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Mkubwa B, Angwenyi V, Nzioka B, Newton CR, Sijbrandij M, Abubakar A. Knowledge, attitudes, and practices on child and adolescent mental health among healthcare workers in sub-Saharan Africa: a scoping review. Int J Ment Health Syst 2024; 18:27. [PMID: 39014469 PMCID: PMC11253363 DOI: 10.1186/s13033-024-00644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Child and adolescent mental health is a global priority. In sub-Saharan Africa, despite the high burden, there is a gap in health services for children and adolescents with mental health disorders. To bridge this gap, healthcare workers require a good understanding of child and adolescent mental health, the right attitude, and practices geared to improving child and adolescent mental health. This scoping review examined the knowledge, attitudes, and practices related to child and adolescent mental health among sub-Saharan African healthcare workers. METHODS The search was restricted between January 2010, the year when the Mental Health Gap Action Programme guidelines were launched, and April 2024. The review followed the methodological framework proposed by Arksey and O'Malley for conducting scoping reviews. The databases searched included CINHAL, PubMed, Web of Science, PsycINFO, and grey literature databases. Additional articles were identified through cited references of the studies included. A data extraction template was used to retrieve relevant text. A narrative synthesis approach was adopted to explore the relationships within and between the included studies. RESULTS The literature search yielded 4658 studies. Among these, 817 were identified as duplicates, and 3740 were excluded after screening. Only twenty-one articles met the criteria for inclusion in the review. The findings showed that healthcare workers have insufficient knowledge of child and adolescent mental health, hold negative attitudes toward children and adolescents with mental health problems, and exhibit poor practices related to child and adolescent mental health. CONCLUSION It is crucial to build capacity and improve healthcare workers' practices, knowledge, and attitudes toward child and adolescent mental health in sub-Saharan Africa. This could lead to better access to mental health services for children and adolescents in the region.
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Affiliation(s)
- Beatrice Mkubwa
- Institute for Human Development, Aga Khan University, Nairobi, Kenya.
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Vibian Angwenyi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Brenda Nzioka
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Charles R Newton
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Neuroscience Unit, KEMRI-Wellcome Trust, Center for Geographic Medicine Research Coast, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Neuroscience Unit, KEMRI-Wellcome Trust, Center for Geographic Medicine Research Coast, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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Alliende LM, Strauss GP, Yang LH, Mittal VA. Perceptions of stigma in youth at clinical high risk for psychosis and depressive symptomatology. Schizophr Res 2024; 269:79-85. [PMID: 38754312 PMCID: PMC11249038 DOI: 10.1016/j.schres.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
It is unclear what types of stigma youth at clinical high risk for psychosis (CHR) experience, and the relationship between them and symptomatology. 94 CHR youth, and a control group of 45 youth with no psychosis spectrum symptoms (NP) were rated for perceived devaluation (i.e. negative views from others) and internalized mental health stigma (i.e. the extent to which they would agree with said views) as well as positive and mood symptomatology. CHR youth reported stigma more frequently than the NP group (χ2(1) = 53.55, p < .001) and at higher levels (perceived devaluation: t (137) = 8.54, p < .001; internalized stigma: t (137) = 7.48, p < .001). Surprisingly, in the CHR group, positive symptoms held no significant relationship to stigma measures. However, ratings of perceived devaluation stigma were associated with depressive symptomatology (β = 0.27, t = 2.68, p = .0087) and depression scores were conversely associated with perceived devaluation stigma (β = 0.30, t = 2.05, p = .043). These findings speak to the relationship between depressive symptomatology and perceived devaluation stigma in CHR youth. Perceived devaluation stigma showed greater clinical significance and could have different mechanisms than internalized stigma in CHR youth. It is also noteworthy that while positive symptoms play a central role in defining the CHR syndrome, they seem less relevant to the experience of stigma than mood symptoms. These findings highlight the importance of interventions aimed at ameliorating youth's exposure to negative views about mental health as those managing depressive symptomatology.
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Affiliation(s)
| | | | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
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Fischer R, Bailey Y, Shankar M, Safaeinili N, Karl JA, Daly A, Johnson FN, Winter T, Arahanga-Doyle H, Fox R, Abubakar A, Zulman DM. Cultural challenges for adapting behavioral intervention frameworks: A critical examination from a cultural psychology perspective. Clin Psychol Rev 2024; 110:102425. [PMID: 38614022 DOI: 10.1016/j.cpr.2024.102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/14/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
We introduce the bias and equivalence framework to highlight how concepts, methods, and tools from cultural psychology can contribute to successful cultural adaptation and implementation of behavioral interventions. To situate our contribution, we provide a review of recent cultural adaptation research and existing frameworks. We identified 68 different frameworks that have been cited when reporting cultural adaptations and highlight three major adaptation dimensions that can be used to differentiate adaptations. Regarding effectiveness, we found an average effect size of zr = 0.24 (95%CI 0.20, 0.29) in 24 meta-analyses published since 2014, but also substantive differences across domains and unclear effects of the extent of cultural adaptations. To advance cultural adaptation efforts, we outline a framework that integrates key steps from previous cultural adaptation frameworks and highlight how cultural bias and equivalence considerations in conjunction with community engagement help a) in the diagnosis of behavioral or psychological problems, b) identification of possible interventions, c) the selection of specific mechanisms of behavior change, d) the specification and documentation of dose effects and thresholds for diagnosis, e) entry and exit points within intervention programs, and f) cost-benefit-sustainability discussions. We provide guiding questions that may help researchers when adapting interventions to novel cultural contexts.
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Affiliation(s)
- Ronald Fischer
- Institute D'Or for Research and Education, Sao Paulo, Brazil; School of Psychology, Victoria University of Wellington, New Zealand.
| | | | - Megha Shankar
- Division of General Internal Medicine, Department of Medicine, University of California San Diego, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford School of Medicine, USA
| | - Johannes A Karl
- School of Psychology, Dublin City University, Dublin, Ireland; School of Psychology, Victoria University of Wellington, New Zealand
| | - Adam Daly
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - Taylor Winter
- School of Mathematics and Statistics, University of Canterbury, New Zealand
| | | | - Ririwai Fox
- School of Psychology, University of Waikato, Tauranga, New Zealand
| | - Amina Abubakar
- Aga Khan University, Nairobi, Kenya & Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Donna Michelle Zulman
- Division of Primary Care and Population Health at Stanford University & Center for Innovation to Implementation (Ci2i) at VA Palo Alto, USA
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Raggi A, Bernard RM, Toppo C, Sabariego C, Salvador Carulla L, Lukersmith S, Hakkaart-van Roijen L, Merecz-Kot D, Olaya B, Antunes Lima R, Gutiérrez-Marín D, Vorstenbosch E, Curatoli C, Cacciatore M. The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study. J Med Internet Res 2024; 26:e48504. [PMID: 38488846 PMCID: PMC10980995 DOI: 10.2196/48504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. OBJECTIVE The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. METHODS Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. RESULTS In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. CONCLUSIONS Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland
| | - Luis Salvador Carulla
- Health Research Institute, University of Canberra, Canberra, Australia
- Healthcare Information Systems (CTS553), University of Cadiz, Cadiz, Spain
| | - Sue Lukersmith
- Health Research Institute, University of Canberra, Canberra, Australia
| | | | | | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rodrigo Antunes Lima
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Desirée Gutiérrez-Marín
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Ellen Vorstenbosch
- Swiss Paraplegic Research, Nottwil, Switzerland
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Chiara Curatoli
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Martina Cacciatore
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Egan SJ, Johnson C, Wade TD, Carlbring P, Raghav S, Shafran R. A pilot study of the perceptions and acceptability of guidance using artificial intelligence in internet cognitive behaviour therapy for perfectionism in young people. Internet Interv 2024; 35:100711. [PMID: 38313140 PMCID: PMC10835279 DOI: 10.1016/j.invent.2024.100711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/30/2023] [Accepted: 01/14/2024] [Indexed: 02/06/2024] Open
Abstract
Perfectionism is a transdiagnostic process associated with a range of psychological disorders. Cognitive Behaviour Therapy for Perfectionism (CBT-P) has been demonstrated as efficacious across guided and unguided internet delivered interventions in reducing perfectionism and psychopathology. The aim of this pilot study was to understand perceptions and acceptability of an artificial intelligence supplemented CBT-P intervention (AI-CBT-P) in young people with lived experience of anxiety and depression (n = 8; age range 19-29 years, M = 24 years, SD = 3.77; 50 % female, 38 % male, 12 % non-binary). Young people reported that they were frequent users of artificial intelligence for study, work and general information, were positive about the intervention and using artificial intelligence for guidance in a self-help intervention, but also noted several concerns. Young people perceived numerous benefits to AI-CBT-P, including ease of access, low cost, lack of stigma and benefits for individuals with social anxiety. Overall, young people appear to be interested in, and have a positive view of, AI-CBT-P. Further research is now required to examine the feasibility and acceptability of the intervention.
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Affiliation(s)
- Sarah J Egan
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Catherine Johnson
- Flinders University Institute of Mental Health and Wellbeing, Adelaide, Australia
| | - Tracey D Wade
- Flinders University Institute of Mental Health and Wellbeing, Adelaide, Australia
| | - Per Carlbring
- Department of Psychology, Stockholm University, Sweden
| | - Shravan Raghav
- Independent lived experience consultant, The Safe Place, Chennai, India
| | - Roz Shafran
- Great Ormond Street Institute for Child Health, University College London, United Kingdom
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Daniel M, Kallakuri S, Gronholm PC, Wahid SS, Kohrt B, Thornicroft G, Maulik PK. Cultural adaptation of INDIGO mental health stigma reduction interventions using an ecological validity model in north India. Front Psychiatry 2024; 15:1337662. [PMID: 38356906 PMCID: PMC10864454 DOI: 10.3389/fpsyt.2024.1337662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Background The International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership is a multi-country international research program in seven sites across five low- and middle-income countries (LMICs) in Africa and Asia to develop, contextually adapt mental health stigma reduction interventions and pilot these among a variety of target populations. The aim of this paper is to report on the process of culturally adapting these interventions in India using an established framework. Methods As part of this larger program, we have contextualized and implemented these interventions from March 2022 to August 2023 in a site in north India. The Ecological Validity Model (EVM) was used to guide the adaptation and contextualization process comprising eight dimensions. Findings Six dimensions of the Ecological Validity Model were adapted, namely language, persons, metaphors, content, methods, and context; and two dimensions, namely concepts and goals, were retained. Conclusion Stigma reduction strategies with varied target groups, based on culturally appropriate adaptations, are more likely to be acceptable to the stakeholders involved in the intervention, and to be effective in terms of the program impact.
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Affiliation(s)
- Mercian Daniel
- Research Department, George Institute for Global Health, New Delhi, India
| | - Sudha Kallakuri
- Research Department, George Institute for Global Health, New Delhi, India
| | - Petra C. Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Syed Shabab Wahid
- Department of Global Health, School of Health, Georgetown University, Washington, DC, United States
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Pallab K. Maulik
- Research Department, George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Department of Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Musyimi CW, Muyela LA, Ndetei DM, Evans-Lacko S, Farina N. Acceptability and Feasibility of a Community Dementia Stigma Reduction Program in Kenya. J Alzheimers Dis 2024; 100:699-711. [PMID: 38905046 DOI: 10.3233/jad-240192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
Background Dementia stigma has adverse effects on people with dementia and their carers. These effects can lead to poor quality of life among other negative impacts. Objective The aim of this study is to develop and pilot a novel dementia stigma reduction intervention in rural Kenya, leveraging existing Community Health Workers (CHWs) for its delivery. Methods The pre-post pilot study was conducted, utilizing a parallel mixed-methods design. Ten CHWs were trained to deliver a contextually developed dementia anti-stigma intervention. These CHWs delivered four workshops to 59 members of the general public in Makueni County, with each workshop lasting between 1.5 to 2 hours. Focus group discussions and pre/post surveys were used as measures. Results The intervention was well received amongst the participants, particularly in terms of its format and accessibility. We observed the largest effects in reducing negative beliefs related to treatment (η2 = 0.34), living well with dementia (η2 = 0.98), and care (η2 = 0.56) for the general public post intervention. Improvements to attitudes were also observed in the CHWs, but the effect sizes were typically smaller. Conclusions The intervention was accessible and feasible in rural Kenya, while also showing preliminary benefits to stigma related outcomes. The findings indicate that culturally sensitive interventions can be delivered in a pragmatic and context specific manner, thus filling an important knowledge gap in addressing stigma in low-resource settings. Future research is needed to ascertain the intervention's long-term benefits and whether it tackles important behavioral outcomes and beliefs deeply ingrained within communities.
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Affiliation(s)
| | - Levi A Muyela
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- University of Nairobi, Nairobi, Kenya
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Trani JF, Yen BJ, Duncan A, Bakhshi P, Palmo T, Jadhav S, Deshpande S. People with mental illness stigmatize mental illness less: A comparison study between a hospital-based sample of people with mental illness and a non-clinical general population sample in urban India. Transcult Psychiatry 2023; 60:954-972. [PMID: 37551092 DOI: 10.1177/13634615231179265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Evidence shows that stigma negatively influences the quality of life of persons with severe mental illness. Nonetheless, stigma towards mental illness is lower among persons with a lived experience of mental illness compared to the rest of the population. Understanding the association between stigma of mental illness and the mental status of individuals living in urban India and whether this association is moderated by demographic factors opens a new avenue for prevention of social exclusion. Persons diagnosed with schizophrenia, bipolar disorder, or severe unipolar depression (cases, n = 647) were recruited from among hospital patients in New Delhi between November 2011 and June 2012 and matched with non-psychiatric urban dwellers by age, sex, and location of residence (controls, n = 649). Propensity score matching with multivariable linear regression was used to test whether stigma towards mental illness, measured by a 13-item Stigma Questionnaire, differed between cases and controls. Cases reported significantly lower stigma scores than controls (b = -0.50, p < 0.0001). The strength of the association between mental illness and stigma was not affected after controlling for age, caste, sex, education, and employment status, while wealth marginally reduced the strength of the association. These findings suggest individuals with a lived experience of mental illness, in New Delhi, India, may be more tolerant towards mental illness and support the need to involve persons with lived experience in the development and implementation of health promotional campaigns and programs aimed at reducing stigma towards mental illness.
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Affiliation(s)
- Jean-Francois Trani
- Brown School and Institute of Public Health, Washington University in St Louis, USA
- National Pedagogical school Health and Solidarity, National Center for Arts and Crafts, France
| | - Bing-Jie Yen
- School of Public Health, Indiana University Bloomington, USA
| | - Alexis Duncan
- Brown School and Institute of Public Health, Washington University in St Louis, USA
| | - Parul Bakhshi
- School of Occupational Therapy, Medical School, Washington University in St Louis, USA
| | - Trinley Palmo
- Students health and wellness, University of Virginia, USA
| | | | - Smita Deshpande
- Department of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, PGIMER-Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Lee JJ, Li Verdugo J, Xiao AY, Vo K. Digital Interventions to Enhance PrEP Uptake and Adherence Through Stigma Reduction. Curr HIV/AIDS Rep 2023; 20:458-469. [PMID: 38057685 DOI: 10.1007/s11904-023-00685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Although pre-exposure prophylaxis (PrEP) is effective for reducing risk of HIV transmission, stigma persists as a barrier to HIV prevention. Digital technologies present opportunities to access hard-to-reach populations and increase the efficiency of established interventions. This review examines current digital interventions addressing stigma to improve PrEP-related outcomes. RECENT FINDINGS Digital technologies are increasingly used for HIV prevention and include a wide range of formats. Recent interventions focused on stigma and PrEP tend to engage mobile phone-related technology and focus on younger populations with particular attention to men who have sex with men and transgender women. Digital interventions that address stigma are promising for improving PrEP-related outcomes. No single technology currently demonstrates consistent superiority. Limited access to PrEP and heightened stigma in under-resourced countries present challenges for interventions supporting diverse communities. Further research should examine how digital interventions can reduce stigma beyond the individual level to enhance PrEP use and explore opportunities to improve and integrate approaches to stigma measurement.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA.
| | - Juliann Li Verdugo
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA
| | | | - Katie Vo
- School of Public Health, University of Washington, Seattle, WA, USA
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Hartog K, Peters RMH, Tukahiirwa RK, Jordans MJD. Reducing stigma impacting children and adolescents in low- and middle-income countries: The development of a common multi-component stigma reduction intervention. PLoS One 2023; 18:e0292064. [PMID: 37906579 PMCID: PMC10617710 DOI: 10.1371/journal.pone.0292064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/12/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Stigmatisation impedes health and quality of life. Evidence regarding stigma reduction interventions is, albeit growing, limited. There is a gap in the availability and evidence of interventions for reducing stigma among children and adolescents, especially in low- and middle-income countries. This paper describes the process that led to a stigma reduction intervention impacting children and adolescents in low- and middle-income countries, following previously conducted formative research. METHODS In this study, we conducted (i) online stakeholder consultations (FGD) (n = 43), including a survey assessing intervention acceptability, appropriateness, feasibility and scalability (n = 16); and (ii) preliminary field-testing of intervention content online and in a refugee settlement in Uganda. FINDINGS Stakeholder consultation showed the initial version of STRETCH (Stigma Reduction to Trigger Change for Children), albeit positively received, required adaptations. We made adjustments to i) take into account implementation duration, intervention flexibility and intersectionality; (ii) strengthen the involvement of individuals, including adolescents/youth, with lived stigma experience; (iii) target people close to individuals with lived stigma experience; and (iv) address feasibility and sustainability concerns. Preliminary field-testing simplified STRETCH while adding a community outreach component and revisiting the intervention setup, to ensure STRETCH can also be applied from a modular perspective. CONCLUSION We conducted a process to develop a child-focused multi-component stigma reduction intervention, with intended applicability across stigmas and settings. This paper provides an overview of the intervention development process, generating intervention-specific learnings with generic value. STRETCH aims to reduce stigmatisation at the implementing organisation, create community-wide reflection and stigma reduction demand, and reduce stigmatisation among various target groups.
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Affiliation(s)
- Kim Hartog
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Ruth M. H. Peters
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Mark J. D. Jordans
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands
- Research and Development Department, War Child, Amsterdam, The Netherlands
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Segre G, Cargnelutti C, Bersani C, Njogu W, Roberti E, Campi R, De Vita MV, Morino G, Canevini MP, Bonati M. Early detection of neurodevelopmental disorders in African children living in informal settlements in Nairobi. BMJ Paediatr Open 2023; 7:e002117. [PMID: 37890890 PMCID: PMC10619007 DOI: 10.1136/bmjpo-2023-002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Children in low-income and middle-income countries (LMICs) are at a substantially increased risk of delayed physical, emotional and sociocognitive outcomes, with consequential neurodevelopmental disorders. Evidence based, cost-effective and culturally appropriate screening tools are recommended for early identification of developmental disorders. METHODS The present study aims to assess the feasibility of early screening for neurodevelopmental disorders in children living in informal settlements in Nairobi, Kenya (Korogocho). The selected tools (ie, the CDC checklist and the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)), widely used in high-income countries, are applied in two different populations: one from Kenya (LMIC) and one from Italy, to compare the different scores. RESULTS Of 509 children screened, 8.6% were classified at-risk based on the results of the screening tools. Significant risk factors are history of low birth weight and Apgar score, presence of neurological disorders, malnutrition and/or rickets, younger age of the child and older age of the mother. Caesarean section delivery, first pregnancy and mothers' older age were common risk factors among the Kenyan and the Italian samples. The Italian sample had a significantly greater rate of missed milestones. CONCLUSIONS Our data demonstrate the feasibility of using the CDC and M-CHAT-R tools in informal settlement dwellers. Further studies are needed to explore the opportunity for early diagnosis of developmental disorders in LMICs.
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Affiliation(s)
- Giulia Segre
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Cecilia Cargnelutti
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Carlotta Bersani
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | | | - Elisa Roberti
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Rita Campi
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | | | | | | | - Maurizio Bonati
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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12
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Okoli CZ. Board of Directors' Column: (de)Stigmatization of Mental Illness and Mental Health Care. J Am Psychiatr Nurses Assoc 2023; 29:432-435. [PMID: 37555439 DOI: 10.1177/10783903231191105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
- Chizimuzo Zim Okoli
- Chizimuzo (Zim) Okoli, PhD, MPH, MSN, PMHNP-BC, FAAN, American Psychiatric Nurses Association, Falls Church, VA, USA
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13
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Ramírez-Vielma R, Vaccari P, Cova F, Saldivia S, Vielma-Aguilera A, Grandón P. Interventions to reduce the stigma of mental health at work: a narrative review. PSICOLOGIA-REFLEXAO E CRITICA 2023; 36:14. [PMID: 37213032 DOI: 10.1186/s41155-023-00255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/07/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND While there are reviews of the literature on mental health stigma reduction programs, very few have focused on the workplace. OBJECTIVE We sought to identify, describe and compare the main characteristics of the interventions to reduce the stigma towards mental health at work. METHOD The search of original articles (2007 to 2022) was carried out in the Web of Science Core Collection and Scopus databases, selecting 25 articles from the key terms: 1. Stigma, 2. Workplace, 3. Anti-stigma intervention/program, 4. Mental health. RESULTS These interventions can be effective in changing the knowledge, attitudes, and behaviors of workers towards people with mental health problems, although further verification of these results is needed as they are limited to date. DISCUSSION AND CONCLUSION Interventions to reduce stigma in the workplace could create more supportive work environments by reducing negative attitudes and discrimination and improving awareness of mental disorders.
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Affiliation(s)
- Raúl Ramírez-Vielma
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Barrio Universitario S/N, Concepción, Chile
| | - Pamela Vaccari
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Barrio Universitario S/N, Concepción, Chile
| | - Félix Cova
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Barrio Universitario S/N, Concepción, Chile
| | - Sandra Saldivia
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Alexis Vielma-Aguilera
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Pamela Grandón
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Barrio Universitario S/N, Concepción, Chile.
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14
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Gronholm PC, Bakolis I, Cherian AV, Davies K, Evans-Lacko S, Girma E, Gurung D, Hanlon C, Hanna F, Henderson C, Kohrt BA, Lempp H, Li J, Loganathan S, Maulik PK, Ma N, Ouali U, Romeo R, Rüsch N, Semrau M, Taylor Salisbury T, Votruba N, Wahid SS, Zhang W, Thornicroft G. Toward a multi-level strategy to reduce stigma in global mental health: overview protocol of the Indigo Partnership to develop and test interventions in low- and middle-income countries. Int J Ment Health Syst 2023; 17:2. [PMID: 36732828 PMCID: PMC9896727 DOI: 10.1186/s13033-022-00564-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/31/2022] [Indexed: 02/04/2023] Open
Abstract
There is increasing attention to the impacts of stigma and discrimination related to mental health on quality of life and access to and quality of healthcare. Effective strategies for stigma reduction exist, but most evidence comes from high-income settings. Recent reviews of stigma research have identified gaps in the field, including limited cultural and contextual adaptation of interventions, a lack of contextual psychometric information on evaluation tools, and, most notably, a lack of multi-level strategies for stigma reduction. The Indigo Partnership research programme will address these knowledge gaps through a multi-country, multi-site collaboration for anti-stigma interventions in low- and middle-income countries (LMICs) (China, Ethiopia, India, Nepal, and Tunisia). The Indigo Partnership aims to: (1) carry out research to strengthen the understanding of mechanisms of stigma processes and reduce stigma and discrimination against people with mental health conditions in LMICs; and (2) establish a strong collaborative research consortium through the conduct of this programme. Specifically, the Indigo Partnership involves developing and pilot testing anti-stigma interventions at the community, primary care, and mental health specialist care levels, with a systematic approach to cultural and contextual adaptation across the sites. This work also involves transcultural translation and adaptation of stigma and discrimination measurement tools. The Indigo Partnership operates with the key principle of partnering with people with lived experience of mental health conditions for the development and implementation of the pilot interventions, as well as capacity building and cross-site learning to actively develop a more globally representative and equitable mental health research community. This work is envisioned to have a long-lasting impact, both in terms of the capacity building provided to participating institutions and researchers, and the foundation it provides for future research to extend the evidence base of what works to reduce and ultimately end stigma and discrimination in mental health.
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Affiliation(s)
- Petra C Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anish V Cherian
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Kelly Davies
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, UK
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dristy Gurung
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fahmy Hanna
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Claire Henderson
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jie Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Santosh Loganathan
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ning Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Uta Ouali
- Department Psychiatry A, Razi University Hospital, La Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Renee Romeo
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicolas Rüsch
- Section of Public Mental Health, Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicole Votruba
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College London, London, UK
| | - Syed Shabab Wahid
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
- Department of Global Health, School of Health, Georgetown University, Washington, DC, USA
| | - Wufang Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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15
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Thornicroft G, Sunkel C, Alikhon Aliev A, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC, Guerrero Z, Gurung D, Habtamu K, Hanlon C, Heim E, Henderson C, Hijazi Z, Hoffman C, Hosny N, Huang FX, Kline S, Kohrt BA, Lempp H, Li J, London E, Ma N, Mak WWS, Makhmud A, Maulik PK, Milenova M, Morales Cano G, Ouali U, Parry S, Rangaswamy T, Rüsch N, Sabri T, Sartorius N, Schulze M, Stuart H, Taylor Salisbury T, Vera San Juan N, Votruba N, Winkler P. The Lancet Commission on ending stigma and discrimination in mental health. Lancet 2022; 400:1438-1480. [PMID: 36223799 DOI: 10.1016/s0140-6736(22)01470-2] [Citation(s) in RCA: 134] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK.
| | | | - Akmal Alikhon Aliev
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Sue Baker
- Mind international, London, UK; Changing Minds Globally, London, UK
| | - Elaine Brohan
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | - Kelly Davies
- Centre for Implementation Science, King's College London, London UK
| | - Mekdes Demissie
- College of Health Sciences and Medicine, School of Nursing and Midwifery, Haramaya University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | | | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Zoe Guerrero
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Dristy Gurung
- Centre for Implementation Science, King's College London, London UK; Transcultural Psychosocial Organization (TPO), Kathmandu Nepal
| | - Kassahun Habtamu
- Addis Ababa University, School of Psychology, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; WHO Collaborating Centre for Mental Health Research and Training, King's College London, London UK; Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Heim
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | - Claire Henderson
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | | | - Nadine Hosny
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | | | | | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington DC, USA
| | - Heidi Lempp
- Institute of Psychiatry, Psychology and Neuroscience, and Academic Department of Rheumatology, King's College London, London UK
| | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ning Ma
- Institute of Mental Health, Peking University, Beijing, China
| | - Winnie W S Mak
- Department of Psychology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, NSW, Australia
| | - Maria Milenova
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | | | - Uta Ouali
- Razi Hospital and El Manar Medical School, University of Tunis, La Manouba, Tunisia
| | - Sarah Parry
- South London and the Maudsley NHS Foundation Trust, London, UK
| | | | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Taha Sabri
- Taskeen Health Initiative, Karachi, Pakistan
| | - Norman Sartorius
- Association for the Improvement of Mental health Programs, Geneva, Switzerland
| | | | | | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | - Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London UK
| | - Nicole Votruba
- and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Petr Winkler
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
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16
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Jara-Ogeda R, Leyton D, Grandón P. Stigmatization of people diagnosed with a mental disorder in secondary mental health centers in Chile: An ethnographic study. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3307-3324. [PMID: 35290673 DOI: 10.1002/jcop.22838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Romina Jara-Ogeda
- Magister in Psychology, Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Daniela Leyton
- Department of Anthropology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Pamela Grandón
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
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17
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Chang CT, Thum CC, Lim XJ, Chew CC, Rajan P. Monkeypox outbreak: Preventing another episode of stigmatisation. Trop Med Int Health 2022; 27:754-757. [PMID: 35779015 DOI: 10.1111/tmi.13798] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Chern Choong Thum
- Department of Psychiatry, Universiti Putra Malaysia Teaching Hospital, Serdang, Malaysia
| | - Xin Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Chii Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
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18
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Parra Videla C, Sapag JC, Klabunde R, Velasco PR, Anríquez S, Aracena Álvarez M, Mascayano F, Bravo P, Sena BF, Jofré Escalona A, Bobbili SJ, Corrigan PW, Bustamante I, Poblete F, Alvarado R. Cross-cultural adaptation of four instruments to measure stigma towards people with mental illness and substance use problems among primary care professionals in Chile. Transcult Psychiatry 2022; 60:286-301. [PMID: 35821607 DOI: 10.1177/13634615221100377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of stigma research focuses on Europe or North America leading to a lack of culturally relevant stigma research instruments for the Latin American context. The present study describes and discusses the methodology for cross-culturally adapting four stigma measurement scales to the Chilean context. The cross-cultural adaptation process included nine phases: (1) preparation; (2) independent translations; (3) synthesis 1 with expert committee; (4) focus groups and interviews with researchers, PHC professionals, and PHC users; (5) synthesis 2 with expert committee; (6) independent back translations; (7) synthesis 3 with expert committee; (8) pilot with PHC professionals; and (9) final revisions. The adaptation process included an array of diverse voices from the PHC context, and met three adaptation objectives defined prior to beginning the process (Understandability, Relevance, and Acceptability and Answer Options). The resulting, culturally adapted questionnaire is being validated and implemented within PHC settings across Chile to provide in-depth insight into stigma among PHC professionals in the country. The authors hope it will be useful for future research on mental illness and substance use stigma in similar settings across Latin America.
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Affiliation(s)
- Claudia Parra Videla
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime C Sapag
- Departamentos de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Division of Clinical Public Health, Dalla Lana School of Public Health, 274071University of Toronto, Toronto, Ontario, Canada.,Collaborator Scientist WHO/PAHO Collaborating Centre, Institute for Mental Health Policy Research, 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel Klabunde
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paola R Velasco
- Collaborator Scientist WHO/PAHO Collaborating Centre, Institute for Mental Health Policy Research, 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Samanta Anríquez
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, 33638Columbia University, New York, NY, USA.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
| | - Paulina Bravo
- Escuela de Enfermería, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Social Sciences, Cardiff University, Cardiff, UK
| | - Brena F Sena
- Center for Innovation in Social Work and Health, Boston University School of Social Work, Boston, MA, USA
| | - Ana Jofré Escalona
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sireesha J Bobbili
- WHO/PAHO Collaborating Centre for Addiction & Mental Health, Institute for Mental Health Policy Research, 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Inés Bustamante
- Facultad de Salud Pública y Administración, 33216Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fernando Poblete
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Alvarado
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile/Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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19
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Gavan L, Hartog K, Holland WC, Koppenol-Gonzalez G, Gronholm PC, Feddes AR, Kohrt BA, Jordans MJ, Peters RH. Assessing stigma in low- and middle-income countries: A systematic review of scales used with children and adolescents. Soc Sci Med 2022; 307:115121. [DOI: 10.1016/j.socscimed.2022.115121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
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20
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Fernández D, Grandón P, López-Angulo Y, Vielma-Aguilera AV, Peñate W. Systematic Review of Explanatory Models of Internalized Stigma in People Diagnosed with a Mental Disorder. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Sapag JC, Traub C, Velasco PR, Arratia T, Alvarado R, Aracena M, Poblete FC, Villarroel L, Bravo P, Álvarez-Huenchulaf C, Jofré Escalona A, Vargas-Malebrán N, Bobbili S, Bustamante I, Khenti A, Corrigan PW. Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study. Front Psychiatry 2022; 13:1083042. [PMID: 36606131 PMCID: PMC9808783 DOI: 10.3389/fpsyt.2022.1083042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention. METHODS The intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or "cluster"). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects. DISCUSSION This study represents a new stage of relevant and innovative research in mental health and stigma in Chile that will contribute to improving access and quality of care for people with MISUI. Evaluating the impact of the intervention model and its implementation will provide the necessary tools to scale the intervention up to other CESFAMs across Chile. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT05578066].
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Affiliation(s)
- Jaime C Sapag
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Medicina Familiar, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Carolina Traub
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paola R Velasco
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tamara Arratia
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Alvarado
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile.,Programa de Salud Mental, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Marcela Aracena
- Escuela de Psicología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando C Poblete
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Bravo
- Escuela de Enfermería, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cinthia Álvarez-Huenchulaf
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Jofré Escalona
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nelson Vargas-Malebrán
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sireesha Bobbili
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Inés Bustamante
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Akwatu Khenti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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22
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Grandón P, Saldivia S, Cova F, Bustos C, Vaccari P, Ramírez-Vielma R, Vielma-Aguilera A, Zambrano C, Ortiz C, Knaak S. Effectiveness of an intervention to reduce stigma towards people with a severe mental disorder diagnosis in primary health care personnel: Programme Igual-Mente. Psychiatry Res 2021; 305:114259. [PMID: 34752990 DOI: 10.1016/j.psychres.2021.114259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the effectiveness of a program (called Igual-Mente, Equal-Mind) designed to reduce stigma in primary health care personnel. A random clinical trial was performed (ISRCTN46464036). There were 316 primary care professionals and technicians who were randomized and assigned to the experimental or control group. The program considered as strategies the education, the contact and the development of skills. There were six sessions with the primary care staff and two sessions with the managers of the health centers. It was executed by two facilitators, a professional psychologist and an expert by experience, i.e., a person diagnosed with a severe mental disorder (SMD). Attitudes, social distance, and humane treatment behaviors toward people with SMD were assessed. The intervention was effective in reducing stigma attitudes y social distance towards people diagnosed with SMD. The magnitude of the changes ranged from moderate to high in all these variables and the effects were maintained for four months after the end of the program. Regarding humane treatment behaviors, the effects were less clear. This study shows good results indicating that well-designed interventions can effectively reduce stigma towards people diagnosed with SMD, which is one of the main challenges of health systems.
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Affiliation(s)
- Pamela Grandón
- Psychology Department, Universidad de Concepcion, Concepcion, Chile.
| | - Sandra Saldivia
- Psychiatric Department, Universidad de Concepcion, Concepcion, Chile
| | - Felix Cova
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Claudio Bustos
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Pamela Vaccari
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | | | | | | | - Camila Ortiz
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Stephanie Knaak
- Social Sciences Department, University of Calgary, Calgary, Canada
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23
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Javed A, Lee C, Zakaria H, Buenaventura RD, Cetkovich-Bakmas M, Duailibi K, Ng B, Ramy H, Saha G, Arifeen S, Elorza PM, Ratnasingham P, Azeem MW. Reducing the stigma of mental health disorders with a focus on low- and middle-income countries. Asian J Psychiatr 2021; 58:102601. [PMID: 33611083 DOI: 10.1016/j.ajp.2021.102601] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/07/2021] [Indexed: 01/12/2023]
Abstract
Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.
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Affiliation(s)
- Afzal Javed
- Pakistan Psychiatric Research Centre, Lahore, Pakistan; World Psychiatric Association (WPA), UK.
| | - Cheng Lee
- Institute of Mental Health, Singapore
| | - Hazli Zakaria
- Malaysian Psychiatric Association (MPA), Kuala Lumpur, Malaysia
| | - Robert D Buenaventura
- Department of Neurosciences, Manila Theological College - College of Medicine, Manila, Philippines
| | - Marcelo Cetkovich-Bakmas
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Kalil Duailibi
- Department of Psychiatry, Santo Amaro University, São Paulo, Brazil
| | - Bernardo Ng
- Asociación Psiquiátrica Mexicana, Mexico; University of California, San Diego, CA, USA
| | - Hisham Ramy
- NeuroPsychiatry Department, Ain Shams University, Cairo, Egypt; Egyptian Psychiatric Association (EPA), Cairo, Egypt; Egyptian Association of Cognitive Behavioral Therapy (EACBT), Cairo, Egypt
| | - Gautam Saha
- Clinic Brain Neuropsychiatric Institute and Research Center, Kolkata, India; Indian Psychiatric Society, Kolkata, India
| | | | - Paola M Elorza
- Research, Development & Medical, Upjohn - A Pfizer Division, Buenos Aires, Argentina
| | | | - Muhammad Waqar Azeem
- Department of Psychiatry, Sidra Medicine, Weill Cornell Medical College, Doha, Qatar
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24
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Arefaynie M, Damtie Y, Kefale B, Yalew M. Predictors of Discrimination Towards People Living with HIV/AIDS Among People Aged 15–49 Years in Ethiopia: A Multilevel Analysis. HIV AIDS (Auckl) 2021; 13:283-292. [PMID: 33758550 PMCID: PMC7979683 DOI: 10.2147/hiv.s299812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Correspondence: Mastewal Arefaynie Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaTel +251 912867518 Email
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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25
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Martínez V, Crockett MA, Jiménez-Molina Á, Espinosa-Duque HD, Barrientos E, Ordóñez-Carrasco JL. Stigmatizing Beliefs and Attitudes to Depression in Adolescent School Students in Chile and Colombia. Front Psychol 2020; 11:577177. [PMID: 33192890 PMCID: PMC7645029 DOI: 10.3389/fpsyg.2020.577177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
Major depressive disorder (MDD) affects between 4 and 5% of adolescents. However, there is still a huge gap between adolescents who meet criteria for MDD and those who receive mental health care. Stigmatizing attitudes toward depression are among the main barriers to seeking professional help. The aim of this article is to examine the individual characteristics associated with stigmatizing attitudes toward depression in a sample of adolescent school students from Chile and Colombia, and present the adaptation and psychometric properties of the Personal Depression Stigma Scale (DSS-Personal) for both countries. A total of 2971 adolescents, aged 10–19 (M = 14.6, SD = 1.5), who were recruited from eight schools in Santiago, Chile (n = 2022), and eight schools in Medellín, Colombia (n = 949), completed the DSS-Personal, the Patient Health Questionnaire (PHQ-9), and a questionnaire of individual sociodemographic characteristics. Factor structure, internal consistency, and validity of the DSS-Personal were assessed. Multiple linear regression models were used to evaluate the association between DSS-Personal scores and sociodemographic information, depression scores, and the use of health services by country. Confirmatory factor analysis supported the unidimensional structure of the DSS-Personal, while the estimated reliability of its scores was acceptable. Results show that DSS-Personal scores were higher in adolescents in Colombia than in Chile (U = 9.36, p < 0.001). Immigrant status was the only variable significantly related to personal depression stigma in both samples. Being female was associated with lower levels of stigma in adolescents in Chile, while depressive symptoms were associated with lower levels of stigma in adolescents in Colombia. Age, having been diagnosed with depression, and being in pharmacological or psychological treatment were not related to levels of personal depression stigma in either sample. The identified associated factors of personal depression stigma should be considered in the development of anti-stigma campaigns; also, gender differences require special attention. The results of this study suggest that it is important to offer school-based programs to reduce personal stigma, and that specific anti-stigma campaigns should address personal stigma in men and immigrants.
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Affiliation(s)
- Vania Martínez
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Marcelo A Crockett
- ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile.,Doctorado en Salud Pública, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
| | - Álvaro Jiménez-Molina
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Nucleus in Social Development (DESOC), Santiago, Chile.,Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - H Daniel Espinosa-Duque
- ANID, Millennium Science Initiative Program, Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile.,Facultad de Psicología, Universidad CES, Medellín, Colombia
| | - Elisa Barrientos
- ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.,Departamento de Psiquiatría y Salud Mental Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jorge L Ordóñez-Carrasco
- ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.,Departamento de Psicología, Universidad de Almería, Almería, Spain
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26
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Trani JF, Moodley J, Anand P, Graham L, Thu Maw MT. Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem. Soc Sci Med 2020; 265:113449. [PMID: 33183862 PMCID: PMC7576188 DOI: 10.1016/j.socscimed.2020.113449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 01/28/2023]
Abstract
Despite the fact that universal inclusion is a basic principle of the Sustainable Development Goals, the inclusion of persons with disabilities in humanitarian interventions and development policies remains elusive. Persons with disabilities face high risks of poverty, poor nutrition, limited inclusion in labor markets and poor mental health as a result. Stigma is likely to play a negative role in this regard and yet, no study has investigated the impact of stigma on depression and self-esteem of persons with disabilities. To address this gap in the literature, we conducted in June 2017 a random sample disability case control household study in Soweto, a township in Johannesburg, South Africa. Using propensity score analysis and structural equation modeling, we investigated the relationship between disability, stigma, depression and self-esteem controlling for socioeconomic covariates. Our main empirical results showed that stigma significantly mediates the association between disability and higher depression on the one hand and between disability and lower self-esteem on the other. This mediating effect exists even after controlling for age, gender, marital status, education, employment and wealth. We also found strong direct associations between disability and depressive mood, somatic indicators and negative feelings such as unhappiness and low self-esteem. Unemployment aggravates depression and low self-esteem while low education worsens self-esteem only. In addition, depression exacerbates low self-esteem. Both unemployment and low education are more common among persons with disabilities aggravating the disability, depression, poor self-esteem nexus. Similarly, persons with disabilities who are more likely to be depressed are also at higher risk of low self-esteem. These results point to a vicious reinforcing circle of exclusion from society, despair and self-deprecation, which could prove difficult to break. Substantial psycho-social support and anti-stigma policies anchored in local cultural values, engaging persons with disabilities and their communities, are required to break this vicious circle.
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Affiliation(s)
- Jean-Francois Trani
- Brown School and Institute of Public Health,Washington University in St Louis, 1 Brookings Drive, St Louis, MO, 63130, USA.
| | - Jacqueline Moodley
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| | | | - Lauren Graham
- Centre for Social Development in Africa, University of Johannesburg, Johannesburg, South Africa
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27
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Abstract
In recent years, efforts in Global Mental Health (GMH) have evolved alongside critical engagement with the field's claims and interventions. GMH has shifted its agenda and epistemological underpinnings, increased its evidence base, and joined other global policy platforms such as the Sustainable Development Goals. This editorial introduction to a thematic issue traces the recent shifts in the GMH agenda and discusses the changing construct of "mental health" as GMH moves away from a categorical biomedical model toward dimensional and transdiagnostic approaches and embraces digital technologies. We highlight persistent and emerging lines of inquiry and advocate for meaningful interdisciplinary engagement. Taken together, the articles in this special issue of Transcultural Psychiatry provide a snapshot of current interdisciplinary work in GMH that considers the socio-cultural and historical dimensions of mental health important and proposes reflexive development of interventions and implementation strategies.
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Affiliation(s)
- Dörte Bemme
- University of North Carolina at Chapel Hill, USA.,Division of Social & Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
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