Mental health stigma: Impact on mental health treatment attitudes and physical health

Patient Perspectives of Integrated Behavioral Health in Primary Care: A Mixed Methods Analysis

Integrated and collaborative care models, in which mental/behavioral health providers work closely with primary care providers within a primary care setting, help support the quadruple aim of improved health outcomes, patient satisfaction, provider experience, and lower cost. In this paper, we describe patients' general perspectives of integrated care and their unique experiences accessing this care within one health system. Qualitative (interviews with patients) and quantitative (surveys with patients) methods were used to collect and analyze these results separately and together. The results highlight important features to the provision of integrated care from the perspective of patients using integrated care. They include the importance and experience of access, whole-person care and a team-based approach, the availability and use of telehealth when appropriate, having high quality mental health providers, scheduling and service usage suggestions, and means to connect with longer-term services for ongoing mental health care when needed.

Mental health treatments and the influence of culture: portrayals of hypnotherapy and electroconvulsive therapy in Singaporean television dramas

Stigma is one of the chief reasons for treatment-avoidant behaviour among people with mental health conditions. Stigmatising attitudes are spread through multiple determinants, including but not limited to: (i) individual beliefs; (ii) interpersonal influences; (iii) local cultural values and (iv) shared culture such as depictions in television shows. Our research indicates that popular television shows are currently understudied vectors for narratives that alternately reify or debunk assumptions and stereotypes about people with mental health conditions. Although such shows are fictional, they influence perception by normalising 'common sense' assumptions over extended periods of time. Consequently, representations of patients, psychiatrists and treatments influence knowledge and understanding of mental health and treatment-seeking behaviour. While storytelling about sickness can inspire possibilities and bestow meaning on traumatic experiences, fictional narratives written without sufficient care can have the inverse effect of curtailing horizons and limiting expectations. Problematic portrayals of patients, mental health professionals and psychological interventions are often reductive and may increase stigma and prevent treatment-seeking behaviour. This article analyses the representation of hypnotherapy and electroconvulsive therapy (ECT) in Singaporean television dramas that attract a wide, mainstream audience. Our diverse team investigated dramas in all four of the official languages of Singapore: English, Mandarin Chinese, Bahasa Melayu and Tamil. We found that depictions of hypnotherapy tend to produce problematic images of mental health professionals as manipulative, able to read minds, engaging in criminal behaviour, lacking in compassion and self-interested. Meanwhile, representations of ECT typically focus on the fear and distress of the patient, and it is primarily depicted as a disciplinary tool rather than a safe and effective medical procedure for patients whose condition is severe and refractory to pharmacotherapy and behavioural interventions. These depictions have the potential to discourage treatment-seeking behaviour-when early intervention has found to be crucial-among vulnerable populations.

Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen

Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.

Reduce stress and the risk of burnout by using yoga techniques. Pilot study

Introduction

This article examines the effectiveness of yoga in managing stress, with a particular focus on work-related stress. Yoga combines physical postures, breath control, and meditation, and has gained recognition for its potential to relieve stress.

Purpose

This study aimed to investigate the motivating factors behind individuals adopting yoga exercises and to assess the effects of regular yoga practice, with a particular focus on age-related differences. Additionally, we aimed to compare participants' expectations with the actual results of their yoga practice.

Methods

To achieve this, we conducted a comprehensive survey using an online form, which was completed by 520 yoga practitioners. Participants were surveyed about their motivation, the effects they experienced, and the type of yoga they practiced.

Results

The results showed that the most common motivation for individuals practicing yoga was stress reduction. Additionally, the analysis of the effects of regular yoga practice demonstrated a significant reduction in stress levels, with experienced practitioners reporting lower stress levels compared to beginners. In conclusion, the study suggests that regular yoga practice can be an effective way to reduce stress levels.

Conclusion

Dynamic forms of yoga, which incorporate fluid movements and synchronized breathing techniques, are highly effective approaches to stress management and relief. These findings highlight the value of yoga as a tool for individuals of all ages seeking stress relief and overall well-being. Another advantage of yoga practice is its affordability and lack of negative side effects.

A Qualitative Analysis of Latina Migrant Farmworkers' Perception of Mental Health: Voices From Wisconsin

INTRODUCTION

Despite evidence showing Latinos' high prevalence of mental health, little is known about Latina migrant farmworkers' mental health experiences, especially those working in Midwestern states. Considering the multiple vulnerabilities observed among Latina migrant farmworkers, it is necessary to gain insight from own accounts and perceptions of mental health and mental health-seeking experiences.

METHOD

A qualitative descriptive approach, using in-depth semi-structured interviews with open-ended questions, served to retrieve data from 34 Latina migrant farmworkers. This study was informed by Chicana, postcolonial, and Black feminist epistemologies.

RESULTS

Thematic analysis identified themes within the data. These findings pertained to the conceptualization of mental health within the contexts of family, capacities, stigma, denial, and faith.

DISCUSSION

Our results demonstrate the need for health care providers to consider Latina migrant farmworkers' perceptions about mental health and apply those in designing and implementing culturally informed policy and practice.

Attitudes of Emergency Nurses toward Clients with Mental Illness: A Descriptive Correlational Study in a Nationwide U.S. Sample

Introduction: Individuals with mental illness often experience stigma from healthcare professionals, including emergency nurses. The purpose of this study was to identify personal and professional attributes of emergency nurses that may be related to their level of stigma toward people with mental illness in the U.S. Methods: Secondary analysis of a cross-sectional study to analyze emergency nurses' characteristics against their perceptions of stigma toward mental illness as measured by the Mental Illness: Clinicians' Attitudes Scale-4 (MICA v4). Data analyses consisted of descriptive statistics; stepwise linear regression; and analysis of the internal consistency of the MICA v4 in the current sample. Results: The mean MICA v4 scores for this sample were 53.4. The linear regression analysis revealed a significant model explaining 23.5% of the variance of MICA v4 scores (F[34] = 6.4, p < 0.001, R2 = 0.235). Many attributes were found to have a strong association with lower stigmatizing attitudes. Discussion: The results of this study indicated high levels of stigma toward individuals with mental illness. Findings from this study can inform nursing education and research, and ultimately improve the health outcomes of individuals with mental illness.

The Promotion of Mental Health and Prevention of First-Episode Psychosis: A Pilot and Feasibility Non-Randomised Clinical Trial

BACKGROUND

Mental-health-related stigma prevents active help seeking and therefore early therapeutic approaches and the recovery of functionality. National and international agencies recommend the implementation of prevention and mental health promotion programs that support the elimination of stigma in the classroom, since most mental health problems usually start in the adolescent stage. In view of the evidence that teachers present stigmatizing attitudes towards mental health, it has been considered as convenient to carry out an anti-stigma program with the main objective of evaluating the impact of an intervention based on the education and promotion of mental health, aimed at teachers and counsellors of a secondary school. The specific objectives were to get to know which were the most stigmatising attitudes that prevailed in the sample before and after the intervention; to evaluate the knowledge of the teaching staff and counsellors on psychosis before the intervention; to analyse correlations between clinically relevant variables; and assess whether this programme was beneficial and feasible for alphabetising counsellors/teachers of educational centres on stigma and FEP.

METHODS

This was a non-randomised clinical trial in which a nursing intervention was performed.

TOOLS

a psychosis test (pre), Stigma Attribution Questionnaire (AQ-27) (pre-post), and satisfaction survey (post) were used. The inferential analysis included the Wilcoxon and the Pearson Correlation Test.

RESULTS

In the sample (n = 22), the predominant stigmatising attitude was "Help". The p-values obtained in the Wilcoxon Test were statistically significant, except for "Responsibility" and "Pity". The following constructs of interest were faced: "Fear"-"Age" and "Professional experience"; and "Help"-"Psychosis test".

CONCLUSIONS

Despite the scores obtained in "Responsibility" and "Pity", the intervention was useful for reducing stigma in the sample. Implications for the profession: There are adolescents who have suffered stigma from their teachers, and consequently have minimized their symptoms and not asked for help. For this reason, we implemented a nursing intervention based on the education and promotion of mental health, with the aim of expanding knowledge and reducing stigma. In fact, this intervention, which we carried out on high school teachers, managed to reduce the majority of stigmatizing attitudes measured on the stigma attribution scale.

Arabic validation of the "Mental Health Knowledge Schedule" and the "Reported and Intended Behavior Scale"

Objectives

Mental illness affects one in eight people in the world according to the WHO. It is a leading cause of morbidity and a major public health problem. Stigma harms the quality of life of people with mental illness. This study aimed at validating the Arabic version of the Mental Health Knowledge Schedule (MAKS) and the Reported and Intended Behavior Scale (RIBS) in a sample of Tunisian students and determining socio-demographic and clinical factors correlated with stigma.

Methods

This cross-sectional study was conducted on 2,501 Tunisian students who filled in the MAKS, the RIBS, and a sociodemographic and clinical questionnaire. The validation of the questionnaires in Arabic was carried out using the validity criteria: face and content validity, reliability, and construct validity. Next, the associations between stigma and sample characteristics have been studied using multivariate linear regression.

Results

Face and content validity of the measures MAKS and RIBS were satisfactory, with adequate internal consistency. There were significant positive correlations between the items and scales, and test-retest reliability was excellent. The internal validity showed that the items were well-aligned with the intended factors, and the external validity revealed a significant positive relationship between the MAKS and RIBS. Besides, gender, the field of study, psychiatric history, and contact with someone with a mental illness were all contributing factors to mental illness stigma. Additionally, men performed better than women in terms of behavior toward people with mental illness, while women had a greater level of knowledge about mental health.

Conclusion

The Arabic versions of the MAKS and RIBS have appropriate psychometric properties, making them effective tools for evaluating mental illness stigma. With multiple factors contributing to this issue, these instruments can help focus anti-stigma efforts and promote a more inclusive society.

"It Is OK Not to Be OK": Nursing Students' Backgrounds and Perceptions of Mental Health Stigma and Implications for Mental Health Nursing Education

There has been a notable increase in reported mental illnesses in recent years. Although mental illness is being discussed more openly, stigma toward mental illness still exists. Stigma can result in inadequate care for people with mental illnesses. Students come into nursing from a variety of backgrounds and these backgrounds influence their nursing clinical judgments, especially related to caring for people with mental illnesses. A qualitative descriptive analysis was conducted using 60 undergraduate nursing student reflections on their backgrounds and perceptions of mental health stigma. Students wrote about their Previously Held Beliefs and the Influence of Culture, Overcoming Stigma through their Experiences with Friends and Family, Influence of Popular Culture, and Personal Experiences, and their New Understanding of mental illness and what that means for their future nursing practice. These findings have important implications for nursing education including providing more opportunities for nursing students to care for people with mental illnesses, reframing how mental health content is delivered in undergraduate nursing programs, and providing additional support for students with personal mental illnesses.

Effectiveness of an intervention to reduce stigma towards people with a mental disorder diagnosis in university students of healthcare careers

Students in healthcare careers present stigma towards people with psychiatric diagnoses, so the development of interventions to reduce it is essential. This study aimed to evaluate the effectiveness of an intervention to reduce stigma towards people diagnosed with mental disorders in healthcare students in Chile. A randomized clinical trial with a before and after measurement was carried out. The intervention was part of a compulsory course and combined educational and contact strategies. A total of 244 fourth-semester students of medicine, nursing, dentistry, obstetrics, psychology, and social work participated. The intervention was effective in reducing stigmatizing attitudes and the desire for social distance. For almost all variables, the magnitude of the stigma reduction depended on the initial level of stigma, not on the profession. The intervention had positive effects on all careers. In conclusion, incorporating a stigma reduction intervention into mandatory professional training, with the active participation of the teacher in charge and experts by experience, can be a valuable tool to promote humanized and non-stigmatizing treatment.

Relationship between Sports Practice, Physical and Mental Health and Anxiety-Depressive Symptomatology in the Spanish Prison Population

The objective of this study was to evaluate, in a group of Galician inmates, if there were variations in the levels of physical and mental health and anxiety-depressive symptomatology, depending on the sports' practice performed. The relationship between these constructs was also investigated. The sample was composed of 509 people deprived of liberty in prisons in the Autonomous Community of Galicia, Spain. A quantitative methodology was used, with the questionnaire as an information collection instrument, Student's t-tests, Pearson's correlation analysis and a stepwise regression analysis were carried out. The results indicated that those who performed physical activity during their stay in prison had higher levels of physical and mental health, as well as lower indicators of anxiety-depressive symptoms. People who did not practice sports showed a decrease in their perceived health levels when compared to those perceived in their pre-prison stage. A negative association was shown between perceived health levels and anxiety-depressive symptomatology. Perceived physical health, alone, explained 35% of the variance in perceived mental health. These results add to knowledge about the relationships between perceived health, anxiety-depressive symptoms and sports practice in the group of people deprived of liberty, highlighting the importance of promoting physical activity in penitentiary institutions.

American Academy of Nursing consensus recommendations to advance system level change for nurse well-being

The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media.

Addressing Maternal Depression Through Home Visiting: One State's Experience With a Breakthrough Series Collaborative

BACKGROUND AND OBJECTIVES

From 2013 to 2017, a national Breakthrough Series (BTS) collaborative in Maternal, Infant, and Early Childhood Home Visiting programs developed a toolkit that led to improvements in maternal depression outcomes. In 2018, Alabama's home visiting program (First Teacher) aimed to reproduce these impacts with a state-led BTS that enrolled 8 local implementing agencies (LIAs) serving more than 500 families.

METHODS

LIAs tested changes in practices using Plan-Do-Study-Act cycles and tracked data regarding depression screening, referrals, service access, and symptom improvement via run charts. First Teacher administered a post-collaborative survey to assess LIA team members' satisfaction with their BTS experience.

RESULTS

Alabama's BTS resulted in positive shifts in maternal depression referrals, service access, and symptom improvement. Change ideas that supported these shifts included the use of a screening script, motivational interviewing, "Mothers and Babies," and a registry. LIAs noted that BTS tools and resources helped build capacity to address the difficult and frequently stigmatized topic of maternal depression.

CONCLUSION

Findings from this study indicate that evidence- and experience-based practices regarding maternal depression screening, referrals, and service access can lead to symptom improvement among mothers enrolled in a state-based home visiting program. Results of this investigation corroborate findings from previous studies while also incorporating feedback from LIAs about the BTS experience.

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.

Analysis on the literature communication path of new media integrating public mental health

The communication of mental health is an important branch of health communication, and it is also an important factor affecting people’s physical and mental health. With the increasing pressure of life, people’s mental health problems have huge challenges. Under the enormous pressure of economy and life, people’s mental health problems are becoming increasingly prominent. This calls for attention to mental health issues. In the context of new media, knowledge about mental health can be disseminated through the Internet and mobile platforms. This approach will spread awareness of mental health prevention and basic issues. Mental health problems are also a manifestation of the lack of humanistic spirit. Excellent works related to humanistic spirit can promote the relief of mental health problems. Literature can contribute to the development of mental health problems. This research studies the communication of mental health issues in the context of new media using literary works as a carrier. At the same time, it also considers big data-related algorithms to mine the traditional characteristics of mental health problems. The research results show that new media technology can well assist the dissemination of mental health education, and literary works also contribute to the dissemination of mental health education knowledge. Collaborative filtering algorithm and atrous convolution algorithm can better predict the relevant characteristics in the process of mental health communication. For the CF algorithm, its maximum similarity index reached 0.987 when recommending mental health propagation paths using new media technology. For ACNN, the smallest prediction error is only 1.78%.

Stigmatization of people diagnosed with a mental disorder in secondary mental health centers in Chile: An ethnographic study

To understand how stigmatization of people diagnosed with a mental disorder occurs in secondary mental healthcare staff in mental healthcare centers in Chile was the objective of the study. A descriptive qualitative and interpretative design with an ethnographic approach was used. Participants' observations, ethnographic, and semi-structured interviews were conducted with professionals at three secondary mental health centers. Qualitative descriptive and interpretative content analysis was used. Stigmatization of users is shaping up in their trajectory in the health center. Identity changes from person to "patient," which generates dependence on the expert role of healthcare professionals. Stigma is expressed in the interactions between a health institution, a professional team, and a user, reproducing power and control relationships associated with the biomedical model and reinforcing a cycle of chronification in the user. Health teams are stressed by discrepancies between the current mental health policy and the user's biomedical understanding.

Mental Health of Czech University Psychology Students: Negative Mental Health Attitudes, Mental Health Shame and Self-Compassion

High rates of mental health problems are a growing concern in Czech higher education, negatively impacting students’ performance and wellbeing. Despite the serious nature of poor mental health, students often do not seek help because of negative attitudes and shame over mental health problems. Recent mental health research reports self-compassion is strongly associated with better mental health and reduced shame. However, relationships between those constructs remain to be evaluated among Czech students. This study aims to appraise the relationships between mental health problems, negative mental health attitudes, mental health shame, and self-compassion in this population. An opportunity sample of 119 psychology students from a Czech university completed questionnaires regarding these constructs. Correlation, regression, and path analyses were conducted. Mental health problems were positively associated with negative mental health attitudes and shame, and negatively associated with self-compassion. Self-compassion negatively predicted mental health problems, while negative attitudes and shame did not. Last, self-compassion fully mediated the negative attitudes-mental health problems relationship, and partially mediated the shame-mental health problems relationship. Findings suggest self-compassion is essential for mental health in Czech students and associated with negative mental health attitudes and mental health shame. Czech universities can benefit from incorporating self-compassion training into their curricula to protect students’ mental health.

Effects of Internet-based Storytelling Programs (Amazing Adventure Against Stigma) in Reducing Mental Illness Stigma with Mediation by Interactivity and Stigma Content: A Randomized Controlled Trial (Preprint)

Background

Mental illness stigma has been a global concern, owing to its adverse effects on the recovery of people with mental illness, and may delay help-seeking for mental health because of the concern of being stigmatized. With technological advancement, internet-based interventions for the reduction of mental illness stigma have been developed, and these effects have been promising.

Objective

This study aimed to examine the differential effects of internet-based storytelling programs, which varied in the levels of interactivity and stigma content, in reducing mental illness stigma.

Methods

Using an experimental design, this study compared the effects of 4 storytelling websites that varied in the levels of interactivity and stigma content. Specifically, the conditions included an interactive website with stigma-related content (combo condition), a noninteractive website with stigma-related content (stigma condition), an interactive website without stigma-related content (interact condition), and a noninteractive website without stigma-related content (control condition). Participants were recruited via mass emails to all students and staff of a public university and via social networking sites. Eligible participants were randomized into the following four conditions: combo (n=67), stigma (n=65), interact (n=64), or control (n=67). The participants of each group viewed the respective web pages at their own pace. Public stigma, microaggression, and social distance were measured on the web before the experiment, after the experiment, and at the 1-week follow-up. Perceived autonomy and immersiveness, as mediators, were assessed after the experiment.

Results

Both the combo (n=66) and stigma (n=65) conditions were effective in reducing public stigma and microaggression toward people with mental illness after the experiment and at the 1-week follow-up. However, none of the conditions had significant time×condition effects in reducing the social distance from people with mental illness. The interact condition (n=64) significantly reduced public stigma after the experiment (P=.02) but not at the 1-week follow-up (P=.22). The control condition (n=67) did not significantly reduce all outcomes associated with mental illness stigma. Perceived autonomy was found to mediate the effect of public stigma (P=.56), and immersiveness mediated the effect of microaggression (P=.99).

Conclusions

Internet-based storytelling programs with stigma-related content and interactivity elicited the largest effects in stigma reduction, including reductions in public stigma and microaggression, although only its difference with internet-based storytelling programs with stigma-related content was not statistically significant. In other words, although interactivity could strengthen the stigma reduction effect, stigma-related content was more critical than interactivity in reducing stigma. Future stigma reduction efforts should prioritize the production of effective stigma content on their web pages, followed by considering the value of incorporating interactivity in future internet-based storytelling programs.

Trial Registration

ClinicalTrials.gov NCT05333848; https://clinicaltrials.gov/ct2/show/NCT05333848

Stigma towards Mental Disorders among Nursing Students and Professionals: A Bibliometric Analysis

Stigma is one of the main barriers to prevention, treatment and recovery from mental illness. However, bibliometric studies in this area are still scarce. Therefore, our aim was to quantify and analyze the scientific literature on the stigma of nursing students and professionals towards mental disorders. To this purpose, bibliometric indicators of scientific production, impact and collaboration were used. Among our results, it stands out that only 14.3% of the total number of studies analyzed measure the efficacy of the interventions carried out to reduce stigma. Furthermore, with exceptions such as Happell B and Byrne L, collaborations between authors and institutions are limited. “Service user involvement” appeared as a prominent keyword in 2018, coinciding with the increase in publications on the effectiveness of interventions. Interventions based on the involvement of people with psychiatric diagnoses in the design of nursing curricula seem to become a promising line of research. More studies measuring the efficacy of such interventions are needed. Knowledge of the lines of research that are being developed and of the researchers and institutions involved can contribute to creating synergy between the different researchers and to continue adding projects to the existing ones, thus contributing to the generation of more robust results that show the most indicated interventions to reduce the still present stigma and improve care for people with psychiatric diagnoses.

Stigma in the media: Investigating journalism students attitudes towards mental illness

Given the profound role that media play in public opinion, there exists an ongoing necessity to understand the portrayal of mental illness by journalists. There is a plethora of studies that have examined how mental illness is portrayed in the media, but few studies have sought to understand what journalist opinions about mental illness are, and none could be found regarding journalism students' opinions. This study aimed to bridge this gap by examining journalism student's attitudes towards mental illness using the Social Distance Scale (SDS). This study adheres to STROBE guidelines for cross-sectional studies. One hundred and seventy-two undergraduate journalism students (n = 172) completed the SDS with findings suggesting that students had moderate stigmatizing attitudes, with varying degrees of stigma present depending on the social context. Positively framed reporting and constructive media coverage surrounding mental illness may be improved by shared communication and education with health professionals who specialize in mental health: mental health nurses.

Psychiatric Functioning, Resilience, and Recovery Among Deaf Consumers of Public Behavioral Health Services

Studies of deaf individuals generally indicate higher levels of mental illness and negative mental health outcomes compared to the general population (Anglemyer and Crespi in JAMA 2018: 3285153, 2018; Dammeyer and Chapman in JAMA 52: 807-813, 2017; Fellinger et al. in JAMA 379: 17-23, 2012; Hall et al. in JAMA 52: 761-776, 2017; as reported by Leigh and Pollard (M. Marschark and P. Spencer (eds) Oxford handbook of deaf studies, language and education, Oxford University Press, UK 2003); Landsberger et al. in JAMA 45, 42-51, 2014; Pollard in JAMA 39, 147-160, 1994). The purpose of this study is to understand the demographic variables, psychiatric symptoms, functioning, resilience, and recovery in a sample of 11,703 deaf adults. The de-identified dataset was provided by Beacon Health Options and Maryland Behavioral Health Administration and includes information about deaf adult consumers of public behavioral health services. Findings revealed that compared to hearing consumers in the dataset, deaf consumers were less likely to live in independent housing. They were more likely to live in structured community housing, such as group homes, or be homelessness. They had higher rates of arrests and incarcerations, higher proportion of unemployment, and higher rates of cigarette smoking. Deaf participants had lower rates of substance use. Deaf women in this sample reported significantly more difficulty in managing their psychiatric symptoms than deaf men. Deaf people of color had lower levels of psychiatric dysfunction, lower resilience, and greater recovery compared to white participants, which was inconsistent with other studies of people of color. Younger participants had significantly more difficulty with psychiatric symptoms and functioning than those in the older groups. Those who were 31-55 years old had higher resilience than those who were older than 56 years old. The author offers several recommendations for further research of the mental health of deaf populations, especially round race, age, and gender.

Mental Health and the City in the Post-COVID-19 Era

The article describes the risks for the mental health and wellbeing of urban-dwellers in relation to changes in the spatial structure of a city that could be caused by the COVID-19 pandemic. A year of lockdown has changed the way of life in the city and negated its principal function as a place of various meetings and social interactions. The danger of long-term isolation and being cut-off from an urban lifestyle is not only a challenge facing individuals, but it also creates threats on various collective levels. Hindered interpersonal relations, stress, and the fear of another person lower the quality of life and may contribute to the development of mental diseases. Out of fear against coronavirus, part of the society has sought safety by moving out of the densely populated city centres. The dangerous results of these phenomena are shown by research based on the newest literature regarding the influence of COVID-19 and the lockdown on mental health, urban planning, and the long-term spatial effects of the pandemic such as the urban sprawl. The breakdown of the spatial structure, the loosening of the urban tissue, and urban sprawl are going to increase anthropopressure, inhibit access to mental health treatment, and will even further contribute to the isolation of part of the society. In addition, research has shown that urban structure loosening as a kind of distancing is not an effective method in the fight against the SARS-COV pandemic. Creating dense and effective cities through the appropriate management of development during and after the pandemic may be a key element that will facilitate the prevention of mental health deterioration and wellbeing. It is also the only possibility to achieve the selected Sustainable Development Goals, which as of today are under threat.

Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers

Background

Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services.

Methods

Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers.

Results

Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow.

Conclusion

Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge.

Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT03711786

Clinical Ecopsychology: The Mental Health Impacts and Underlying Pathways of the Climate and Environmental Crisis

Humankind is confronted with progressing climate change, pollution, environmental degradation, and/or destruction of the air, soil, water, and ecosystems. The climate and environmental crisis is probably one of the greatest challenges in the history of humankind. It not only poses a serious current and continuing threat to physical health, but is also an existing and growing hazard to the mental health of millions of people worldwide. This synergy of literature provides a current summary of the adverse mental health impacts of the climate and environmental crisis from the perspective of Clinical Psychology. Furthermore, it presents potential underlying processes, including biological, emotional, cognitive, behavioral, and social pathways. The existing data suggest that the climate and environmental crisis not only acts as a direct stressor, but can also exert a detrimental impact on the various pathways, with the potential to amplify an individual's biopsychosocial vulnerability to develop mental ill-health. This is a call for an increased investigation into this emerging research field of Clinical Ecopsychology by clinical psychologists and other researchers.

Online peer to peer support: Qualitative analysis of UK and US open mental health Facebook groups

Objective

This research aimed to gain further understanding of how open Facebook groups are used for online peer to peer support and identify any similarities and/or differences between UK and US groups.

Method

A systematic search of mental health related open Facebook groups was conducted using relevant key words. The posts from 14 UK and 11 US groups were acquired over a three month period and content thematically analysed using Nvivo.

Results

Findings support previous research which evidences that online peer to peer support is beneficial for users seeking mental health information. Said support can increase feelings of connectedness, reduce feelings of isolation, and provide a platform for comparison of perspectives relating to personal experiences. Group membership may offer hope and increase feelings of empowerment in those using Facebook groups as a support mechanism. There was similar discourse seen throughout both UK and US posts in regards to gender inequality, lack of awareness and stigmatisation.

Conclusions

The study highlights the positive impact of shared personal experiences, and offers a greater understanding of the benefits of online peer to peer support for mental health and wellbeing. There is evidence that, whilst mental health is becoming a more widely discussed topic, in both the UK and US, it remains negatively perceived. Questions are posed for group administrators and health professionals relating to their utilisation and moderation of such online peer to peer support networks.

The value of doing philosophy in mental health contexts

People experiencing mental distress and illness are frequently on the receiving end of stigma, epistemic injustice, and social isolation. A range of strategies are required to alleviate the subsequent marginalisation. We ran a series 'philosophy of mind' workshops, in partnership with a third-sector mental health organisation with the aim of using philosophical techniques to challenge mental health stigma and build resources for self-understanding and advocacy. Participants were those with lived experience of mental distress, or unusual beliefs and experiences; mental health advocates; and mental health service providers (such as counsellors, psychologists and psychiatrists). We draw on a shared perspective as a participant and facilitator of the workshop series to assess their impact. We discuss the following benefits: (i) the opportunity for structured discussion of experiences and models; (ii) dialogue across different mental health backgrounds; (iii) the potential to reduce self-stigma and to increase self-understanding and advocacy; and (iv) the potential to alleviate (some) epistemic injustice. We invite researchers and mental health practitioners to consider further opportunities to investigate the potential benefits of philosophy groups in mental health settings to establish whether they generalise.

Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial

Forty percent of all general-practitioner appointments are related to mental illness, although less than 35% of individuals have access to therapy and psychological care, indicating a pressing need for accessible and affordable therapy tools. The ubiquity of smartphones offers a delivery platform for such tools. Previous research suggests that gamification-turning intervention content into a game format-could increase engagement with prevention and early-stage mobile interventions. This study aimed to explore the effects of a gamified mobile mental health intervention on improvements in resilience, in comparison with active and inactive control conditions. Differences between conditions on changes in personal growth, anxiety and psychological wellbeing, as well as differences in attrition rates, were also assessed. The eQuoo app was developed and published on all leading mobile platforms. The app educates users about psychological concepts including emotional bids, generalization, and reciprocity through psychoeducation, storytelling, and gamification. In total, 358 participants completed in a 5-week, 3-armed (eQuoo, "treatment as usual" cognitive behavioral therapy journal app, no-intervention waitlist) randomized controlled trial. Relevant scales were administered to all participants on days 1, 17, and 35. Repeated-measures ANOVA revealed statistically significant increases in resilience in the test group compared with both control groups over 5 weeks. The app also significantly increased personal growth, positive relations with others, and anxiety. With 90% adherence, eQuoo retained 21% more participants than the control or waitlist groups. Intervention delivered via eQuoo significantly raised mental well-being and decreased self-reported anxiety while enhancing adherence in comparison with the control conditions. Mobile apps using gamification can be a valuable and effective platform for well-being and mental health interventions and may enhance motivation and reduce attrition. Future research should measure eQuoo's effect on anxiety with a more sensitive tool and examine the impact of eQuoo on a clinical population.

Interventions to Reduce Stigma Related to Mental Illnesses in Educational Institutes: a Systematic Review

This investigation reviews the effectiveness of anti-stigma interventions employed at educational institutes; to improve knowledge, attitude and beliefs regarding mental health disorders among students. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guidelines were followed and protocol was registered in PROSPERO (CRD42018114535). Forty four randomized controlled trials were considered eligible after screening of 104 full-text articles against inclusion and exclusion criteria.Several interventions have been employed to tackle stigma toward psychiatric illnesses, including education through lectures and case scenarios, contact-based interventions, and role-plays as strategies to address stigma towards mental illnesses. A high proportion of trials noted that there was a significant improvement for stigma (19/25, 76%), attitude (8/11, 72%), helping-seeking (8/11, 72%), knowledge of mental health including recognition of depression (11/14, 78%), and social distance (4/7, 57%). These interventions also helped in reducing both public and self-stigma. Majority of the studies showed that the anti-stigma interventions were successful in improving mental health literacy, attitude and beliefs towards mental health illnesses.

Identifying Risk and Resilience Factors Associated With the Likelihood of Seeking Mental Health Care Among U.S. Army Soldiers-in-Training

INTRODUCTION

The Department of Defense aims to maintain mission readiness of its service members. Therefore, it is important to understand factors associated with treatment seeking in order to identify areas of prevention and intervention early in a soldier's career that can promote positive functioning and increase their likelihood of seeking mental health care when necessary.

METHOD

Using a theory of planned behavior lens, this study identified potential barriers (risk) and facilitators (resilience) to treatment seeking among 24,717 soldiers-in-training who participated in the New Soldiers Study component of the "Army Study to Assess Risk and Resilience in Servicemembers" (Army STARRS). Approval for this study was granted by the University of Iowa IRB # 201706739. Hierarchal linear regression modeling and independent samples t-tests were used to examine associations between demographics and study variables, intersections of risk and resilience, and to explore differences in the likelihood of seeking help based on mental health diagnoses.

RESULTS

A four-stage hierarchical linear regression was conducted, using likelihood of help-seeking as the dependent variable, to identify the most salient factors related to help-seeking. "Step one" of the analysis revealed soldiers-in-training who identified as female, Hispanic or Other ethnicity, and married, divorced, or separated reported a greater likelihood of seeking help. "Step two" of the analysis indicated soldiers-in-training with a history of sexual trauma, experience of impaired parenting, and clinical levels of mental health symptomatology (anxiety, depression, PTSD) reported a greater likelihood of seeking help. Inversely, soldiers-in-training with a history of emotional trauma and parental absence/separation reported a lower likelihood of seeking help. "Step three" of the analysis demonstrated soldiers-in-training with a prior history of seeking help and larger social networks had a greater likelihood of seeking help. "Step four" of the analysis revealed several interactive effects between risk and resilience factors. Specifically, soldiers-in-training who reported greater depressive symptomatology in combination with prior history of treatment seeking reported a greater likelihood of help seeking, whereas soldiers-in-training who reported prior sexual trauma and PTSD in combination with large social networks reported a lower likelihood of seeking help. Finally, a greater percentage of soldiers-in-training with clinical levels of anxiety, depression, and PTSD indicated they would likely seek help in comparison to soldiers-in-training without clinical symptoms.

CONCLUSION

Findings suggest few soldiers-in-training are likely to seek help when experiencing a problem. General efforts to encourage help-seeking when needed are warranted with particular focus on subsets of soldiers-in-training (eg, men, those with a history of some adverse childhood experiences). Strengths of this study include the examination of a large sample of soldiers-in-training to identify possible leverage points for early intervention or prevention prior to entering stressful military operating environments. Limitations of this study include the examination of only one military branch and exclusion of soldiers not "in-training." Future studies could consider replicating the current study using a sample of military personnel longitudinally to track behavioral trends as well as looking at military populations outside of basic combat training.

Undergraduate nursing and midwifery student's attitudes to mental illness

Aim

To explore levels of stigma in students of all fields of nursing and midwifery at different years and examine the impact of exposure to people with mental illness.

Design

A cross-sectional survey was used.

Methods

The Community Attitudes to Mental Illness questionnaire was administered to all branches of student nurses (adult health, mental health, child health and learning disability) and midwives in all three years in one Higher Education Institution (HEI) in Scotland.

Results

Mental health nursing students scored significantly better on all stigma subscales. Stigma worsened with a little professional exposure to people with mental illness but then improved with increasing exposure. Both personal exposure and professional exposure to people with mental illness change perceptions. The professional results follow a J-curve. Current plans for cross-field experience involving short or virtual placements during student nurse training are likely to worsen stigma rather than improve it.

Psychological symptom screening in an adult sickle cell disease clinic and predictors of treatment follow up

Absence of formal and systematic screening for mood and anxiety disorders among patients with sickle cell disease (SCD) can result in under-recognized psychological problems. This study examined the prevalence of psychological symptoms using a systematic screening process. Patients with SCD completed four self-report screening tools for measurement of depressive and anxiety symptoms, self-efficacy, and pain. The goal was to detect patients with psychological symptoms and identify predictors of follow-up treatment attendance. A total of 336 adult patients (57% female, mean age 33 years) completed validated screening instruments for major depressive disorder and generalized anxiety disorder. Patients recommended for mental health follow-up included higher proportions of women. Patients who accepted the mental health follow up had higher levels of education compared to groups that did not accept nor attend the follow-up appointment. Overall, 34% of patients who endorsed elevated distress scores and were referred for mental health care attended the follow-up appointment. Findings suggest patients with SCD and elevated psychological distress are likely to use mental health treatment resources, which notes this program's success in identifying needs and responding to them. However, further research is needed to understand ways to engage this population in mental health care.

Perspectives of older adults, caregivers, and healthcare providers on frailty screening: a qualitative study

BACKGROUND

Screening is an important component of understanding and managing frailty. This study examined older adults', caregivers' and healthcare providers' perspectives on frailty and frailty screening.

METHODS

Fourteen older adults and caregivers and 14 healthcare providers completed individual or focus group interviews. Interviews were audio recorded, transcribed verbatim, and analyzed using line-by-line emergent coding techniques and inductive thematic analysis.

RESULTS

The interviews yielded several themes with associated subthemes: definitions and conceptualizations of frailty, perceptions of "frail", factors contributing to frailty (physical,, cognitive, social, pharmaceutical, nutritional), and frailty screening (current practices, tools in use, limitations, recommendations).

CONCLUSION

Older adults, caregivers and healthcare providers have similar perspectives regarding frailty; both identified frailty as multi-dimensional and dynamic. Healthcare providers need clear "next steps" to provide meaning to frailty screening practices, which may improve use of frailty-screening tools.

"That's all Fake": Health professionals stigma and physical healthcare of people living with Serious Mental Illness

BACKGROUND

People living with a Serious Mental Illness (SMI) die earlier than the general population due to preventable medical conditions. Latinos living with SMI are a particularly vulnerable population with higher prevalence of chronic medical conditions. Stigma has been identified as a factor that fosters health inequities for Latinos/as with SMI, particularly Puerto Ricans. Although personal and social consequences of stigmatization have been well documented, research regarding the role of cultural factors on healthcare interactions is scarce. Furthermore, little research has focused on addressing stigma from the perspective of healthcare professionals.

METHODS

We investigated this process through a qualitative design using semi-structured individual interviews with 11 healthcare professionals (8 physicians and 3 nurses) in Puerto Rico. We conducted a thematic analysis to analyze the data.

RESULTS

Following a thematic analysis, we found three main themes and nine sub-themes related to the stigmatization process. Some participants reported perceptions of dangerousness and uneasiness, social distance and inadequate care. Participants also emphasized a lack of medical training regarding SMI within the Puerto Rican context.

CONCLUSIONS

These findings support the need to develop culturally appropriate public health interventions targeting healthcare professionals in order to address stigma and eliminate health disparities among Latinos/as with SMI.

Perception of employees on mental health at a leading botanical garden, India: A qualitative study

BACKGROUND

The prevalence of mental health issues in India is increasing. The lack of knowledge about mental illnesses and negative beliefs about treatment usually lead to delayed treatment. Mental health literacy is a prerequisite for early recognition and intervention in mental disorders.

AIMS

The study was undertaken with the aim to explore the awareness of mental health among the employees of the botanical gardens to address this massive issue.

MATERIALS AND METHODS

Two focus group discussions were carried out with five and ten members from two diverse groups of population respectively.

RESULTS

The study highlights that the signs and symptoms of mental illness were not well recognized by the participants except few.The study also shows the presence of misconceptions among the sample regarding mental health and the role of mental health professionals. This indicates the need for mental health literacy among the community.

CONCLUSION

The study shows that the knowledge of the employees of the botanical garden regarding mental health was limited. This limited knowledge may be a prominent cause of poor treatment turn up. Therefore a need of systematic sensitization program to increase mental health literacy is highlighted through the study.

"That little doorway where I could suddenly start shouting out": Barriers and enablers to the disclosure of distressing voices

Hearing distressing voices is a key feature of psychosis. The time between voice onset and disclosure may be crucial as voices can grow in complexity. This study aimed to investigate barriers and enablers to early voice disclosure. In total, 20 voice hearers were interviewed, and Thematic Analysis was used to identify themes. Beliefs about the effect of disclosure on self and others acted as a barrier and enabler to voices being discussed. Voice hearing awareness should be increased among young people, the public, and care services. To support earlier disclosure, measures should be taken to increase skill among those likely to be the recipients of disclosure.