizophrenia, respectively. Depression was recognized more often by females than males. Professional help was suggested by a minority of the respondents for managing symptoms of depression (22.5%) or schizophrenia (32.6%). Altruistic behaviors, examined through the willingness to help an acquaintance with mental illness symptoms, were apparent among 58.2% of the respondents and to a greater extent in females than males. Answers following the schizophrenia vignette also revealed stigmatizing attitudes in 11.5% of the participants.

CONCLUSIONS

There are relatively low levels of MHL among teenagers in Sweden. Awareness campaigns and the implementation of psychoeducation in the school curriculum could increase MHL in this group.

Partaking in the global movement for occupational mental health: what challenges and ways forward for sub-Sahara Africa?

There is an ongoing global movement for the entrenchment of occupational mental health as an integral part of occupational health and safety schemes. Aside from being a fundamental human right issue, this move has been demonstrated to be of cost-benefit in terms of workplace productivity and general economic growth. Despite being among the regions most prone to the human and economic repercussions of work-related mental health problems by reason of her socio-economic circumstance; sub-Sahara Africa is yet to fully plug into this movement. With a view to make recommendations on the ways forward for sub-Sahara Africa, this paper examines the current state of and the barriers to effective occupational mental health policy and practice in the region.

The Nigerian home video boom: should Nigerian psychiatrists be worried? Lessons from content review and views of community dwellers

BACKGROUND

Media depiction of sufferers of mental illness is a widely viewed source of stigmatization and studies have found stigmatizing depictions of mental illness in Nigerian films. With the recent boom in the Nigerian home video industry, there is a need to know how often Nigerians are exposed to films that contain scenes depicting mental illness and how much premium they place on such portrayals as reflecting reality.

AIM

To assess the popularity of Nigerian home videos among Nigerian community dwellers and the frequency of their exposure to scenes depicting mental illness.

METHODS

A semi-structured questionnaire was designed to obtain socio-demographic data and to find out how often respondents see scenes depicting 'madness' in home videos, as well as their views about the accuracy of such depictions from the orthodox psychiatry point of view. Current home videos available in video rental shops were selected for viewing and content review.

RESULTS

All 676 respondents had seen a Nigerian home video in the preceding 30 days: 528 (78%) reported scenes depicting 'mad persons'; 472 (70%) reported that the scenes they saw agreed with their own initial understanding of the cause and treatment of 'madness'. About 20% of the films depicted mental illness. The most commonly depicted cause was sorcery and enchantment by witches and wizards, while the most commonly depicted treatment was magical and spiritual healing by diviners and religious priests.

CONCLUSIONS

Nigerian home video is a popular electronic media in Nigeria and scenes depicting mental illness are not uncommon. The industry could be harnessed for promoting mental health literacy.

Stigma and discrimination toward mental illness: translation and validation of the Italian version of the Attribution Questionnaire-27 (AQ-27-I)

PURPOSE

The aim of this study was to translate the Attribution Questionnaire-27 (AQ-27) to the Italian language (AQ-27-I), and to examine the reliability and validity of this new Italian version.

METHODS

The questionnaire was translated using the standard translation/back-translation method. Cronbach's alpha and intraclass coefficients were used to estimate instrument reliability. Confirmatory factor analysis was conducted to corroborate the original English version factor structure in the new measure, and to establish validity. Path analyses were meant to validate relationships found in the English version among Italian-speaking participants.

RESULTS

The AQ-27-I demonstrated acceptable internal consistency, with a Cronbach's alpha of 0.82 for the total scale and ranging between 0.52 and 0.91 for the subscales. The test-retest reliability was also satisfactory, with intraclass correlation coefficients of 0.72 for the total scale and ranging between 0.51 and 0.89 for the subscales. Fit indices of the model supported the factor structure and paths.

CONCLUSIONS

The AQ-27-I is a reliable measure to assess stigmatizing attitudes in Italian.

Stigma and discrimination in people suffering with a mood disorder: a cross-sectional study

Background. Much research is done on the stigma of mental illness, but little research has been done to characterize these phenomena from the perspective of people with mood disorders. Objective. To characterize the extent to which individuals with bipolar disorder and depression are stigmatized, determine factors related to higher levels of stigmatization, and assess the reliability of the Inventory of Stigmatizing Experiences in a population of people with a mood disorder. Methods. Two hundred and fourteen individuals with depression and bipolar disorder were recruited from a tertiary care psychiatric hospital and surveyed using the Inventory of Stigmatizing Experiences. Results. Participants reported high levels of stigma experiences and this did not differ by diagnosis (P = 0.578). However, people with bipolar disorder reported greater psychosocial impact of stigma on themselves and their family members compared to people with depression (P = 0.019). The two subscales produced internally consistent results with both populations. Conclusion. Stigma negatively affects those with both depression and bipolar disorder but appears to have a greater psychosocial impact on those with bipolar disorder.

Stigma, schizophrenia and the media: exploring changes in the reporting of schizophrenia in major U.S. newspapers

Newspaper media are a major source of information about mental illness in the United States. Previous research has shown that some printed material has been both negative and stigmatizing, which can have a detrimental impact on individuals with mental illnesses. Such perceptions represented in the media may cause those with mental illnesses to internalize a negative and stigmatizing stereotype and hinder the public's understanding of mental illness. In recent years, advocacy groups have increased their efforts to combat stigmatization of those with mental illnesses. This study focused specifically on the use of stigmatizing language concerning schizophrenia in U.S. newspapers. Because advocacy to decrease stigmatization of mental illness has increased in recent years, this study compared media depictions of schizophrenia in 2000 and 2010 to determine if there had been a reduction in reporting of dangerousness and perpetration of crime by people with schizophrenia or in stigmatizing language. All articles published in five high-circulation newspapers from diverse urban geographical regions between January 1 and June 1 in 2000 and 2010 that contained the words "schizophrenia" or "schizophrenic" were reviewed. Articles were categorized under the categories of education, incidental reference, medical and pharmaceutical news, metaphorical use, charity, obituary, medically inappropriate, and human interest. Human interest articles were further subcategorized into advocacy, crimes committed by people with schizophrenia, crimes committed against those suffering from schizophrenia, and issues related to poor mental health care. There was a statistically significant decrease in reporting of crime committed by people with schizophrenia in 2010 compared with 2000. However, no significant difference was found in metaphorical usage of the terms schizophrenia and schizophrenic between 2000 and 2010.

Metaphoric and non-metaphoric use of the term "schizophrenia" in Italian newspapers

PURPOSE

This study examines how the term "schizophrenia" is used in Italian newspapers.

METHODS

The survey was carried out on the 22 Italian newspapers which allow word scanning on their online website. In each newspaper, the terms "schizophrenia" and "schizophrenic" were scanned in all articles, from January 1, 2008 to December 31, 2008. Each article containing these terms was analyzed in relation to metaphorical usage to describe or denigrate people or groups not diagnosed "schizophrenic" and in relation to non-metaphoric, direct descriptions of people using mental health services, or the illness itself.

RESULTS

"Schizophrenia/schizophrenic" was reported in 1,087 articles. It was used far more frequently as a metaphor (73.7%) than in reference to people actually given the diagnosis (19.2%) or to the disorder itself (7.1%). The 801 metaphoric uses were classified into the following categories: incoherence/contradiction/split (682, 85.1%), dangerousness/aggressiveness (34, 4.4%), and eccentricity/oddness (84, 10.5%). 117 out of 209 (55.9%) articles on people diagnosed with the disorder were in news section of which 57 (48.7%) referred to homicides, 17 (14.5%) to other assaults by the person, and 33 (28.2%) to assaults directed at the person.

CONCLUSIONS

These data confirm previous studies showing that the media disproportionately report negative stories about people diagnosed with "schizophrenia", and in particular, equate the diagnosis with violence. The study also demonstrates that the metaphorical use of the term to denigrate groups or individuals may be an equal or greater contributor to the stigma and prejudice experienced by people with this mental disorder.

Human resource challenges facing Zambia's mental health care system and possible solutions: results from a combined quantitative and qualitative study

Human resources for mental health care in low- and middle-income countries are inadequate to meet the growing public health burden of neuropsychiatric disorders. Information on actual numbers is scarce, however. The aim of this study was to analyse the key human resource constraints and challenges facing Zambia's mental health care system, and the possible solutions. This study used both qualitative and quantitative methodologies. The WHO-AIMS Version 2.2 was utilized to ascertain actual figures on human resource availability. Semi-structured interviews and focus group discussions were conducted to assess key stakeholders' perceptions regarding the human resource constraints and challenges. The results revealed an extreme scarcity of human resources dedicated to mental health in Zambia. Respondents highlighted many human resource constraints, including shortages, lack of post-graduate and in-service training, and staff mismanagement. A number of reasons for and consequences of these problems were highlighted. Dedicating more resources to mental health, increasing the output of qualified mental health care professionals, stepping up in-service training, and increasing political will from government were amongst the key solutions highlighted by the respondents. There is an urgent need to scale up human and financial resources for mental health in Zambia.

Educational interventions in secondary education aiming to affect pupils' attitudes towards mental illness: a review of the literature

Dealing with persons who have mental health problems is an issue that many people are likely to face with, whether they are health professionals or not. Positive attitudes towards people with mental illness play a major factor in their quality of life and social inclusion. Since adolescents will become active adult members of their communities in the near future, this paper reviews educational interventions in secondary education and how they aim to affect adolescent attitudes towards mental illness. Twelve studies conducted on the relevant issue have been identified. The results indicate a positive impact on attitudes towards mental illness and improvements in the knowledge of mental health and illness among secondary school pupils. However, the limited number of studies highlights the need for further research.

Perceptions of young women using SSRI antidepressants — a reclassification of stigma

Objective

To contribute to an understanding of young women's perspective on using selective serotonin re-uptake inhibitors (SSRIs).

Method

Eight in-depth interviews and four re-interviews were conducted with young women (aged 21–34) using SSRIs. Informants were recruited through pharmacies in Copenhagen, Denmark. Pharmacy personnel identified potential participants based on dispensed prescriptions and gave them a contact letter with information about the study.

Key findings

When suffering from emotional problems, the women saw themselves as dysfunctional in their daily lives. They felt that they deviated from what is considered “normal” in society and thus felt stigmatised. When the women contacted their physicians they were prescribed SSRIs. After starting the medication, the women felt that they could once again function in everyday life and they felt relieved. However, the women also associated taking SSRIs with Stigmatisation due to the reputation of the medicines as “happiness pills” and the association with mental instability. The women concealed their emotional problems and medication from most people in their social networks. This was the result of the women's own anticipation of being stigmatised and their fear of negative reactions from others if they revealed the truth.

Conclusion

The young women using SSRIs felt stigmatised, initially due to their emotional problems. After the women were diagnosed, the stigma was reclassified and then became associated with taking SSRIs. The women coped primarily by trying to pass for normal. Our findings show that the SSRI users attach psychological and social meanings to their use of the drugs. Pharmacy professionals need to be aware of such meanings if they are to enhance their role in patient care.

Stigma and treatment for alcohol disorders in the United States

Among a nationally representative sample of adults with an alcohol use disorder, the authors tested whether perceived stigmatization of alcoholism was associated with a lower likelihood of receiving alcohol-related services. Data were drawn from a face-to-face epidemiologic survey of 34,653 adults interviewed in 2004-2005 who were aged 20 years or older and residing in households and group quarters in the United States. Alcohol abuse/dependence was diagnosed by using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version (AUDADIS-IV). The stigma measure used was the Perceived Devaluation-Discrimination Scale. The main outcome was lifetime intervention including professional services and 12-step groups for alcohol disorders. Individuals with a lifetime diagnosis of an alcohol use disorder were less likely to utilize alcohol services if they perceived higher stigma toward individuals with alcohol disorders (odds ratio = 0.37, 95% confidence interval: 0.18, 0.76). Higher perceived stigma was associated with male gender (β = -0.75; P < 0.01), nonwhite compared with non-Hispanic white race/ethnicity, lower income (β = 1.0; P < 0.01), education (β = 1.48; P < 0.01), and being previously married (β = 0.47; P = 0.02). Individuals reporting close contact with an alcohol-disordered individual (e.g., relative with an alcohol problem) reported lower perceived stigma (β = -1.70; P < 0.01). A link between highly stigmatized views of alcoholism and lack of services suggests that stigma reduction should be integrated into public health efforts to promote alcohol treatment.

Shame, Labeling and Stigma: Challenges to Counseling Clients in Alcohol and other Drug Settings

This study explores the impact of perceptions of shame on counseling in alcohol and other drug (AOD) settings. While some recent research points to the potential treatment barriers that result from discrimination against AOD clients by health care professionals, there is a dearth of research on the impact of shame and stigma on the work of allied health professionals. The qualitative data presented here are drawn from 17 in-depth interviews with counselors and AOD workers based in New South Wales, Australia. The article focuses on the professional tensions arising in managing stigma, alongside the alienating and isolating manifestations of shame, by exploring three themes: (a) the application of negative labels such as “addicts” and “junkies,” (b) the stigmatization of AOD settings, and (c) the impact of labeling and stigmatization on service provision. These findings point to the potential treatment barriers of stigma when counselling clients in AOD settings.

Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: a cross-sectional study

BACKGROUND

There is a long history of certain medical conditions being associated with stigma, stereotypes, and negative attitudes. Research has shown that such attitudes can have a detrimental effect on patients presenting with stigmatised medical conditions and can even flow on to impact their family. The objective of this study was to measure the attitudes of undergraduate students enrolled in six different health-related courses at Monash University toward patients with intellectual disability, substance abuse, and acute mental illness.

METHODS

A convenience sample of undergraduate students enrolled in six health-related courses in first, second and third years at Monash University were surveyed. The Medical Condition Regard Scale--a valid and reliable, self-report measure of attitudes--was administered to students along with a brief demographic form. Mean scores, t-tests, and ANOVA were used to analyse student attitudes. Ethics approval was granted.

RESULTS

548 students participated. Statistically significant differences were found between the courses (p = 0.05), year of the course (p = 0.09), and gender (p = 0.04) for the medical condition of intellectual disability. There was no statistically significant difference between the courses, year of the course, gender, and age group for substance abuse or acute mental illness conditions.

CONCLUSION

The findings suggest that students in undergraduate health-related courses, as a group, have a strong regard for patients with intellectual disability and some regard for patients with acute mental illness, but not for patients presenting with substance abuse problems.

Practitioner attitudes towards patients in forensic mental health settings

Scotland has a national programme to improve mental health and well-being and addressing stigma among mental health practitioners is a priority. This study explores practitioner attitudes towards patients in medium and low secure forensic mental health settings through qualitative and quantitative approaches. Two questionnaires were used with nursing staff. A qualitative questionnaire asked participants to list examples of positive and negative practice and anti-discriminatory and discriminatory attitudes towards patients within forensic services. A quantitative questionnaire then asked participants to answer questions about a hypothetical man with schizophrenia called Harry. The overall balance of responses was more positive than negative in the qualitative results, particularly regarding patient rights, empowerment and control. However, there were a significant minority of negative attitudes in relation to recovery pessimism and desire for social distance. This was supported by the quantitative results where practitioners showed high stigma scores for avoidance and segregation. There were no significant differences in attitudes between medium and low secure settings. However overall, males reported more negative attitudes in relation to blame and avoidance and younger participants demonstrated more negative attitudes than older participants in relation to fear and danger. The implications for addressing stigma are discussed in relation to the wider national anti-stigma campaign and forensic services specifically.

Sri Lankan doctors' and medical undergraduates' attitudes towards mental illness

BACKGROUND

Stigmatizing attitudes towards mental illness can impede help-seeking and adversely affect treatment outcomes, especially if such attitudes are endorsed by medical personnel. In order to help identify targets for anti-stigma interventions, we comprehensively examined negative attitudes towards mental illness displayed by Sri Lankan doctors and medical students and compared these with equivalent UK and other international data.

METHOD

A self-report questionnaire originally developed in the UK was completed by medical students (n = 574) and doctors (n = 74) from a teaching hospital in Colombo. The questions assessed the presence and intensity of stigmatizing attitudes towards patients with schizophrenia, depression, panic disorder, dementia and drug and alcohol addiction.

RESULTS

The study revealed higher levels of stigma towards patients with depression, alcohol and drug addiction in this Sri Lankan sample compared to UK data but attitudes towards schizophrenia were less stigmatized in Sri Lanka. Blaming attitudes were consistently high across diagnoses in the Sri Lankan sample. Sri Lankan medical students displayed more negative attitudes than doctors (P < 0.001). Overall stigma was greatest towards patients with drug addiction, followed by, alcohol addiction, schizophrenia, depression, panic disorder and dementia.

CONCLUSIONS

Sri Lankan doctors and undergraduates endorse stigmatizing attitudes towards mental illnesses and are especially prone to see patients as blameworthy. As such attitudes are likely to affect the engagement of patients in treatment and specific interventions that modify negative attitudes towards people with mental illnesses are needed. Ensuring that medical students have contact with recovered patients in community psychiatry settings may be one way of decreasing stigmatizing attitudes.

The experience and consequences of people with mental health problems, the impact of stigma upon people with schizophrenia: a way forward

The aim of this literature review is to explore stigma as experienced by individuals with mental health problems, focusing primarily on schizophrenia. The concept of stigma has been examined. Service users' reports of their experiences of stigma have been outlined. The role of the media, public perceptions and the role of the nurses and mental health services have been discussed. Proposals have been suggested to address stigma.

Attitudes of Flemish physiotherapy students towards mental health and psychiatry

OBJECTIVES

In general, psychiatry is not very popular among healthcare providers, although no information is available concerning the attitudes of physiotherapy students towards mental heath. This study examined the attitudes of physiotherapy students towards psychiatry considering the subject's gender, previous experience with psychiatry and the impact of a specific course.

METHOD

This experimental study compared the attitudes of physiotherapy students (n=219) with those of students without a biomedical background (n=112) towards psychiatry. All students were between 17 and 28 years of age, and completed an established international questionnaire entitled 'Attitudes Towards Psychiatry'. Within the group of physiotherapy students, the effect of a 65-hour course on psychiatric rehabilitation on their attitudes was evaluated.

RESULTS

Attitudes towards psychiatry were moderately positive [mean (SD) 103.3 (9.9)]. There was a small but significant difference between physiotherapy students and non-medical students (Cohen's d=0.31). Female students had a more positive attitude towards psychiatry than their male peers (Cohen's d=0.44). Prior experience with mental illness was associated with more positive attitudes (Cohen's d=0.68). Attitudes increased in positivity after completion of a psychiatry course (Cohen's d=0.72).

DISCUSSION AND CONCLUSION

To ensure basic physiotherapeutic treatment for the mentally ill, physiotherapy education should aim to promote positive attitudes towards mental illness as well as psychiatry. High-quality courses and personal interaction with patients are the best strategies to achieve this goal.

Primary care physicians' knowledge of and attitudes toward the eating disorders: do they affect clinical actions?

OBJECTIVE

This study examined the influence of primary care physicians' knowledge of and attitudes to eating disorders on their treatment decisions.

METHOD

A sample of primary care physicians completed self-report measures on eating disorders and their attitudes towards such patients. They also indicated their diagnosis and treatment decisions in response to case vignettes.

RESULTS

Physicians had substantial gaps in knowledge of the eating disorders. Attitudes to anorexia nervosa clustered differently to those toward patients with bulimia nervosa. However, for both disorders, the factor that explained the most variance was illness duration and consequences. There was no association of knowledge and attitudes, and these variables did not predicted the likelihood of diagnosing an eating disorder. However, those with higher knowledge scores were more likely to ensure that a follow-up appointment took place, particularly when they held the attitude that people with anorexia nervosa had personal control over their problem.

DISCUSSION

There is a need for greater education of primary care physicians regarding the diagnosis and treatment of the eating disorders, and for that information to be more readily accessible when it is needed. Their clinical actions need to be guided by more objective sources of information and protocols.

Students' perception about mental illness

BACKGROUND

In developing countries like India, there are evidences that stigma associated with mental illness is increasing. As in parts of the developing world, with advancement of urbanization and rapid industrialization, people tend to react in a very peculiar and biased way when they confront a mentally ill person.

MATERIALS AND METHODS

The present study aimed to find out students' opinion about mental illness. A total of 100 students (50 male and 50 female) from Ranchi University were purposively recruited for the study, and the 51-item Opinion about Mental Illness (OMI) Scale was administered.

RESULTS

Majority of the students were from Hindu families, of whom 42 (84%) were males and 38 (68%) were females. With regard to OMI scale, the item, viz., 'The law should allow a woman to divorce her husband as soon as he has been confined in mental hospital with a severe mental illness', both male (46%) and female (56%) students were neutral (significant at 0.014, P < 0.05).

CONCLUSION

Overall no significant level of difference emerged between male and female students with regard to opinion about mental illness.

Mental illness: diagnostic title or derogatory term? (Attitudes towards mental illness) Developing a learning resource for use within a clinical call centre. A systematic literature review on attitudes towards mental illness

With one in three people likely to experience mental health problems during their lifetime, it is paradoxical that stigma and negative attitudes towards mental illness are so prevalent in the UK today. This systematic literature review was completed to investigate what the most common negative attitudes towards mental illness are, and the most common recommendations made to address them. The findings were used to inform teaching resources used in an National Health Service Direct call centre. Guidelines for undertaking a systematic review, produced by the Centre for Reviews and Dissemination, were used. Terms were set and a search of electronic databases and peer-reviewed academic journals was completed, from which 16 primary research papers (from the UK) were obtained and used. These were assessed, using evidence-based critical appraisal tools, to obtain data pertinent to the original question. This paper describes the process, including a detailed account of the methodologies employed to gather and analyse relevant data. Put into context, alongside key drivers (e.g. government papers), the findings are presented and discussed, along with underlying theories, where appropriate. Recommendations for professional practice are then presented.

The cultural context of visual hallucinations

Visual hallucinations (VH) are a cardinal neuropsychiatric symptom and often have important diagnostic implications. The interpretation of VH is influenced by the patient's social and cultural milieu, but the impact of socio-cultural factors on the interpretation, presentation and detection of VH has been little studied. When patients exhibit VH and other neuropsychiatric phenomena, appropriate sensitivity to the role of cultural factors is an important determinant of the success of the medical consultation. We discuss this issue using three illustrative cases.

Stigma, discrimination, empowerment and social networks: a preliminary investigation of their influence on subjective quality of life in a Swedish sample

BACKGROUND

Studies investigating the importance of social network, empowerment and experiences of stigma on subjective quality of life among persons with mental illness are rare.

AIM

This study aimed to investigate beliefs of devaluation/discrimination, actual rejection experiences, empowerment, social network and the relationship of these factors to subjective quality of life among subjects with mental illness.

METHODS

A cross-sectional study assessing beliefs of devaluation/discrimination, actual rejection experiences, empowerment, social network and subjective quality of life was performed on 150 subjects with mental illness.

RESULTS

The factors most prominently related to subjective quality of life were overall empowerment and overall social network. For a subgroup of subjects suffering from psychotic disorders there was a significant negative relationship between subjective quality of life and rejection experiences. This group also reported more frequent rejection experiences.

CONCLUSION

The findings indicate that persons with mental illness are a heterogeneous group with regard to the influence of social network, stigma and empowerment on subjective quality of life. The negative impact of actual rejection experiences might express that, in order to increase subjective quality of life, stigma must be addressed as a separate and important factor in its own right.