Responses to mental health stigma questions: the importance of social desirability and data collection method

Feasibility and Acceptability of Mobile Phone-Based Surveys to Identify Mental Health Symptoms in Parents/Guardians of PICU Patients

OBJECTIVE

Parents experience psychologic distress during their child's admission to a PICU, but effective screening for parental mental health symptoms is not the standard of care. We aimed to test the feasibility and acceptability of a mobile phone-based mental health survey for parents/guardians of PICU patients to facilitate their support by the PICU team.

DESIGN

Post hoc analysis of a single-institution pilot study conducted in 2022. Mental health surveys were delivered by text message to parents/guardians of PICU patients over 1 month, beginning 3 days after their child's PICU admission. In-person interviews 1 month after hospital discharge were used to solicit participants' opinions on the survey platform and content.

SETTING

A quaternary U.S. academic medical center.

PARTICIPANTS

Parents/guardians of PICU patients.

INTERVENTIONS

None.

MEASUREMENT AND MAIN RESULTS

Of the 53 participants who consented, 31 (58%) completed the study. Symptoms of acute stress (ASS) were the most common and most severe: 21 participants screened positive for ASS, and 20 of those that screened positive had "moderate" or "severe" symptoms. Among the 23 participants who screened positive for one mental health condition, 10 met the thresholds for all three. Scoring of the protocol's usability, acceptability, and feasibility showed a System Usability Scale equal to 82 of 100, an Acceptability of Intervention Measure score equal to 4.2 of 5, an Intervention Appropriateness Measure score equal to 4.5 of 5, and Feasibility of Intervention Measure score equal to 4.5 of 5.

CONCLUSIONS AND RELEVANCE

Mobile phone-based screening for parental mental health symptoms is acceptable and may offer the advantage of privacy and flexibility.

French validation of the barriers to access to care evaluation (BACE-3) scale

BACKGROUND

The aim of this study was to develop and evaluate a French version of the Barriers to Access to Care Evaluation (BACE-3) scale that is tailored to the socio-cultural and language setting of the study.

METHODS

The translation of the BACE-3 into French and its validation were the two key components of this psychometric investigation. An online survey was created and circulated to French-speaking participants who volunteered to participate in the study.

RESULTS

For all translated questions, the reliability analysis key results (Cronbach's alpha and McDonald's Omega) were both>0.95, which is an excellent reliability value. The BACE-3 items were shown to be positively related to one another, implying excellent validity. Results of exploratory and confirmatory factor analyses showed that all stigma-related items were loaded under the same factor.

CONCLUSIONS

The BACE-3 has been validated in French, and its psychometric qualities have been thoroughly evaluated and found to be excellent.

Effectiveness of participatory video in lowering stigma against people with mental, neurological and substance use disorders in Kenya

BACKGROUND

Globally, stigma associated with mental, neurological and substance use (MNS) disorders is rampant and a barrier to good health and overall well-being of people with these conditions. Person-centred digital approaches such as participatory video may reduce stigma, but evidence on their effectiveness in Africa is absent.

AIMS

To evaluate the effectiveness of participatory video in reducing mental health-related stigma in a resource-limited setting.

METHOD

We evaluated the effectiveness of using participatory video and face-to-face interaction between people with MNS disorders and a target audience in lowering stigma among 420 people living in Kilifi, Kenya. Changes in knowledge, attitudes and behaviour (KAB) were measured by comparing baseline scores with scores immediately after watching the participatory videos and 4 months after the intervention. Sociodemographic correlates of stigma scores were examined using multivariable linear regression models.

RESULTS

Compared with baseline, KAB scores significantly improved at both time points, suggesting reduced stigma levels. At 4 months, the changes in scores were: knowledge (β = 0.20, 95% CI 0.16-0.25; P < 0.01), liberal attitude (β = 1.08, 95% CI 0.98-1.17; P < 0.01), sympathetic attitude (β = 0.52, 95% CI 0.42-0.62; P < 0.01), tolerant attitude (β = 0.72, 95% CI 0.61-0.83; P < 0.01) and behaviour (β = 0.37, 95% CI 0.31-0.43; P < 0.01). Sociodemographic variables were significantly correlated with KAB scores; the correlations were not consistent across the domains.

CONCLUSIONS

Participatory video is a feasible and effective strategy in improving knowledge, attitudes and intended behaviour in a resource-limited setting. Further studies are required to understand the mechanisms through which it lowers stigma and to examine long-term sustainability and the effectiveness of multicomponent interventions.

Regional differences in the assessment of depressive symptoms in the former German Democratic Republic and Federal Republic of Germany

AIM

The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health.

SUBJECT AND METHODS

To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802).

RESULTS

Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude.

CONCLUSION

We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.

The socioeconomic context of stigma: examining the relationship between economic conditions and attitudes towards people with mental illness across European countries

Introduction

Efforts to reduce the stigma associated with mental illness have intensified over the past 30 years with a particular focus on improving public attitudes. Difficult economic circumstances can be harmful to intergroup relations, but little is known about whether there is a relationship between socioeconomic conditions and attitudes towards people with mental illnesses.

Methods

Random effects logistic regression modelling was employed to explore the relationship between individual financial circumstances, contextual socioeconomic factors and difficulty speaking to a person with a significant mental illness across European countries.

Results

Lower GDP per capita and higher income inequality at the country level, alongside individual financial difficulties, were each associated with a greater likelihood of reporting difficulty speaking to a person with a significant mental illness.

Discussion

Micro and macro-economic factors are associated with public attitudes towards people with mental illness across Europe. With prolonged economic instability predicted over the coming years in Europe it is important that these findings are taken into consideration when designing mental health and social policies, in order to safeguard the progress that has been made in reducing mental health stigma to date.

A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain

Objectives

Research comparing mental and physical health stigma is scarce. The aim of this study was to compare social exclusion towards hypothetical males and females with depression or chronic back pain. Furthermore, the study investigated whether social exclusion is associated with participant's empathy and personality traits, while controlling for their sex, age and personal exposure to mental/physical chronic health conditions.

Design

This study employed a cross-sectional questionnaire design.

Methods

Participants (N = 253) completed an online vignette-based questionnaire and were randomly allocated to either a depression or chronic back pain study condition. Measures of social exclusion through respondents' willingness to interact with hypothetical individuals, empathy and the Big Five personality traits were completed.

Results

Willingness to interact scores did not significantly differ depending on the diagnosis or sex of the hypothetical person in the vignette. For depression, higher levels of conscientiousness significantly predicted less willingness to interact. Whilst being a female participant and having higher empathy significantly predicted greater willingness to interact. For chronic back pain, higher empathy significantly predicted greater willingness to interact, with no significant predictors found from the Big Five personality traits.

Conclusion

Findings indicate that females and males with depression or chronic back pain face similar levels of social exclusion, with empathy being a core variable driving social exclusion behaviours. These findings enhance our understanding of potential variables driving social exclusion, in-turn informing campaign development to reduce public stigma towards depression and chronic back pain.

Counseling women of reproductive age about emergency preparedness - Provider attitudes and practices

We report healthcare provider attitudes and practices on emergency preparedness counseling for women of reproductive age (WRA), including pregnant, postpartum, and lactating women (PPLW), for disasters and weather emergencies. DocStyles is a web-based panel survey of primary healthcare providers in the United States. During March 17-May 17, 2021, obstetricians-gynecologists, family practitioners, internists, nurse practitioners, and physician assistants were asked about the importance of emergency preparedness counseling, level of confidence, frequency, barriers to providing counseling, and preferred resources to support counseling among WRA and PPLW. We calculated frequencies of provider attitudes and practices, and prevalence ratios with 95% CIs for questions with binary responses. Among 1503 respondents (family practitioners (33%), internists (34%), obstetrician-gynecologists (17%), nurse practitioners (8%), and physician assistants (8%)), 77% thought emergency preparedness was important, and 88% thought counseling was necessary for patient health and safety. However, 45% of respondents did not feel confident providing emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of knowledge (34%) as barriers to providing counseling. Most respondents (79%) stated they would use emergency preparedness educational materials for WRA, and 60% said they were willing to take an emergency preparedness training. Healthcare providers have opportunities to provide emergency preparedness counseling; however, many have not, noting lack of time and knowledge as barriers. Emergency preparedness resources combined with training may improve healthcare provider confidence and increase delivery of emergency preparedness counseling.

The Continued Impacts of the COVID-19 Pandemic on Education and Mental Health Among Sub-Saharan African Adolescents

PURPOSE

This multicountry survey assessed the levels and the determinants of the impacts of the pandemic on education and mental health among adolescents in sub-Saharan Africa and the potential factors that may exacerbate these adverse impacts.

METHODS

A phone survey was conducted among adolescents in nine diverse areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania between July and December 2021. Approximately 300 adolescents per area and 2,803 adolescents in total were included. The survey collected information on adolescents' sociodemographic characteristics, current COVID-19 preventive measures, and the impacts of the pandemic on daily activities, education, and mental health. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) for determinants of education and mental health outcomes.

RESULTS

Overall, 17% of the adolescents were not receiving any education. Compared to boys, girls were 15% more likely than boys to lack fully in-person education (aPR: 1.15; 95% confidence interval [CI]: 1.02, 1.30). Rural residence was associated with 2.7 times the prevalence of not currently receiving any education (aPR: 2.68; 95% CI: 2.23, 3.22). Self-reported experience of the current impacts of the pandemic on daily activities was associated with a higher prevalence of possible psychological distress (aPR: 1.86; 95% CI: 1.55, 2.24), high anxiety level (aPR: 3.37; 95% CI: 2.25, 5.06), and high depression level (aPR: 3.01; 95% CI: 2.05, 4.41).

DISCUSSION

The COVID-19 pandemic presents continued challenges to adolescents' education and mental health. Multisectoral efforts are needed to ensure that adolescents in sub-Saharan Africa do not fall further behind due to the pandemic.

The Role of Bias in Clinical Decision-Making of People with Serious Mental Illness and Medical Co-morbidities: a Scoping Review

The aim of this review was to examine the evidence for the impact of explicit and implicit biases against mental illness on the clinical decision-making of primary care physicians, medical students, and nurses when they are providing care to individuals with serious mental illness for cardiovascular disease, diabetes, and cancer. Studies were identified by searching MEDLINE, EBSCO host, and PsychINFO. A total of 18 studies published between 1996 and 2020 were reviewed and summarized. The studies were divided into two groups-studies that used a simulation or vignette methodology and those with a qualitative approach (interviews and focus groups). Of the simulation/vignette studies that allowed participants to report what they would have done in various clinical scenarios, there were roughly equal numbers of neutral or negative clinical decisions that represented 80% of the relevant behavioral results. Only 21% of the findings demonstrated a clinical decision that was favorable towards people with mental illness. Of the qualitative studies, all of the studies reported behaviors (either self-reported or observed) that were likely to be biased against people with mental illness, while 3 of the studies reported mixed results. Healthcare provider bias against individuals with mental illness does exist and impacts clinical decisions negatively. Much more empirical work needs to be done to determine the full extent and impact of the problem, including how these decisions affect the lives of individuals with mental illness.

Discrimination and social stigma against people with mental illnesses in Argentina

BACKGROUND

Individuals with mental and neurological illnesses face stigma and discrimination every day. There are only a few studies regarding the degree of discrimination in the comparison between the illnesses, and no recent research has been found in Argentina about this topic.

AIMS

The aim of this research is to study and compare stigma and discrimination toward people with mental illnesses (schizophrenia, substance use disorder, and bipolar disorder) and with neurological disorders (epilepsy) in Argentina, while analyzing the social distance toward them. The level of responsibility attributed to individuals with these disorders were also assessed and compared.

METHOD

Individuals from Buenos Aires, Argentina, were surveyed in order to measure the social distance given to people with mental illnesses and a neurological disease. For that purpose a modified version of the Bogardus scale was used, with a sample of 500 individuals contacted online in January 2021.

RESULTS

Social distance toward people with mental illnesses was higher than those with a neurological disorder (epilepsy). A significant difference was found in the level of responsibility attributed to people with substance use disorder in comparison to the other illnesses. On the contrary, there were no significant differences of discrimination according to age or sex. Finally, the research outcomes showed that people with substance use disorder are the most discriminated against and stigmatized.

CONCLUSION

A significant level of discrimination was found against individuals with mental disorders and, specially, toward people with substance use disorder. Moreover, they are perceived as responsible for their disorder. For this reason, anti-stigma campaigns should be directed to end the misconceptions toward the most discriminated groups. More support is needed to counteract the stigmatization and exclusion of individuals with mental and neurological disorders in our society.

Predictors of Mental Health Literacy among Parents, Guardians, and Teachers of Adolescents in West Malaysia

Parents, guardians, and teachers are the informal sources of mental health support that adolescents rely on. Nevertheless, limited mental health knowledge limits their ability and confidence in providing appropriate assistance. This study aims to (1) evaluate the relationship between the roles of parents/guardians and teachers and their responses to discover the common misconceptions on mental health among those providing informal support to adolescents and (2) determine which demographic factors would act as the strongest predictor influencing their mental health literacy (MHL) status. The cross-sectional study recruited 867 parents, guardians, and teachers of adolescents from 24 government secondary schools' parent-teacher associations via multistage stratified random sampling. Parents, guardians, and teachers' MHL were evaluated using the Mental Health Knowledge Schedule-Malay Version (MAKS-M). The collected data were analyzed using Pearson's Chi-squared test to investigate the association between the respondents' roles and responses. Multiple Regression analysis was used to determine the predictors of MHL. The score of MAKS-M for the current study sample is 73.03% (M = 43.82, SD = 4.07). Most respondents responded incorrectly on Items 1 (employment), 6 (help-seeking), 8 (stress), and 12 (grief). Teachers provided more favorable responses on several items than parents and guardians. Finally, younger age, higher income, knowing someone with mental disorders, and having experience of attending formal training on mental health first aid were the significant predictors of MHL. MHL interventions in Malaysia should cater to older adults of lower socioeconomic status and lesser experience in mental health, specifically highlighting the stigmas on mental health help-seeking behaviors, treatment, and employment concerns, plus the recognition of various mental health diagnoses.

Condemn or Treat? The Influence of Adults' Stigmatizing Attitudes on Mental Health Service Use for Children

Stigmatizing attitudes towards mental disorders influence parents’ help-seeking behavior for their child’s mental health problems. As untreated mental disorders can cause morbidity and mortality, such parental attitudes are a serious barrier for public health promotion. Therefore, the help-seeking readiness in a distressed child’s broad social environment is essential. However, the role of stigma was unexplored in this context. This study empirically investigated the influence of adults’ stigmatizing attitudes towards mentally disabled people on their readiness to seek professional help for children’s mental health issues. Data from a representative German sample (N = 1906; 52% female) were collected between July and October 2021. A heteroscedastic ordered probit model was used for estimation. An empirical analysis provides evidence for a significant negative relationship between adults’ stigmatizing attitudes and their readiness to initiate mental health support for children (ß = −0.01; p < 0.001). Support acceptance seems to be independent of having children. To tackle stigmatizing attitudes and to promote public health, mental health literacy should be fostered through broad-based approaches. Awareness should be raised that children are also entitled to mental health care, just as they are in other health areas. Policy makers need to promote comprehensive information about mental illnesses and create incentives for acute and preventive service use.

Alcohol use disorder and disability insurance in Switzerland: the attitudes and views of lawyers, insurance medical experts, and addiction-specialist therapists

BACKGROUND

According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent.

METHODS

Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases.

RESULTS

Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent.

CONCLUSIONS

Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings.

Family Carers of People with Dementia in Japan, Spain, and the UK: A Cross-Cultural Comparison of the Relationships between Experiential Avoidance, Cognitive Fusion, and Carer Depression

Objective and research design This study investigated whether the relationship between experiential avoidance and carer depression is mediated by cognitive fusion using path analysis and whether this model differs between family carers from Japan, Spain, and the UK using multi-group path analysis. Results The whole sample model (N = 745) showed a good fit to the data. The direct effect of experiential avoidance on carer depression (β = .10) and its indirect effect on carer depression through cognitive fusion (β = .15) were significant. Examined variables accounted for 45% of the variance of depression. Multi-group path analysis confirmed the same pattern of indirect path across 3 countries, while the direct path was no longer significant in Spanish and UK samples.Conclusion These findings suggest that targeting cognitive fusion may be particularly critical in culturally diverse carers and pre-emptive efforts to reduce experiential avoidance using psychological techniques may be beneficial among family carers prone to cognitive fusion regardless of cultural differences.

Creating a hierarchy of mental health stigma: testing the effect of psychiatric diagnosis on stigma

BACKGROUND

Levels of mental health stigma experienced can vary as a function of the presenting mental health problem (e.g. diagnosis and symptoms). However, these studies are limited because they exclusively use pairwise comparisons. A more comprehensive examination of diagnosis-specific stigma is needed.

AIMS

The aim of our study was to determine how levels of mental health stigma vary in relation to a number of psychiatric diagnoses, and identify what attributions predict levels of diagnosis-specific stigma.

METHOD

We conducted an online survey with members of the public. Participants were assessed in terms of how much stigma they had, and their attributions toward, nine different case vignettes, each describing a different mental health diagnosis.

RESULTS

We recruited 665 participants. After controlling for social desirability bias and key demographic variables, we found that mental health stigma varied in relation to psychiatric diagnosis. Schizophrenia and antisocial personality disorder were the most stigmatised diagnoses, and depression, generalised anxiety disorder and obsessive-compulsive disorder were the least stigmatised diagnoses. No single attribution predicted stigma across diagnoses, but fear was the most consistent predictor.

CONCLUSIONS

Assessing mental health stigma as a single concept masks significant between-diagnosis variability. Anti-stigma campaigns are likely to be most successful if they target fearful attributions.

The Stigma and Self-Stigma Scales for attitudes to mental health problems: Psychometric properties and its relationship to mental health problems and absenteeism

The Stigma and Self-Stigma scales (SASS) measure multiple aspects of stigmatic beliefs about mental health problems, including cognitive aspects of stigma towards others (Stigma to Others) and emotional stigma toward others (Social Distance), anticipated stigma by others, self-stigma, avoidant coping strategies, and help-seeking intentions, alongside an index of social desirability. The properties of the SASS were investigated by employees of a large UK government organization. With minor exceptions, each of the SASS scales had strong psychometric properties, good internal reliability, and test-retest reliability. Social Distance, Anticipated Stigma, Self-Stigma, and Avoidant Coping were all strongly associated with a lack of help-seeking for mental health problems. Similarly, Stigma to Others, Self-Stigma, and Avoidant Coping were all associated with current mental health problems. Finally, absenteeism from the workplace was found to be negatively related to Stigma to Others, and positively related to Avoidant Coping and Anticipated Stigma. In conclusion, the SASS was able to measure several different forms of stigma about mental health simultaneously in people both with and without a history of mental health problems. The SASS can be used to monitor changes in mental health attitudes outcomes following intervention programs to investigate stigmatic attitudes to mental health problems across different samples.

At home or in hospital: Home treatment and mental health stigma

BACKGROUND

Stigmatized attitudes towards people with mental illness may influence treatment choice for oneself and others.

AIM

To gauge the attitudes of the UK general public towards treatment at home for mental illness and to assess the extent to which non-acceptability was related to stigmatized attitudes.

METHODS

Two hundred and two (101 female) people living in the UK completed an online (vignette) questionnaire in which we asked demographic details and personal experience of mental illness. To measure stigma, we used an adapted version of the Attitudes to Mental Illness Questionnaire (AMIQ) with vignettes asking about treatment at home and using scales for social distance and poor expectations; participants also filled in the Mental Health Knowledge Schedule (MAKS).

RESULTS

Participants did not evidence overall agreement with treatment at home for mental illness (i.e. >0; range = -16-to-+16, Mean (M) = 0.86, 95% confidence interval (CI) = -0.08, 1.80, p = .073), although they showed significant agreement with treatment at home should they experience mental illness themselves (range = -8-to-+8, M = 1.36, CI = 0.82, 1.89, p < .001). Acceptability for treatment at home differed according to specific mental illness considered (range = -4-to-+4); depression (M = 0.47, CI = 0.13, 0.81, p = .006) and alcohol abuse (M = 1.46, CI = 1.14,1.77, p < .001) were considered suitable for being treated at home but schizophrenia was not (M = -0.78, CI = -1.13,-0.43, p < .001). Multivariate analyses revealed that older age and attitudes indicating comfort with less social distance from people with mental illness were independently associated with treatment at home agreeability.

CONCLUSIONS

Public acceptability of home treatment for mental illness remains ambivalent in the UK, most obviously when considering treatment approaches for individuals other than themselves and for people with schizophrenia. Disagreement with home treatment is particularly evident in younger people and those who prefer less social contact with people with mental illness.

Neighborhood Social Cohesion and Dementia-Related Stigma Among Mothers of Adolescents in the Pre- and Current COVID-19 Period: An Observational Study Using Population-Based Cohort Data

Background: Middle-aged adults may be the ideal target group for dementia-related stigma reduction interventions to encourage the utilization of services among those who may become family caregivers. Neighborhood social cohesion may diminish dementia-related stigma, particularly in terms of perceived public attitudes. The COVID-19 pandemic can further negatively impact perceived public stigma. Objective: To investigate the association between neighborhood social cohesion and dementia-related stigma during the pre- and current COVID-19 period. Methods: We employed a cross-sectional design using data from a large population-based cohort, the Tokyo Teen Cohort, in Japan. Overall, 2,469 mothers of 16-year-old adolescents self-completed a questionnaire comprising nine dementia-related stigma questions evaluating perceived public and personal attitudes. Neighborhood social cohesion was assessed using a five-item instrument. The participants were divided into two groups according to the time of assessment: prior to the pandemic’s onset (February 2019–March 2020) and during the pandemic (April 2020–July 2021). A multiple regression analysis of stigma was performed using neighborhood social cohesion as an independent variable, and caring experience, age, educational level, and working status as covariates. Results: Personal and perceived public stigma were significantly lower in participants who perceived greater neighborhood social cohesion. However, level of personal and perceived public stigma did not differ between pre- and during the pandemic period. Conclusion: Neighborhood social cohesion may be a modifiable factor for dementia-related stigma. A localized intervention to enhance social cohesion in the neighborhood community would promote the utilization of services among those who may become family caregivers.

Attitudes toward epilepsy assessed by the SAPE questionnaire in Germany - Comparison of its psychometric properties and results in a web-based vs. face-to-face survey

OBJECTIVE

The aims of this study were (1) to investigate psychometric properties of a new questionnaire (SAPE, Scales of the Attitudes toward People with Epilepsy) that assesses attitudes toward people with epilepsy (PWE) (2) to compare the effects of mode of survey administration (web-based vs. face-to-face) on attitudes, and (3) to identify predictors of attitudes.

METHODS

A face-to-face and a web-based survey were performed in Germany. Weighting factors were used to achieve representative samples of the German population. Reliability and validity of the 6 scales of the SAPE (social distance, stereotypes, personal concerns, and emotional reactions differentiated by fear, anger, and pity) were evaluated and compared for both surveys. Epilepsy knowledge was also assessed. General linear models were performed to investigate predictors of attitudes toward PWE including the type of survey.

RESULTS

In total, 1001 participants of the web-based survey and 1026 participants of face-to-face survey were included. Psychometric analyses indicated satisfactory reliability and validity of the scales and differed only slightly between modes of survey. In both surveys, fears and concerns were more pronounced than stereotypes and social distance. However, mean values of two scales were slightly or moderately higher in the face-to-face survey indicating more negative attitudes toward PWE (p < 0.001). Fewer participants of the face-to-face survey reported personal experience with PWE, claiming to know what to do in case of a seizure and claiming to know that seizures can be treated successfully (p < 0.001). These variables proved to be important predictors of positive attitudes toward PWE, besides demographic factors (e.g. age < 65, female gender). When controlling for them, the differences remained significant only for the scales Social Distance (moderately) and Fear (slightly).

SIGNIFICANCE

In total, psychometric analyses show that web-based surveys using the SAPE may be an alternative to face-to-face surveys to assess attitudes toward PWE. This applies also to the scales Social Distance and Emotional Reactions that allow comparisons with other diseases, e.g. psychiatric disorders. Most scales differ only slightly between survey modes, except social distance. This indicates that single components of attitudes toward PWE may be dependent on the mode of survey or different characteristics of respondents.

Analysis of Stigma in Relation to Behaviour and Attitudes towards Mental Health as Influenced by Social Desirability in Nursing Students

The training undergraduate nursing students receive, both in terms of theoretical input and clinical practice, may help to instil a less stigmatising perception of mental health. To analyse the perceived evolution of attitudes and expected behaviours, a longitudinal repeated measures study was conducted in a population of student nurses during their undergraduate mental health education. The Mental Illness: Clinicians’ Attitudes Scale, a Scale for measuring attitudes to the mentally ill among future Health workers, and the Reported and Intended Behaviour Scale were completed. A mixed linear model was used to assess the effect of each factor in the questionnaires before and after the various stages of the students’ training in mental health. The overall effect of each factor was assessed by testing the interaction between factor and group, both with and without adjustment with the Social Desirability Scale. The results showed that the clinical practice stage, due to the proximity to care for people with mental health problems, improves attitudes and behaviours towards mental health in students who have not had mental health problems, and also in younger students. In conclusion, integrated, holistic training during the period of clinical practice was associated with positive changes in the attitudes and intended behaviour.

Effects of online continuum and categorical belief manipulations on schizophrenia stigma, help-seeking, and help-provision

Most research investigating the effect of continuum beliefs on stigma has used weak manipulations which may contribute to mixed findings within the experimental literature. There is also a lack of research into how continuum belief manipulations may impact help-seeking and help-provision. This study used an online manipulation of continuum and categorical beliefs about schizophrenia to examine the subsequent impacts on stigma, help-seeking, and help-provision. A total of 271 participants were randomised into either a continuum, categorical, or control condition. Participants received an informational video, a magazine article, and research highlights relevant to their condition. Prosocial support behaviour was assessed through a novel volunteering measure. The magnitude of change between pre-intervention and post-intervention measures of continuum and categorical beliefs was large. Continuum presentations reduced prognostic pessimism and negative stereotyping. Meanwhile, categorical presentations increased prognostic pessimism. Participants across conditions showed increased help-providing intentions after removing the highest scores to avoid ceiling effects. Fear and blame also decreased significantly across all conditions. There was no difference between conditions on our novel volunteer help-provision measure. Our findings have implications for anti-stigma programs and may help inform the design of future continuum belief manipulations.

Dog-related activities and human well-being in Brazilian dog owners: A framework and cross-cultural comparison with a British study

Despite the abundance of studies investigating the benefits of having a dog, the specific aspects of dog ownership that impacts human well-being are not well understood. This study used a qualitative approach to create a framework of the main dog-related activities perceived by Brazilian owners to impact their well-being and compared the findings with those of a similar study in England. Thirty-two Brazilian dog owners from the five regions of the country were remotely interviewed. The thematic analysis of the transcripts generated a total of 58 dog-related activities, organised into 13 themes. Most activities were reported to have a positive effect on participants' well-being, accounting for 76.8% of the total number of mentions in the interviews. 'Playing with dog' and 'Dog presence' were the themes most frequently associated with positive well-being outcomes, whereas 'Unwanted behaviours' and 'Failing to meet dog's needs' were the most commonly associated with negative outcomes. The dog-related activities reported by Brazilian dog owners and the well-being outcomes linked to those activities were consistent with the previous British sample in the framework that emerged. These findings suggest reliability between the two methods used to gather data (remote interview versus focus group) and, most importantly, provide consistent cross-cultural evidence for how certain activities impact dog owner's well-being.

Mental health difficulties in students with suspected COVID-19 symptoms and students without suspected COVID-19 symptoms: A cross-sectional comparative study during the COVID-19 pandemic

INTRODUCTION

Mental health problems are taking a heavy toll on students during the COVID-19 pandemic. The purpose of this study was to compare the level of anxiety symptoms, depressive symptoms, post-traumatic stress symptoms (PTSS), and fear of COVID-19 between students with suspected COVID-19 symptoms and students without any suspected symptoms during the pandemic in Bangladesh.

METHODS

This cross-sectional comparative study was conducted online among Bangladeshi students from May to July 2020. Anxiety symptoms, depressive symptoms, PTSS, and fear of COVID-19 were assessed by using the Generalized Anxiety Disorder scale, Patient Health Questionnaire, the Impact of Event Scale, and Fear of COVID-19 Scale, respectively. College and University students were the participants of the study.

RESULTS

Among 3777 students, 1259 had suspected COVID-19 symptoms and 2518 had no suspected COVID-19 symptoms. Students who experienced suspected COVID-19 symptoms had higher prevalence (moderate to severe) of depressive symptoms (61.15% vs. 47.62%), anxiety symptoms (44.96% vs. 36.97%), and PTSS (48.3% vs. 39.75%) compared to those who had no such symptoms. The study identified having suspected COVID-19 symptoms as a significant associated factor for anxiety symptoms (β1' = 1.39; 95% CI: 1.03-1.74), depressive symptoms (β1' = 1.88; 95% CI: 1.43-2.32), PTSS (β1' = 3.66; 95% CI: 2.66-4.65), and fear of COVID-19 (β1' = 0.48; 95% CI: 0.02 to 0.94). Students with suspected COVID-19 symptoms thought more that they would be better off dead, or of hurting themselves (P < 0.01) and felt more afraid as if something awful might happen (P < 0.01) than their counterparts.

CONCLUSION

Mental health difficulties are more prevalent among students with suspected COVID-19 symptoms than the students without having such symptoms. This finding suggests that public health practitioners should deploy a rapid diagnostic system and consider psychological intervention in addition to clinical management for those who have COVID-19 like symptoms during the pandemic.

Contact With Persons With Mental Illness and Willingness to Live Next Door to Them: Two Waves of a California Survey of Adults

OBJECTIVE

This study sought to extend findings from previous studies of the association between having had interpersonal contact with individuals with mental illness and the desire to avoid contact with them (i.e., social distance).

METHODS

The authors used a longitudinal design with a representative sample of 1,057 California adults who completed a survey in 2013 (wave 1) and 2014 (wave 2). Bivariable and multivariable logistic regression analyses were used to test whether demographic characteristics and changes in past-year contact with individuals with mental illness affected perceptions of the dangerousness of individuals with mental illness and willingness to move next door to someone with mental illness.

RESULTS

An increase in contact with someone with mental illness between the two waves was associated with a decrease in unwillingness to move nearby a person with mental illness, even after the analysis accounted for contact and unwillingness at wave 1 (odds ratio [OR]=0.51, 95% confidence interval [CI]=0.31-0.84). Wave 1 beliefs that persons with mental illness are dangerous were associated with unwillingness to move nearby (OR=3.81, 95% CI=2.29-6.35) but changes in beliefs about dangerousness were not (OR=0.71, 95% CI=0.42-1.19).

CONCLUSIONS

Increased naturally occurring contact with individuals with mental illness appears to decrease unwillingness to move near a person with mental illness for as long as 1 year after the contact. Housing and services that aim to integrate individuals with mental illness into the community should consider strategies that include contact with individuals with mental illness to counter community opposition.

Mental Health Consequences of the Coronavirus 2020 Pandemic (COVID-19) in Spain. A Longitudinal Study

Background: Covid-19 remains a pandemic that most countries in the world are still dealing with. This is study aims to report the psychological impact of Covid-19 over time on the Spanish population. Methods: A longitudinal study (N = 1041) was carried out with two measurements: after 2 and 5 weeks starting from the declaration of the state of emergency in Spain. The presence of depressive symptoms, anxiety, and posttraumatic stress disease (PTSD) was evaluated by means of screening tests. Sociodemographic data, variables about Covid-19, loneliness, spiritual well-being, social support, discrimination, and a sense of belonging were collected. Results: The data showed how depressive symptomatology increased significantly over time, while anxiety and PTSD did not show statistically significant changes. Spiritual well-being and loneliness were the main predictors of psychological impact. A younger age was a significant predictor of depression and anxiety, while female gender was associated with anxiety and PTSD. Conclusions: The impact of the pandemic is sustained over time, even increasing in depression, and vulnerable groups that need greater psychological health support could be identified.

Validation and Measurement Invariance of the Leuven Obsessional Intrusions Inventory in Two Different Cultures

Obsessions - recurrent unwanted intrusive thoughts - are one of the two pillars of the Obsessive Compulsive Disorder (OCD). Although OCD has been reported across many different cultures, research on these cultural variations is hampered by the lack of cross-culturally sound instruments to assess intrusive thoughts. The aim of the current study is to investigate the psychometric properties of the recently developed Leuven Obsessional Intrusions Instrument (LOII) in two different cultural contexts. Turkish (N = 663) and Belgian (N = 496) participants were sampled from non-clinical student populations. Results from confirmatory factor analyses yielded a shortened version of the LOII (i.e., LOII-R) with a four-factor solution - aggressive, sexual, and contamination intrusions, and 'just-right' doubts - as the best fitting model across both cultures. The model met most criteria for strong measurement invariance, and proved to be both valid and reliable. The results of this study suggest that the LOII-R is a good candidate for cross-cultural studies on obsessional intrusions.

EXPLICIT-IMPLICIT DISCREPANCY IN MACRO-LEVEL MENTAL ILLNESS STIGMA IS LINKED TO PREVALENCE AND CARE

Introduction: This study explores the associations in the United States between each state's stereotypes about the dangerousness of people with mental illness and important outcomes for people with mental illness.

Methods: Implicit association test and questionnaire data from 17,312 online participants were aggregated within states and years. Each state's annual average implicit and explicit stereotypes were used to predict state differences in prevalence, and treatment, unemployment, and homelessness among people with mental illness.

Results: Implicit and explicit perceived dangerousness interact such that in states with low explicit perceived dangerousness, implicit perceived dangerousness is positively associated with all outcomes. In states with high explicit perceived dangerousness, implicit perceived dangerousness is negatively associated with homelessness.

Discussion: Explicit-implicit discrepancy in macro-level perceived dangerousness is generally associated with worse outcomes for people with mental illness, but the effects are small. Macro-level stereotypes might have larger effects in smaller regions, like counties, than in states.

An Anti-Stigma Course for Occupational Therapy Students in Taiwan: Development and Pilot Testing

Attitudes of healthcare professionals towards people with disorders/disabilities are important for the development of therapeutic relationships, as well as to the evaluation and intervention processes. Therefore, it is critical to be aware and reduce stigmatizing attitudes in future healthcare professionals. An 18-week anti-stigma course was developed for occupational therapy students based on literature review and focus group interview. The course consisted of three components, including social contact, roleplaying, and critical reflection strategies. A quasi-experimental design was implemented to evaluate participants at three time points (i.e., pre-test, post-test, and one year after completion) using the Social Distance Scale and several questionnaires (i.e., stigmatising attitudes towards mental illness, physical disabilities, and children with emotional behavioural disorders). A total of 16 students completed the course and had significantly decreased social distance and stigmatising attitudes towards mental illness and emotional behavioural disorders in the post-test. These decreases remained one year later. The results support the provision of an anti-stigma course for occupational therapy students to reduce stigmatising attitudes. Future research should extend the anti-stigma course to occupational therapy students at other universities to increase both the sample size and overall generalisability.

Initial psychological impact of COVID-19 and its correlates in Indian Community: An online (FEEL-COVID) survey

BACKGROUND

The pandemic of Corona Virus (COVID-19) hit India recently; and the associated uncertainty is increasingly testing psychological resilience of the masses. When the global focus has mostly been on testing, finding a cure and preventing transmission; people are going through a myriad of psychological problems in adjusting to the current lifestyles and fear of the disease. Since there is a severe dearth of researches on this issue, we decided to conduct an online survey to evaluate its psychological impact.

METHODS

From 26th to 29th March an online survey (FEEL-COVID) was conducted using principles of snowballing, and by invitation through text messages to participate. The survey collected data on socio-demographic and clinical variables related to COVID-19 (based on the current knowledge); along with measuring psychological impact with the help of Impact of Event-revised (IES-R) scale.

RESULTS

There were a total of 1106 responses from around 64 cities in the country. Out of these 453 responses had at least one item missing; and were excluded from the analysis. The mean age of the respondents was around 41 years with a male female ratio of 3:1 and around 22% respondents were health care professionals. Overall approximately one third of respondents had significant psychological impact (IES-R score > 24). Higher psychological impact was predicted with younger age, female gender and comorbid physical illness. Presence of physical symptoms and contact history predicted higher psychological impact, but did not reach statistical significance.

CONCLUSION

During the initial stages of COVID-19 in India, almost one-third respondents had a significant psychological impact. This indicates a need for more systematic and longitudinal assessment of psychological needs of the population, which can help the government in formulating holistic interventions for affected individuals.

Racial discrimination and disability among Asian and Latinx populations in the United States

Purpose: This study examined the association between perceived racial discrimination and disability among Asian and Latinx residents of the United States, as the link between discrimination and disability has gone largely ignored in analyses of these populations.Materials and methods: Nationally representative samples included 2046 Asian Americans and 2515 Latinx Americans from the National Latino and Asian American Study (NLAAS). We used multivariable logistic regression and multivariable negative binomial regression to analyze the association between racial discrimination and five different disability domains as well as racial discrimination and a count of simultaneous functional limitations, respectively. The disability domains included: self-care, cognition, mobility, time out of role, and social interaction.Results and conclusions: Perceived racial discrimination positively and significantly predicted impairments across a variety of disability domains for both Asian and Latinx populations. The estimated associations between racial discrimination and disability were heterogeneous across Asian and Latinx ethnicities. Racial discrimination may contribute to stress for Asians and Latinxs in the United States, potentially increasing the possibility these populations develop disabilities. Rehabilitation efforts should consider the social contexts in which people of color live, recognizing that discrimination may differentially affect risk profiles for disabilities across racial and ethnic groups.IMPLICATIONS FOR REHABILITATIONAcross Asian and Latinx populations, racial discrimination is associated with impairments in self-care, cognition, mobility, time out of role, and social interaction.Future translational research can explore the utility of brief racial discrimination screens in clinical settings to assess risk for disability in various domains.Professionals should attend to the stress and overall impact of racial discrimination, as it is conceivable that racial discrimination may result in the exclusion or hindrance of people of color who are pursuing meaningful participation in places of work, public spaces, and civic life.Society bears the collective obligation to reduce discrimination against Asian and Latinx populations, particularly against those who experience disability.

Empowering the Next Generation to End Stigma by Starting the Conversation: Bring Change to Mind and the College Toolbox Project

OBJECTIVE

To examine outcomes in a 4-year college pilot program built on stigma change research. U Bring Change to Mind (UBC2M) was developed and launched at Indiana University (IU) in 2014 as an institutionally supported, student-led organization to make campuses "safe and stigma-free zones." The accompanying College Toolbox Project (CTP) assessed change in student prejudice and discriminatory predispositions as well as perceptions and behaviors at follow-up.

METHOD

All entering Class of 2019 students were invited to complete a Web-based survey (N = 3,287; response rate = 44.6%). In their third year, students were sent a follow-up survey. Stigma indicators for 1,132 students completing both waves were analyzed using descriptive statistics and multivariate regressions. Models controlled for social desirability, prior contact, socio-demographics, and self-reported mental illness. Participation was examined for potential biases.

RESULTS

Statistically significant positive changes in attitudes and behavioral predispositions emerged. Although fewer students with prior contact endorsed stigma items initially, they reported significant reduction at follow-up. UBC2M active engagement was associated with lowering prejudice. Both passive and active engagement predicted change in discriminatory predispositions as well as current inclusive behaviors and positive perceptions of campus mental health culture.

CONCLUSION

A long-term, community-based, student empowerment approach with institutional supports is a promising avenue to reduce stigma on college campuses, to develop the next generation of mental health leaders, and to potentially reduce societal levels of stigma in the long run. CTP provides evidence that both contact and contextual visibility matter, and that UBC2M offers a nationally networked organizational strategy to reduce stigma.

Time to Change's social marketing campaign for a new target population: results from 2017 to 2019

BACKGROUND

Since 2009 Time to Change has included among its strategies a social marketing campaign to tackle the stigma surrounding mental health problems. At the start of its third phase (2016-2021) the target group of the campaign was kept as people aged between mid-twenties and mid-forties but changed to middle-low income groups and the content was focused on men.

METHODS

Participants (n = 3700) were recruited through an online market research panel, before and after each burst of the campaign. They completed an online questionnaire evaluating knowledge (Mental Health Knowledge Schedule, MAKS); attitudes (Community Attitudes toward Mental Illness, CAMI); and desire for social distance (Intended Behaviour subscale of the Reported and Intended Behaviour Scale, RIBS). Socio-demographic data and awareness of the campaign were also collected.

RESULTS

For each of the 3 bursts, significant pre-post awareness differences were found (OR = 2.83, CI = 1.90-4.20, p < 0.001; OR = 1.72, CI = 1.22-2.42, p = 0.002; OR = 1.41, CI = 1.01-1.97, p = 0.043), and awareness at the end of the third burst was 33%. Demographic factors associated with awareness for one or more bursts included having children, familiarity with mental illness, male sex, being Black, Asian or other ethnic minorities and living in London or the East Midlands regions. An improvement across bursts in the "living with" subscale item of the RIBS, and in the "recover" and "advice to a friend" MAKS items were found. Familiarity with mental illness had the strongest association with all outcome measures, while the awareness of the campaign was also related with higher scores in MAKS and RIBS.

CONCLUSIONS

These interim results suggest that the campaign is reaching and having an impact on its new target audience to a similar extent as did the TTC phase 1 campaign. While over the course of TTC we have found no evidence that demographic differences in stigma have widened, and indeed those by age group and region of England have narrowed, those for socioeconomic status, ethnicity and sex have so far remained unchanged. By targeting a lower socioeconomic group and creating relatively greater awareness among men and in Black and ethnic minority groups, the campaign is showing the potential to address these persistent differences in stigma.

Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda

BACKGROUND

Mental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness.

METHODS AND FINDINGS

Study participants were randomly assigned to receive a vignette describing a typical woman (control condition) or one of nine variants describing a different symptom presentation (suggestive of schizophrenia, bipolar, or major depression) and treatment course (no treatment, treatment with remission, or treatment with remission followed by subsequent relapse). Participants then answered questions about personal beliefs and perceived norms in three domains of stigma: willingness to have the woman marry into their family, belief that she is receiving divine punishment, and belief that she brings shame on her family. We used multivariable Poisson and ordered logit regression models to estimate the causal effect of vignette treatment assignment on each stigma-related outcome. Of the participants randomized, 1,355 were successfully interviewed (76%) from November 2016 to June 2018. Roughly half of respondents were women (56%), half had completed primary school (57%), and two-thirds were married or cohabiting (64%). The mean age was 42 years. Across all types of mental illness and treatment scenarios, relative to the control vignette (22%-30%), substantially more study participants believed the woman in the vignette was receiving divine punishment (31%-54%) or believed she brought shame on her family (51%-73%), and most were unwilling to have her marry into their families (80%-88%). In multivariable Poisson regression models, vignette portrayals of untreated mental illness, relative to the control condition, increased the risk that study participants endorsed stigmatizing personal beliefs about mental illness and about persons with mental illness, irrespective of mental illness type (adjusted risk ratios [ARRs] varied from 1.7-3.1, all p < 0.001). Portrayals of effectively treated mental illness or treatment followed by subsequent relapse also increased the risk of responses indicating stigmatizing personal beliefs relative to control (ARRs varied from 1.5-3.0, all p < 0.001). The magnitudes of the estimates suggested that portrayals of initially effective treatment (whether followed by relapse or not) had little moderating influence on stigmatizing responses relative to vignettes portraying untreated mental illness. Responses to questions about perceived norms followed similar patterns. The primary limitations of this study are that the vignettes may have omitted context that could have influenced stigma and that generalizability beyond rural Uganda may be limited.

CONCLUSIONS

In a population-based, randomized survey experiment conducted in rural southwestern Uganda, portrayals of effectively treated mental illness did not appear to reduce endorsement of stigmatizing beliefs about mental illness or about persons with mental illness. These findings run counter to evidence from the United States. Further research is necessary to understand the relationship between mental illness treatment and stigmatizing attitudes in Uganda and other countries worldwide.

TRIAL REGISTRATION

The experimental procedures for this study were registered with ClinicalTrials.gov as "Measuring Beliefs and Norms About Persons With Mental Illness" (NCT03656770).

How does mental health stigma get under the skin? Cross-sectional analysis using the Health Survey for England

Despite increased awareness of mental health problems, stigma persists. Little research has examined potential health and wellbeing outcomes associated with stigma. The aim of this study was to investigate relationships between mental health stigma, metabolic and cardiovascular biomarkers, as well as wellbeing and quality of life among people with no mental disorder, common mental disorders and severe mental illness. Data were taken from adults aged 16 + years participating in the Health Survey for England in 2014 (N = 5491). Mental health stigma was measured using the 12-item Community Attitudes towards the Mentally Ill (CAMI) scale, intended to measure attitudes around prejudice and exclusion, and tolerance and support for community care. Individuals were divided into six groups based on their mental health (no mental disorder, common mental disorder, severe mental illness) and whether they exhibited more (≤25^th percentile) or less (>25^th percentile) stigmatising attitudes. Metabolic and cardiovascular biomarker outcomes included systolic and diastolic blood pressure; total cholesterol; high-density lipoprotein (HDL) cholesterol; glycated haemoglobin, body mass index (BMI), waist-hip ratio and resting pulse rate. Biomarkers were analysed individually and as an allostatic load score. Wellbeing was measured using Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and quality of life via Euro-QoL-5D (EQ-5D). Linear regression models were calculated adjusted for confounders. Compared to individuals with less stigmatising attitudes, results suggested that those with more negative attitudes exhibited poorer wellbeing and quality of life across all mental disorder/stigma groups, including those with no mental disorder (WEMWBS (range 14–70): b = -1.384, 95% CI: -2.107 to -0.661). People with severe mental illness generally had unhealthier biomarker profiles and allostatic load scores, but results were inconsistent for any additional influence of mental health stigma. Reducing stigma may be beneficial for population wellbeing, but further research is needed to clarify whether stigma contributes to adverse biomarkers amongst people with mental illness.

•

Few studies have researched the consequences of mental health stigma.

•

More stigmatising attitudes relate to poorer wellbeing amongst all groups.

•

People with severe mental illness had more adverse biomarker profiles.

•

Results were inconclusive for any additional influence of mental health stigma.

Assessment of mental health and psycho-social support pilot program's effect on intended stigmatizing behavior at the Saftawi Health Center, Gaza: a cross-sectional study

Background: In the midst of a global refugee crisis, addressing mental health is critical for refugee health care delivery. Understanding efficacy of mental health interventions is more important than ever. Aims: In this study, we aim to assess the efficacy of comprehensive mental health and psychosocial support services for refugees in Gaza by comparing intended stigmatizing behavior toward mental health disorders between two health centers (HCs)(Saftawi and Nasser). Methods: One year after these services by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East were implemented at Saftawi HC, a randomly selected sample of HC patrons (n = 205) from Saftawi, and a comparable number from a control HC (n = 203 at Nasser) completed the Reported and Intended Behavior Scale (RIBS) regarding stigma towards mental illnesses. Multivariable linear regressions were used to determine the impact of these services in the HC on attitudes against mental health. Results: Saftawi respondents endorsed significantly less intended stigmatizing behavior compared to Nasser respondents (p < 0.001). Multivariable analysis demonstrated significantly less intended stigmatizing behavior at Saftawi compared to Nasser (p < 0.01) while controlling for demographic covariables. Conclusions: UNRWA primary care services and education implemented for refugees in Gaza was associated with reduced stigmatizing behavior toward mental health, which can help guide efficacious mental health care interventions within the Palestine refugee community and in other simiilar communities.

Triple Jeopardy: Complexities of Racism, Sexism, and Ageism on the Experiences of Mental Health Stigma Among Young Canadian Black Women of Caribbean Descent

This article explores how the intersection of race, gender, and age intertextually complicate and nuance the experience of mental health stigma among young Black women of Caribbean descent living in Canada. The Mental Health Commission of Canada acknowledged that mental health stigma continues to affect the help-seeking behavior of young adults. Some youth-serving agencies and many advocates within Black communities have become increasingly vocal about mental health stigma and the lackluster response to the needs of Black youth (e.g., no increase in funding for the Substance Abuse Program for African, Canadian, and Caribbean Youth-SAPACCY, since the program was established in the mid-1990s). The issue of mental health stigma within the African, Caribbean, and Black Canadian (ACB) communities is widely known and often discussed at public forums. Several recent mental health forums and mental health initiatives held in Toronto made it clear that mental health in Black communities is at a crisis point in the Greater Toronto Area (GTA) and possibly across Canada. Forum discussions also revealed that the issue is further compounded by the intersection of race, gender, and age. In addition, while research studies have also identified stigma as a barrier to accessing mental health services and/or supports, there is a paucity of research on how mental health stigma, when complicated by the experience of racism, sexism, and ageism, affects access to services among young Black women of Caribbean descent. This lack of research on Caribbean women's experience with mental illness limits insights into concepts, issues, and problems that directly impact broader issues related to mental health in Canada. This article engenders a discussion that strengthens the focus on mental health stigma campaigns and education on the mental health of young Black women in Canada. The lack of literature relating to this topic in the Canadian context, as previously noted, limits the extent to which this issue can be fully discussed within Canada. As such, insights into concepts and existing discussions on women's mental health throughout this paper will include references to literature from the U.S., U.K., and Australia, professional experiential knowledge, and personal insights from conversations with young Black women of Caribbean descent. The paper calls for more research on Caribbean women's mental health in Canada to provide better insights and understanding of the issue within a Canadian context.

Obsessions Across Two Cultures: A Comparison of Belgian and Turkish Non-clinical Samples

There is a growing interest in the role of culture in Obsessive-Compulsive Disorder, yet cultural studies to date have suffered from methodological limitations and lack a clear theoretical framework. In the current study, we adopted a rigorous methodological approach, and a clear cultural psychological framework. We compared the structure and frequency of obsessions in non-clinical samples (N = 706) from Belgium, a Western culture, and Turkey, a non-Western cultural context. Obsessions were measured by a newly compiled instrument that included a broad range of obsessions. Cross-cultural equivalence of the structure of obsessions was assessed both in the pooled data, and in each culture separately. At an abstract level, we found a two-factor structure that was cross-culturally invariant, and that fit both cultures equally well. These two types of obsessions each corresponded with a different model of agency. Compared to the Turkish sample, the Belgian sample reported more obsessions that can be understood from a disjoint (independent) model of agency as frequently found in Western cultures, whereas the Turkish sample, compared to their Belgian counterparts, reported more obsessions that can be tied to a conjoint (shared) model of agency as frequently found in non-Western cultural contexts. Differences in the prevalent types of obsessions were systematic and interpretable, therefore. In addition to the cross-culturally equivalent two-factor structure, we found culture-specific factor solutions; these solutions point to cultural differences in the experience of obsessions that have yet to be fully understood. In the Discussion, we outline future directions of the research on culture and obsessions.

Perceptions of positive treatment and discrimination towards people with mental health problems: Findings from the 2017 Attitudes to Mental Illness survey

Anti-stigma programme evaluations primarily measure knowledge and attitudes, and rarely assess behaviour. This study describes perceived and self-reported avoidance, discrimination and positive treatment using data from the 2017 Attitudes to Mental Illness survey. A nationally representative quota sample of 1720 English participants were interviewed about mental health-related knowledge and attitudes, reported and intended contact with people with mental health problems, awareness of the Time to Change anti-stigma programme and knowledge of anyone with a mental health problem. Participants who knew someone were asked how they thought the person was treated in different life areas, and whether they had avoided the person, treated them unfairly or treated them more positively. 30.1% of respondents knew someone with a mental health problem. Most believed the person had been treated fairly across various life domains. 5.1% of participants reported avoiding the person, 2.1% reported unfair treatment, and 58.1% reported positive treatment. Less stigmatising attitudes were associated with reduced avoidance and discrimination. Greater knowledge and reported contact were associated with positive treatment. Anti-stigma campaigns can reduce discrimination or increase positive treatment by targeting knowledge, attitudes and awareness of people with mental health problems. Evaluations should measure discrimination and positive treatment to fully assess behavioural change.

Regional differences in mental health stigma-Analysis of nationally representative data from the Health Survey for England, 2014

Background

Mental health stigma persists despite coordinated and widely-evaluated interventions. Socioeconomic, structural, and regional context may be important in shaping attitudes to mental illness, and response to stigma interventions. Regional differences in attitudes towards mental illness could be relevant for intervention, but have not been systematically explored. We evaluated regional variation in mental health stigma using nationally representative data from England, the Health Survey for England (HSE), from 2014.

Methods

A previously derived scale for mental health-related attitudes with 2 factors (i. tolerance and support, ii. prejudice and exclusion), and overall attitudes, were outcomes. Weighted linear regressions estimated contribution of individual characteristics and region of residence to inter-individual variability in mental health-related attitudes.

Results

London and southern regions tended to have more negative mental health-related attitudes. These differences were not fully or consistently explained by individual sociodemographic characteristics, or personal familiarity with mental illness.

Conclusions

Stigma policies could require refinements based on geographic setting. Regions may be in particular need of stigma interventions, or be more resistant to them. Regional differences might be related to media coverage of mental illness, funding differences, service availability, or accessibility of educational opportunities. Greater geographic detail is necessary to examine reasons for regional variation in stigmatizing attitudes towards people with mental illness, for example through multilevel analysis.

Long-term effects of filmed social contact or internet-based self-study on mental health-related stigma: a 2-year follow-up of a randomised controlled trial

PURPOSE

There is a critical need to clarify the long-term effects of anti-stigma interventions. The study aimed to assess the long-term effects of repeated filmed social contact or internet-based self-study on mental health-related stigma through a randomised controlled trial with 2-year follow-up.

METHODS

We randomly allocated 259 university or college students to a filmed social contact group, an internet-based self-study group, or a control group. The filmed social contact and internet-based self-study groups each received a 30-min initial intervention followed by emailed interventions every 2 months over a 12-month period. The Japanese version of the Reported and Intended Behaviour Scale (RIBS-J) and the Mental Illness and Disorder Understanding Scale (MIDUS) were used to assess behaviour, behavioural intentions (attitudes), and knowledge regarding mental health.

RESULTS

Of the 259 original participants, 187 completed the 24-month follow-up assessment. Mean scores for the RIBS-J future domain and MIDUS peaked at 1 month after initial intervention. Compared with baseline, at 24-month follow-up, we found a significant difference in RIBS-J future domain scores between the filmed social contact and control groups at 24-month follow-up (B = 0.95, 95% CI = 0.01,1.90, p = 0.049), while MIDUS scores in the filmed social contact group (B = - 4.59, 95%CI = - 6.85, - 2.33, p < 0.001) and the internet-based self-study group (B = - 4.51, 95%CI = - 6.86, - 2.15, p < 0.001) significantly decreased compared with the control group.

CONCLUSION

While outcome scores peaked at 1 month after initial intervention, results suggest that filmed social contact might have a long-term effect on behavioural intentions, and both filmed social contact and internet-based self-study may contribute to improved knowledge of mental health.

Decreasing Stigmatization: Reducing the Discrepancy Between "Us" and "Them". An Intervention for Mental Health Care Professionals

Objective: Stigmatization has negative consequences for people with mental health disorder diagnosis. Studies indicate that professionals have stigmatizing attitudes and behavior towards clients. Continuum beliefs are associated with less stigmatizing attitudes. The effect of a workshop to diminish stigmatizing attitudes and to enhance continuum beliefs is examined. Method: A total of 202 mental health professionals from (Functional) Assertive Community Treatment [(F)ACT] teams were randomly assigned to a workshop or a waiting list control group. Stigmatizing attitudes and continuum beliefs were assessed in both conditions at baseline and follow-up. Results: Compared to baseline, the workshop group showed an increase on continuum beliefs. However, there was no effect of the intervention on stigmatizing attitudes. Contrary to the expectations, stigmatizing attitudes increased in the waiting list condition. Conclusion: Communicating the continuity aspect can be valuable in decreasing the "us and them" discrepancy between professionals and people with mental health disorders. Further research on continuum beliefs is needed.

The Effect of the Content of Patient-Reported Outcome Measures on Patient Perceived Empathy and Satisfaction: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to examine whether positively or negatively phrased Patient-Reported Outcome Measures (PROMs) prior to a visit with the hand surgeon affect patient perceived empathy and patient satisfaction (Patient-Reported Experience Measures [PREMs]).

METHODS

Between June 2017 and July 2017, we enrolled 134 patients who presented to 3 hand surgeons at 2 outpatient offices. They were randomly assigned to 1 of 2 groups: completion of negatively framed questionnaires (Patient Health Questionnaire [PHQ-2], Pain Catastrophizing Scale [PCS-4], and Patient-Reported Outcomes Measurement Information System [PROMIS] depression Computer Adaptive Test [CAT]) or completion of positively framed questionnaires (Pain Self-Efficacy Questionnaire [PSEQ-2]) prior to the visit. At the end of the visit, all patients completed questionnaires on patient-perceived physician empathy and patient satisfaction. Five patients were excluded from the analysis after randomization.

RESULTS

There was no statistically significant differences between groups on patient-perceived physician empathy and patient satisfaction.

CONCLUSIONS

Our findings suggest that the content of psychological questionnaires completed prior to the visit does not affect patient satisfaction and perceived empathy recorded after the visit.

CLINICAL RELEVANCE

Given the degree to which PROMs are influenced by psychosocial factors, and prior evidence that PROMs are primed by negatively framed questionnaires, it is reassuring that negatively framed PROMs did not affect PREMs, but more research is merited.

Religious landscape in Brazil: Comparing different representative nationwide approaches to obtain sensitive information in healthcare research

Although the basis of religious studies start with demographics, nation-wide data are often extracted from face-to-face interviews (leading to a social-desirability bias) and in studies not originally designed to assess religion. This study aims to understand the religious landscape in Brazil and to investigate the feasibility of carrying out a representative nation-wide survey without interviewers, comparing it with other representative face-to-face surveys. We conducted a nationwide online survey representing all regions in Brazil. These results were compared with five other Brazilian representative surveys. A total of 1169 individuals completed the online questionnaires. The percentage of participants according to the gender and in relation to the Brazilian region was quite similar for all surveys. However, the online survey had the higher level of education among all surveys. In relation to the religious characteristics, the percentage of each variable varied from survey to survey. Those surveys originally designed to assess religion tended to yield more religious affiliations and less ceiling effects. The online survey was able to identify more diverse religious affiliations and more balanced responses in the religious attendance and importance of religion in life. The present study found that, even in nation-wide representative surveys, there are important differences in the results obtained while investigating religion. These differences could be associated with the type of data collection (face-to-face and online), the design of the study (originally designed to investigate religion or not) and options and the type of the questions used.

•

Self-administered questionnaires avoid social desirability bias.

•

This study found important differences while investigating religion among nationwide surveys.

•

Online survey identifies more religious affiliations and more balanced responses in variables.

How broad are state physician health program descriptions of physician impairment?

BACKGROUND

Physician health program websites in 23 states provide many descriptions of possible physician impairment. This study sought to determine whether these descriptions are so broad that almost everyone might potentially be suspected of being impaired given these descriptions.

METHODS

The authors randomly selected 25 descriptions of impairment and then presented them anonymously online to members of the general population in full-time employment through Amazon's Mechanical Turk (N = 199). Half of the respondents randomly received a narrowly worded version, and half received a broadly worded version of the survey questions.

RESULTS

In the narrowly worded version of the survey, 70.9% of respondents endorsed at least one description of impairment, and 59.2% endorsed more than one. In the broadly phrased version, 96.9% endorsed at least one description, and 95.8% endorsed more than one. These respondents endorsed a median of 10 out of 25 (40%) descriptions.

CONCLUSIONS

These findings call into question whether these descriptions really identify persons with poor performance or who pose a high risk of substantial, imminent harm to self or others in the workplace. They also demonstrate the extent to which these descriptions could potentially be misapplied and brand almost anyone as impaired.

Mental health nurses' encounters with occupational health services

Background

Staff well-being is vital to the functioning of the UK National Health Service (NHS). Mental health nurses (MHNs) with personal experience of mental illness can offer a professionally and personally informed insight into the occupational health (OH) service offered by their employer.

Aims

To investigate MHNs' views of OH provision in the NHS, based on their personal experience.

Methods

A qualitative interview study using a purposive sample of MHNs with personal experience of mental illness.

Results

Twenty-seven MHNs met the inclusion criteria. Thematic analysis identified three themes: comparisons of 'relative expertise' between the mental health nurse and the OH clinician; concerns about 'being treated' by a service at their work; and 'returning to work'.

Conclusions

OH provision in mental health settings must take account of the expertise of its staff. Further research, looking at NHS OH provision from the provider perspective is warranted.

Is manager support related to workplace productivity for people with depression: a secondary analysis of a cross-sectional survey from 15 countries

OBJECTIVES

To examine variations in manager reactions and support for people with depression and to investigate how these reactions are related to (1) absenteeism and (2) presenteeism due to depression among employees with self-reported depression across 15 diverse countries.

DESIGN

Secondary data analysis of cross-sectional survey data.

SETTING

15 countries, diverse in geographical region and gross domestic product (GDP): Brazil, Canada, China, Denmark, France, Germany, Great Britain, Italy, Japan, Mexico, Spain, South Africa, South Korea, Turkey and the USA.

PARTICIPANTS

16 018 employees and managers (approximately 1000 per country).

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed level of absenteeism as measured by number of days taken off work because of depression and presenteeism score.

RESULTS

On average, living in a country with a greater prevalence of managers saying that they avoided talking to the employee about depression was associated with employees with depression taking more days off work (B 4.13, 95% CI 1.68 to 6.57). On average, living in a country with a higher GDP was marginally associated with employees with depression taking more days off of work (p=0.09). On average, living in a country with a greater prevalence of managers actively offering help to employees with depression was associated with higher levels of presenteeism (B 7.08, 95% CI 6.59 to 7.58). Higher country GDP was associated with greater presenteeism among employees with depression (B 3.09, 95% CI 2.31 to 3.88).

CONCLUSIONS

Manager reactions were at least as important as country financial resources. When controlling for country GDP, working in an environment where managers felt comfortable to offer help and support to the employee rather than avoid them was independently associated with less absenteeism and more presenteeism.

"They aren't all like that": Perceptions of clinical services, as told by self-harm online communities

Self-harm is a critical public health issue, with strikingly low rates of attendance to clinical services. By offering support, anonymity, and open discussions, online communities hold useful insights into the factors which influence help-seeking behavior. We explore the perceptions of clinical services in three self-harm online communities to understand which services are being used and why. Message threads from each community were extracted randomly until saturation, providing 513 messages across 60 threads. A thematic analysis was performed resulting in four key themes: access to appropriate services during an episode of self-harm, service preference, fears surrounding disclosure, and support.