A first national survey of knowledge, attitudes and behaviours towards schizophrenia, bipolar disorders and autism in France

Factors underlying differences in knowledge, explicit stigma and implicit biases towards autism across Hong Kong, the United Kingdom and the United States

LAY ABSTRACT

Attitudes towards autism vary across countries. Some of this variation could reflect differences in cultural values across countries, or differences in how much people know about autism. Until now, most research on this topic has asked people directly about their attitudes towards interacting with autistic people. As a result, we understand little about why some people unconsciously hold negative attitudes towards autism, and whether these unconscious attitudes vary across countries. We studied explicit attitudes (willingness to interact), implicit attitudes (unconscious beliefs), knowledge about autism, and cultural values in university students from Hong Kong, the United Kingdom and the United States. We found that people were less willing to interact with autistic people if they knew less about autism, aligned with a competitive and hierarchical society ('vertical individualism'), did not see themselves as part of a collective whose members are equal (less 'horizontal collectivism'), and if they unconcsciously associated autism with negative attributes. Students in Hong Kong were less willing to interact with autistic people and had less understanding of autism compared to those in the United Kingdom and the United States. Unconscious biases did not differ across countries. Our findings highlight the need to combat misconceptions about autism to improve attitudes towards autistic people, especially in Hong Kong. Unfortunately, our results suggest that acquiring more accurate knowledge may not be sufficient to alter unconscious biases. Further research is needed to determine the factors underlying unconscious biases.

Assessing Stigma Toward Mental, Neurological, and Substance Use Disorders in Liberia: A Population Representative Study

Mental health stigma remains a major global problem associated with low self-esteem, social withdrawal, and poor health-seeking behavior in individuals. However, limited published evidence details these challenges in Liberia. Knowledge of public perceptions toward mental illness and key trends in the associations between knowledge of mental, neurological, and substance use disorders (MNSs) and stigma is crucial to designing evidence-based mental health policies and supporting service delivery. This population-representative survey explored and quantified stigma related to MNSs in four health regions in Liberia, using a multistage stratified random sampling of 1,148 residents. Four internationally validated scales were used to assess knowledge, attitudes, and perceptions toward schizophrenia, bipolar disorder, epilepsy, and substance use disorder including the 1) Mental Health Attribution Questionnaire; 2) Five Question Stigma Indicator Questionnaire to assess Community Stigma; 3) Reported Intended Behavioral Scale; and 4) Personal Acceptance Level of Conditions. Data from interviews with 1,140 participants (96% response rate) were analyzed using central tendencies, hypothesis testing with simple logistic regression, and bivariate analysis for association between dependent and independent variables. Low mental health knowledge was found to be a strong predictor of discriminatory behaviors and stigma. Results revealed that exposure to movies or television significantly predicted increased discriminatory tendencies and that a lesser degree of acceptance was shown toward substance use disorder than any of the other conditions. These findings underscore the need for increased awareness and education about mental health to eliminate stigma and promote better care and inclusion for people living with MNSs.

Helpful or harmful? The effect of a diagnostic label and its later retraction on person impressions

Diagnostic labels for mental health conditions can inadvertently reinforce harmful stereotypes and exacerbate stigma. If a diagnosis is incorrect and a label is wrongly applied, this may negatively impact person impressions even if the inaccurate label is later corrected. This registered report examined this issue. Participants (N = 560) read a vignette about a hospital patient who was either diagnosed with schizophrenia, diagnosed with major depressive disorder, or not diagnosed with a mental health condition. The diagnostic labels were later retracted strongly, retracted weakly, or not retracted. Participants completed several stigma measures (desire for social distance, perceived dangerousness, and unpredictability), plus several inferential-reasoning measures that tested their reliance on the diagnostic label. As predicted, each mental health diagnosis elicited stigma, and influenced inferential reasoning. This effect was stronger for the schizophrenia diagnosis compared to the major depressive disorder diagnosis. Importantly, the diagnostic label continued to influence person judgments after a clear retraction (strong or weak), highlighting the limitations of corrections in reducing reliance on person-related misinformation and mental health stigma.

A Systematic Review of the Stigma Experienced by People with Autism Spectrum Disorder Associated with Intellectual Disabilities and by Their Family Caregivers

The purpose of this paper was to explore the social stigma experienced by individuals diagnosed with ASD+ID, and to identify knowledge gaps for future studies by conducting a systematic review of peer-reviewed literature. In this systematic review, we included 12 studies exploring the experience of stigma among people with ASD+ID and/or their caregivers. Our aim was to better understand this experience, but also to explore the strategies used to cope with stigma in this population. Our results confirmed that people with ASD+ID and their caregivers experience at least low to moderate levels of stigma, and that this experience is modulated by internal and external factors (such as parental age, mindfulness traits, ASD symptoms…). In addition, our results show the impact of stigma on community integration, psychological well-being and help-seeking behaviour. The role of family, friends and professional support, as well as the formation of networks to share information, appear in our results to be protective factors against stigma. To our knowledge, this study is the first systematic review to examine the stigmatisation of people with ASD+ID and/or their caregivers. Further research is needed to understand the perspective of people with ASD+ID themselves and to explore other factors that modulate this experience, in particular gender and ethnicity.

Individual stigma in people with severe mental illness: Associations with public stigma, psychological capital, cognitive appraisal and coping orientations

INTRODUCTION

The reason why some people with severe mental illness (SMI) maintain positive self-identity, while some are affected by the stigmatized environment is unclear.

AIMS

To describe the status of individual stigma and explore the relationship between self-stigma, stigma resistance and related variables in people with SMI.

METHODS

A cross-sectional study was conducted from April 2021 to March 2022. The Chinese version of Internalized Stigma of Mental Illness Scale and Stigma Resistance Scale were used to assess individual stigma. Perceived public stigma, psychological capital, stigma stress appraisal and coping orientations were also measured by scales. Data was provided by 422 patients with schizophrenia or bipolar disorder, from one psychiatric hospital and four community healthcare centers in China. A structural equation model was applied for analysis.

RESULTS

The total mean scores of self-stigma and stigma resistance were (2.06 ± 0.65), and (3.95 ± 0.84). Perceived public stigma was the primary condition for constructing individual stigma, which indirectly affected self-stigma (β = 0.268) and stigma resistance (β = -0.145). Stigma stress appraisal mediated the transformation of public stigma into individual, which had direct and indirect effects on self-stigma (β = 0.417, 0.166), and an indirect effect on stigma resistance (β = -0.374). Secrecy positively affected self-stigma (β = 0.117), while positive coping positively affected stigma resistance (β = 0.380). Psychological capital significantly directly impacted individual stigma.

CONCLUSIONS

Findings highlighted how public stigma determines the degree to which patients with SMI deal with stigma stress appraisal, and how this influences individuals. Anti-stigma programs and interventions to improve individuals' psychological capital and coping capabilities should be emphasized.

Comparing stigma between French people experiencing schizophrenia versus bipolar disorders

BACKGROUND

Among the multiple challenges that people experiencing mental illness in general, and schizophrenia or bipolar disorders in particular, have to face, stigma appears to be one of the most difficult to tackle. In France, the body of research about stigma regarding people experiencing schizophrenia or bipolar disorders is growing, but not as much as in other western countries.

AIMS

In this context, our study aims to explore and compare stigma in French people experiencing schizophrenia or bipolar disorders, along with their respective mental healthcare system experience, in order to better address them within public health policies.

METHODS

20 French mental health service users experiencing schizophrenia and 20 experiencing bipolar disorders answered the Stigma Scale, which assesses three dimensions of stigma (discrimination, difficulties of divulgation and lack of positive aspects). A semi-structured interview was used to collect information about the experience of the mental healthcare system (level of information, access to diagnosis, treatment, access to psychoeducation, etc.).

RESULTS

People experiencing schizophrenia and people experiencing bipolar disorders are different populations in terms of social impairment. However, they share a comparable negative experience of the mental healthcare system and a comparable level of information about their illness, to the exception of diagnosis divulgation, as people experiencing bipolar disorders have a better access to their diagnosis. People experiencing schizophrenia perceive a higher actual discrimination than people experiencing bipolar disorders.

CONCLUSIONS

Public health policies should take into account the strong perception of actual discrimination of people experiencing schizophrenia, with capitalizing on what seems beneficial for people experiencing bipolar disorders.

Treatment-seeking threshold and accessibility of psychiatric outpatient services in Switzerland: the relationship with stigma and self-esteem

Perceived stigmatization and low self-esteem are linked to poorer mental health outcomes, but their impact on treatment-seeking thresholds and the importance of outpatient service location remain unclear. The study included 525 outpatients of the University Psychiatric Clinic (UPK) Basel, Switzerland, of whom 346 were treated at inner city services and 179 at services located on the main site of the UPK at the outer city limits. Perceived discrimination and devaluation (PDD), self-esteem (SE), treatment-seeking threshold (TST), and accessibility were measured via a self-reported questionnaire. The PDD consisted of 12 items evaluating beliefs about the level of stigma towards individuals with mental illness in the general population on a 5-point Likert scale. SE, TST and accessibility were assessed through single-item 7-point Likert scales. PDD and SE were positively correlated (p < 0.001), suggesting that lower perceived stigma was linked to higher self-esteem, and were not associated with TST. The relationship between PDD and SE remained consistent after controlling for age, gender, and nationality. Age was negatively correlated with TST (p = 0.022), while gender did not significantly influence any of the variables. There was little variation regarding PDD, with emergencies at the site of the psychiatric clinic and substance use disorder (SUD) patients reporting higher levels of stigmatization. Emergency patients and those with SUD and personality disorder reported the lowest SE ratings. TST showed a broad range and was highest for emergency services and transcultural psychiatry patients. Differences in accessibility were mainly linked to the location, with outpatient service users in the inner city reporting better accessibility (p < 0.001) and higher SE (p = 0.009). In comparison to patients using services with planned contacts only, patients in emergency settings differed by higher TST (p = 0.018) and better ratings of accessibility (p = 0.004). In conclusion, there was a relevant amount of stigmatization, impaired self-esteem, and, for some outpatient services, high thresholds to seek treatment. Future research should explore other factors influencing TST. The findings highlight the need to address stigmatization and accessibility when planning mental health services.

Societal Attitudes Towards Autism (SATA): Validation of the Greek Version in the General Population

This study examined the validity of the Greek version of the Societal Attitudes Towards Autism (SATA) scale in a Greek community sample (n = 633) and explored how the demographic variables of the sample modulate knowledge and attitudes regarding people with Autism Spectrum Disorder (ASD). The principal component analysis confirmed the three-dimension model and explained 40.5% of the variance. All Cronbach's alpha values obtained were over 0.70. SATA's subscales were significantly and positively correlated, indicating good internal reliability. Participants presented moderate knowledge about ASD and mediocre positive attitudes towards people with ASD. Gender, age, and educational level significantly affected SATA total scores. Overall, this Greek version of SATA showed acceptable psychometric properties, indicating that can be a reliable scale for use.

"Survival classes for a neurotypical world": What French autistic adults want and need after receiving an autism diagnosis

LAY ABSTRACT

Adults receiving an autism diagnosis might not react the same depending on their countries or cultures. We also know that autistic people are rarely asked what they think would be best for them following this diagnosis. In this study, we asked 12 French autistic adults about their experiences of receiving an autism diagnosis as well as what they thought might be useful afterwards. Overall, we found that some experiences were similar to experiences related by English or American participants, but some were specific to the French culture, suggesting that such research should expand into new territories and cultures, especially non-European ones. Our participants also had quite a few ideas as to what would be useful for people in the same situation. Some of the suggestions can be put into action by peers and professionals alike, while others are wishes relating to how our participants would like society to behave toward them and people like them, for example. This article allows for a better comprehension of how cultural differences can impact the experience of receiving an autism diagnosis as an adult and provides some insight into what these adults want and desire following such a diagnosis.

Social Stigma Toward Individuals with Schizophrenia in a Lebanese Population

Background

Schizophrenia has been recognized as the most stigmatized mental disorder, imposing a substantial burden on affected individuals. However, no prior studies have investigated social stigma toward individuals with schizophrenia in Lebanon.

Purpose

We aimed to examine three components of social stigma including knowledge, attitude, and behavior toward individuals with schizophrenia in a Lebanese population and to explore associated factors with the level of social stigma.

Patients and Methods

A cross-sectional online survey was administered, and data from 469 participants were gathered from January 31, 2023, to February 18, 2023. We used previously validated questionnaires to assess the knowledge, attitude (Social Distance Scale), and behavior (Reported and Intended Behavior Scale) of participants toward individuals with schizophrenia. The score for each section was calculated and used to explore the associations between sociodemographic factors and the levels of stigma in each domain.

Results

The study participants had a moderate understanding of schizophrenia. However, a substantial proportion showed negative attitudes and unfavorable behaviors toward individuals with schizophrenia. We identified several sociodemographic factors associated with the knowledge, attitude, and behavior scores. Notably, a higher knowledge score and more positive attitudes were positively correlated with improved intended behaviors.

Conclusion

This study highlights the pervasive stigma encompassing issues in knowledge, attitudes, and behavior surrounding schizophrenia in a Lebanese population. Our study suggests a pressing need for targeted interventions to increase public awareness and decrease the social stigma of schizophrenia in Lebanon.

Knowledge and awareness of autism spectrum disorder among Libyans

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by the presence of delayed or defective development before the age of three years, as well as behavioral difficulties in social communication and interaction. To evaluate ASD knowledge and awareness, as well as ASD information sources in a sample of the Libyan general population, and to explore factors that could be associated with the knowledge and awareness. A cross-sectional study was carried out between 22 March and 13 August, 2022 using a self-administered questionnaire. The study included 2350 individual aged 18 and up from households living in different regions in Libya (eastern, southern, central, and western). Out of 2195 participants, 48.9% were females and 51.1% were males. Three-quarters of the participants (74.8%) presented a low level of knowledge about autism causes. Of those whose source of knowledge of autism was social media, 78.9% had a low level of knowledge. However, 57.9% of the participants showed a good level of awareness of autism symptoms and signs. The participants had a limited understanding of the causes and characteristics of ASD. Raising community awareness of the causes and characteristics of ASD is a priority.

Knowledge, attitudes, and behaviours towards schizophrenia, bipolar disorder, and autism: a pilot study

OBJECTIVES

Lack of knowledge and discriminatory attitudes and behaviours towards individuals with mental disorders is a worldwide problem but may be particularly damaging for young people. This pilot study examined knowledge, attitudes and behaviours towards schizophrenia, bipolar disorder and autism within a large sample of adults in Ireland, a country with the youngest population in Europe, in order to better understand public views on these groups.

METHODS

In a correlational, cross-sectional design, 307 adults in Ireland over the age of 18 completed a questionnaire over Google Forms examining knowledge, attitudes and behaviours towards schizophrenia, bipolar disorder and autism. Responses to questions specifically relating to each diagnosis were compared using trimmed mean ANOVA to examine whether responses to questions differed depending on diagnosis.

RESULTS

Results indicate varied knowledge, attitudes and behaviours towards these groups, but a majority believe it should be a research priority. ANOVA and post hoc tests revealed significant differences in knowledge, attitudes and behaviours towards each of schizophrenia, bipolar disorder, and autism (p < 0.005), and reported attitudes and behaviours towards schizophrenia were more negative than either bipolar disorder or autism. A majority of participants (54.8%) felt not informed enough about mental health by the media.

CONCLUSIONS

In our Irish sample, type and level of stigma varies according to mental health diagnosis. Our sample also report feeling inadequately informed about mental health by the media. Thus future policy and campaigns could consider targeting individual mental health diagnoses, with a focus on increasing familiarity and knowledge.

Discrimination reported by people with schizophrenia: cross-national variations in relation to the Human Development Index

AIMS

Mental health related stigma and discrimination is a universal phenomenon and a contributor to the adversity experienced by people with schizophrenia. Research has produced inconsistent findings on how discrimination differs across settings and the contextual factors that underpin these differences. This study investigates the association between country-level Human Development Index (HDI) and experienced and anticipated discrimination reported by people with schizophrenia.

METHODS

This study is a secondary data analysis of a global cross-sectional survey completed by people living with schizophrenia across 29 countries, between 2005 and 2008. Experienced and anticipated discrimination were assessed using the Discrimination and Stigma Scale (DISC-10). Countries were classified according to their 2006 HDI. Negative binomial and Poisson regression analyses with a robust standard errors approach were conducted to investigate associations between country-level HDI and discrimination.

RESULTS

In the regression analyses, no evidence was found for a linear association between HDI and experienced or anticipated discrimination. Further exploratory analyses showed a significant non-linear association between HDI ratings and experienced discrimination. Participants in "high" and "very high" HDI countries reported more experienced discrimination compared to those in "medium" HDI countries.

CONCLUSIONS

HDI does, to some extent, appear to be associated with how far discrimination is experienced across different contexts. More high-quality cross-national research, including research focused on "medium" and "low" countries, is needed to substantiate these findings and identify underlying factors that may explain the pattern observed for experienced discrimination, including generating new datasets that would enable for these analyses to be repeated and contrasted with more recent data. An in-depth understanding of these factors will further aid the adaptation of cross-cultural and context specific anti-stigma interventions in future.

A mixed method comparison of stigma toward autism and schizophrenia and effects of person-first versus identity-first language

Introduction

While stigma toward autistic individuals has been well documented, less is known about how autism is perceived relative to other stigmatized disabilities. As a highly stigmatized condition with similar social cognitive features to autism, schizophrenia may offer a useful comparison for stigma. Previous studies have found that autistic people may be perceived more favorably than those with schizophrenia, but little is known about the underlying volitional thoughts that contribute to differences in how these conditions are perceived.

Methods

The present study utilizes a mixed-methods approach, allowing for a detailed understanding of how young adults perceive different diagnostic labels. 533 college undergraduates completed questionnaires reflecting their perceptions of one of eight diagnostic labels: four related to autism (autism, autistic, autism spectrum disorder, or Asperger's), two related to schizophrenia (schizophrenia or schizophrenic), and two related to an unspecified clinical condition (clinical diagnosis or clinical disorder). Participants also completed an open-ended question regarding their thoughts about, and exposure to, these labels. Responses were compared across broader diagnostic categories (autism, schizophrenia, general clinical condition), with thematic analysis used to assess the broader themes occurring within the open-ended text.

Results

While perceptions did not differ significantly for person-first and identity-first language within labels, several differences were apparent across labels. Specifically, quantitative results indicated greater prejudice towards autism and schizophrenia than the generic clinical condition, with schizophrenia associated with more perceived fear and danger, as well as an increased preference for social distance, compared to autism. Patterns in initial codes differed across diagnostic labels, with greater variation in responses about autism than responses about schizophrenia or the general clinical condition. While participants described a range of attitudes toward autism (patronizing, exclusionary, and accepting) and schizophrenia (fear, prejudice, and empathy), they refrained from describing their attitudes toward the general clinical label, highlighting the centrality of a cohesive group identity for the development of stigma. Finally, participants reported a number of misconceptions about autism and schizophrenia, with many believing features such as savant syndrome to be core characteristics of the conditions.

Conclusion

These findings offer a more detailed account of how non-autistic individuals view autism and may therefore aid in the development of targeted programs to improve attitudes toward autism.

Evaluation of an Autism Training in a Much-Needed Context: The Case of France

Background

Autistic people in France have called for community education to reduce autism stigma. As such, training is needed to help university students appreciate autistic peers and autistic people they may work with in their future careers.

Methods

We adapted an autistic-affirming training from a training developed in other cultural contexts and evaluated it with 107 university students in France using a pretest-post-test design.

Results

Questionnaire responses suggested that our brief online training helped improve attitudes toward inclusion, autism knowledge, and stigma among future educators and psychologists in France. Participants' open-ended definitions of autism revealed increased alignment with the neurodiversity movement after training.

Conclusions

Findings suggest that wider-scale autistic-led adaptations of autism trainings like the one described in this report could begin to ameliorate autism stigma in France.

Self-stigma and bipolar disorder: A systematic review and best-evidence synthesis

BACKGROUND

Bipolar disorder is a severe and chronic mental illness characterized by recurrent major depressive episodes and mania or hypomania. In addition to the burden of the disease and its consequences, self-stigma can impact people with bipolar disorder. This review investigates the current state of research in self-stigma in bipolar disorder.

METHODS

An electronic search was carried out until February 2022. Three academic databases were systematically searched, and best-evidence synthesis was made.

RESULTS

Sixty-six articles were related to self-stigma in bipolar disorder. Seven key themes were extracted from these studies: 1/ Comparison of self-stigma in bipolar disorder and other mental illnesses, 2/ Sociocultural context and self-stigma, 3/ Correlates and predictors of self-stigma, 4/ Consequences of self-stigma, 5/ Treatments and self-stigma, 6/ Management of self-stigma, and 7/ Self-stigma and recovery in bipolar disorder.

LIMITATIONS

Firstly, a meta-analysis could not be performed due to the heterogeneity of the studies. Secondly, limiting the search to self-stigma has excluded other forms of stigma that also have an impact. Thirdly, the under-reporting of negative or nonsignificant results due to publication bias and unpublished studies might have limited the accuracy of this reviews' synthesis.

CONCLUSION

Research on self-stigma in persons with bipolar disorder has been the focused on different aspects, and interventions to reduce self-stigmatization have been developed, but evidence of their effectiveness is still sparse. Clinicians need to be attentive to self-stigma, its assessment, and its empowerment in their daily clinical practice. Future work is required to establish valid strategies to fight self-stigma.

Long-term outcomes of the recovery approach in a high-security mental health setting: a 20 year follow-up study

Background

This study examined the outcomes of a descriptive, longitudinal cohort consisting of 241 patients initially examined in a population study at the high secure State Hospital for Scotland and Northern Ireland in 1992-93. A partial follow-up focusing on patients with schizophrenia was conducted in 2000-01, followed by a comprehensive 20 year follow-up that began in 2014.

Aims

To explore what happens to patients who required high secure care during a 20 year follow-up period.

Method

Previously collected data were amalgamated with newly collected information to examine the recovery journey since baseline. Various sources were employed, including patient and keyworker interviews, case note reviews, and extraction from health and national records, and Police Scotland datasets.

Results

Over half of the cohort (56.0%) with available data resided outside secure services at some point during the follow-up period (mean 19.2 years), and only 12% of the cohort were unable to transition out of high secure care. The symptoms of psychosis improved, with statistically significant reductions observed in reported delusions, depression, and flattened affect. Reported sadness [according to the Montgomery-Åsberg Depression Rating Scale (MADRS)] at baseline, first, and 20 year follow-up interviews was negatively correlated with the questionnaire about the process of recovery (QPR) scores at the 20 year follow-up. However, qualitative data depicted progress and personal development. According to societal measures, there was little evidence of sustained social or functional recovery. The overall conviction rate post-baseline was 22.7%, with 7.9% violent recidivism. The cohort exhibited poor morbidity and mortality, with 36.9% of the cohort dying, primarily from natural causes (91%).

Conclusions

Overall, the findings showed positive outcomes in terms of movement out of high-security settings, symptom improvement, and low levels of recidivism. Notably, this cohort experienced a high rate of deaths and poor physical morbidity, along with a lack of sustained social recovery, particularly among those who had negotiated a path through services and who were current residents in the community. Social engagement, enhanced during residence in low secure or open ward settings, diminished significantly during the transition to the community. This is likely a result of self-protective measures adopted to mitigate societal stigma and the shift from a communal environment. Subjective depressive symptoms may impact broader aspects of recovery.

Mental health awareness of secondary schools students: Mediating roles of knowledge on mental health, knowledge on professional help, and attitude towards mental health

Purpose

The mental health situation among adolescents in Malaysia has reached a worrying state with the rising number of cases. Despite a significant increase in the literature on mental health, there is a lack of studies that focused on mental health awareness. Therefore, this study aimed to investigate the factors affecting Malaysian youth's mental health awareness as well as the mediating roles of knowledge on mental health, knowledge on professional help, and attitude towards mental health.

Methods

Self-administered questionnaires were distributed to 450 secondary school students aged 15-19 years old in Kuala Lumpur and Melaka who were recruited via purposive sampling. Data analysis was performed using SPSS and SmartPLS to obtain the descriptive analysis, measurement model, and structural model.

Results

The results indicated that mental health awareness was influenced by knowledge on mental health and attitude towards mental health. The findings also revealed that familiarity and media exposure were important determinants of knowledge on mental health, knowledge on professional help, and attitude towards mental health. Moreover, the results indicated that knowledge on mental health positively mediated the relationship between media exposure and mental health awareness. Besides, attitude towards mental health also found to play mediating roles between familiarity and mental health awareness, as well as between media exposure and mental health awareness.

Conclusion

This study contributed important knowledge to the limited literature in this contemporary domain. An effective public mental health campaign is needed to reduce the burden of disease and the cost of mental illness.

Perceived public stigma and perceived public exposure by persons living with bipolar disorder: A qualitative study

BACKGROUND

Stigma impact the lives of persons living with bipolar disorder.

AIM

The aim of this study was to explore how perceived public stigma is described by people living with bipolar disorder and examine the links between perceived public stigma and perceived public exposure.

METHOD

Face-to-face in-depth interviews were conducted in a purposive sample of euthymic people living with bipolar disorder recruited in a mood disorder ambulatory unit.

RESULTS

Thematic analysis of the transcript yielded five independent themes that were related to perceived public stigma. Perceived public stigma of bipolar disorder was modeled as comprising the three elements of public stigmas (stereotype, prejudice, and discrimination), with the addition of public exposure as a core component.

CONCLUSION

The representation of bipolar disorder in society via newspapers, films/TV series, conferences, and celebrity self-disclosures is considered to have multiple impacts. People living with bipolar disorder have also reported a perceived public stigma of bipolar disorder that has both specific features and characteristics of general mental illness.

Integrating Loss and Processing Grief in Psychotherapy of Psychosis

Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person's identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.

Predicting different dimensions of schizophrenia-related stigma in Israel: Exploring the applicability of the common sense model of illness

The common sense model of illness is a promising conceptual framework that can promote our understanding of the predictors of schizophrenia-related public stigma. Because stigma is a multidimensional phenomenon, studies on schizophrenia-related stigma need to account for the origins of the various aspects of this phenomenon. This study explored which common sense model of illness components (cognitive and emotional) predicted three distinct indicators of stigma (stereotypes and discrimination on the individual and structural levels). A nonprobability sample of 149 students from one of the largest universities in Israel was drawn. Data were collected via a self-reported questionnaire. We found that five of the nine common sense model of illness variables predicted schizophrenia stereotypes, whereas very few predicted discrimination. Additionally, we found that greater belief in the effectiveness of schizophrenia treatment was associated with lower stereotypes and social-level discrimination. The less the perceived consequences of schizophrenia (the extent to which the illness is perceived to affect one's life), the lower the stereotypes and discrimination (individual and social). The perceived cause of schizophrenia and attribution of personal control over the illness did not predict any stigma dimension. The findings suggest that the common sense model of illness is more suitable for predicting stereotypes than discrimination. More research is needed to understand the unique drivers of different dimensions of stigma. The findings also imply the need to design separate programs to address different aspects of schizophrenia-related stigma.

Knowledge, attitudes, and associated factors of caregivers towards children with autism spectrum disorder in East Coast Peninsular Malaysia

Background

Caregivers are directly involved in managing the daily basic needs of children with autism spectrum disorder (ASD). The knowledge and attitudes of these caregivers are important to achieving success in their roles. Thus, this study aimed to determine what constitutes good knowledge, attitudes, and associated factors among caregivers toward children with ASD.

Methods

A cross-sectional study was conducted among 128 caregivers of children with ASD in Kota Bharu, Kelantan from May to August 2020, using convenience sampling. Validated questionnaires were used to assess the knowledge and attitudes toward children with ASD. The data were analyzed using SPSS version 24. Descriptive statistics and simple and multiple logistic regression analyses were then performed.

Results

The response rate was 100%. The proportion of good knowledge and attitudes toward children with ASD among caregivers was 85.1% and 88.3%, respectively. Factors significantly associated with good knowledge were being female (OR (95% CI) 2.79 [0.99-7.90]) and ASD children being non-first-born children (OR (95% CI) 0.41 [0.15-1.12]). Factors significantly associated with good attitudes were age of 30 years and older (OR (95% CI) 0.13 [0.03-0.62]) and caregiver having other children with other types of learning difficulties (OR (95% CI) 0.15 [0.04, 0.52]).

Conclusions

The proportion of caregivers with good knowledge of ASD and good attitudes toward children with ASD was high. The caregiver's age and sex, the position of the ASD child among the siblings, and the presence of other types of learning disorders in the family need to be considered when managing children with ASD.

Effects of a Cognitive Schema Account on the Stigma of Schizophrenia: A Study in a French University Student Sample

Among people with psychiatric disorders, those with schizophrenia are subject to high levels of stigmatization. Research is necessary to identify new strategies that may help reduce the stigma of schizophrenia. Educational strategies using cognitive accounts, particularly early maladaptive schemas (EMSs), have shown promising results in the context of depression, but they have not been evaluated in the context of schizophrenia. The present study compared the effect on the stigma of three different educational strategies, based on cognitive distortions, biogenetics, and EMSs. A total of 378 students were randomly assigned to 1 of 4 groups. Three experimental groups were presented with a vignette that introduced 1 of 3 different etiological accounts of schizophrenia (cognitive distortions, EMSs, or biogenetics). The fourth group was presented with a text unrelated to schizophrenia. The participants completed questionnaires that measured their attitudes, empathic concern, and social distance toward people with schizophrenia, before and after reading the text. The intervention using the EMS etiology account for schizophrenia was the only one that led to a significant decrease in stigma. The latter effect was driven mainly by an increase in the level of empathic concern toward people with schizophrenia. Given that similar results have been observed for depression and that the role of EMSs in many psychiatric disorders has been demonstrated, studying the effects of EMS explanations for other stigmatized disorders may be promising for reducing the stigma of psychiatric disorders.

Parents' knowledge and attitude and behavior toward autism: a survey of Chinese families having children with autism spectrum disorder

BACKGROUND

In recent years, parent-mediated intervention for children with autism spectrum disorder (ASD) has increased. Therefore, implementing effective parent training programs for parents of children with autism is of paramount importance, particularly in low- and middle-income countries. However, little is known about the status of and gaps in parents' knowledge on ASD, which may hinder the development of valid parental training programs. Herein, we aimed at exploring the status of Chinese parents' knowledge, attitude and behavior toward ASD, and potential factors affecting the acquisition of correct knowledge.

METHODS

This study used a self-designed parental knowledge questionnaire of autism (PKQA) comprising 20 questions alongside another questionnaire comprising additional 17 questions covering the aspects of family demographics, attitudes, and behaviors of parents. In total, we included 394 parents who visited the outpatient department of the Child's Development and Behavior Center of the Third Affiliated Hospital of Sun Yat-Sen University between December 2018 and May 2019, with their children meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for ASD.

RESULTS

The median knowledge score in the PKQA was 15 [interquartile range (IQR), 13-17]. Advanced paternal age and longer time interval from diagnosis to enrolling into the parent training program were associated with a lower total knowledge score (all P<0.001). Higher maternal education attainment, higher family income, child being currently under intervention, and family members sharing a common perception of the diagnosis were associated with a higher total knowledge score (all P<0.01). Reading autism-related books (P<0.001) or attending professional lectures (P=0.019) were also associated with a higher total knowledge score.

CONCLUSIONS

Taken together, this study revealed that family demographics and parents' attitudes and behaviors toward ASD may significantly influence their knowledge about autism, suggesting the need for promoting more targeted parental skills training programs.

Analysis of Spanish Parents’ Knowledge about ASD and Their Attitudes towards Inclusive Education

To make possible the inclusion of children with autism spectrum disorder (ASD) in mainstream settings, parental knowledge and attitudes towards the disorder play a key role between the home and the school setting. However, prior literature has not carried out an in-depth analysis of parents’ knowledge about ASD and their attitudes toward the inclusion of children with this diagnosis. This study examined the parental attitudes towards inclusion and knowledge about ASD. Participants were parents of children with ASD (n = 75), parents of children without ASD whose children had prior or current contact with peers with ASD (n = 44), and parents of children with no previous interactions with a peer with ASD (n = 51). The Attitudes of Regular Educators Towards Inclusion for Students with Autism Survey and the Autism Knowledge Questionnaire were filled out. Nonparametric statistical tests were used. Results showed that parents of children with ASD have better knowledge about this disorder and hold more favorable attitudes towards the inclusion of children with ASD than the other parents. These findings suggest that the benefits of inclusive schooling are limited to the school setting and do not appear to affect families of children without ASD.

Anti-stigma psychosocial intervention effects on reducing mental illness self-stigma and increasing self-esteem among patients with schizophrenia in Taiwan: A quasi-experiment

Previous studies have noted that as self-stigma in patients with schizophrenia increases, their quality of life and self-esteem decrease. Considering the cultural differences and scarcity of self-stigma intervention research in Asia, the purpose of this study was to evaluate the intervention effects of the Against Stigma Program on reducing self-stigma and increasing self-esteem among patients with schizophrenia. In this study, 70 patients with schizophrenia were recruited from 3 community psychiatric rehabilitation institutions in Taiwan and assigned to the experimental and control groups. Controls received their usual treatment, and those in the experimental group participated in the Against Stigma Program (60-minute weekly sessions for 6 weeks). The participants were assessed at baseline, post-intervention, and 1-month follow-up, using the Internalized Stigma of Mental Illness Scale (ISMIS) and Rosenberg Self-Esteem Scale (RES). Generalized estimating equations (GEE) were used to analyze the changes in scores over time and differences between the experimental and control groups. Self-stigma significantly decreased and self-esteem significantly increased after participation in the Against Stigma Program. The GEE analysis revealed significant group and time interactions such that self-stigma reduction effect (B = -0.291) was stronger in the experimental group at post-intervention, and self-esteem promotion effects at post-intervention (B = 0.823) and 1-month follow-up (B = 0.543) were both greater in the experimental group. In conclusion, these findings suggest that the Against Stigma Program can help reduce self-stigma and increase self-esteem of patients with schizophrenia. This study can be used as an empirical reference to inform future clinical care of patients with schizophrenia in Taiwan.

Public perceptions of brain health: an international, online cross-sectional survey

OBJECTIVES

To investigate public perspectives on brain health.

DESIGN

Cross-sectional multilanguage online survey.

SETTING

Lifebrain posted the survey on its website and social media and shared it with stakeholders. The survey was open from 4 June 2019 to 31 August 2020.

PARTICIPANTS

n=27 590 aged ≥18 years from 81 countries in five continents completed the survey. The respondents were predominantly women (71%), middle aged (41-60 years; 37%) or above (>60 years; 46%), highly educated (69%) and resided in Europe (98%).

MAIN OUTCOME MEASURES

Respondents' views were assessed regarding factors that may influence brain health, life periods considered important to look after the brain and diseases and disorders associated with the brain. We run exploratory linear models at a 99% level of significance to assess correlates of the outcome variables, adjusting for likely confounders in a targeted fashion.

RESULTS

Of all significant effects, the respondents recognised the impact of lifestyle factors on brain health but had relatively less awareness of the role socioeconomic factors might play. Most respondents rated all life periods as important for the brain (95%-96%), although the prenatal period was ranked significantly lower (84%). Equally, women and highly educated respondents more often rated factors and life periods to be important for brain health. Ninety-nine per cent of respondents associated Alzheimer's disease and dementia with the brain. The respondents made a connection between mental health and the brain, and mental disorders such as schizophrenia and depression were significantly more often considered to be associated with the brain than neurological disorders such as stroke and Parkinson's disease. Few respondents (<32%) associated cancer, hypertension, diabetes and arthritis with the brain.

CONCLUSIONS

Differences in perceptions of brain health were noted among specific segments of the population. Policies providing information about brain-friendly health behaviours and targeting people less likely to have relevant experience may be needed.

Autism Spectrum Disorder and IQ - A Complex Interplay

Autism spectrum disorder (ASD) is characterized as a very heterogeneous child-onset disorder, whose heterogeneity is partly determined by differences in intelligence quotient (IQ). Older epidemiological studies suggested that the IQ-related spectrum tends to be skewed to the left, i.e., a larger proportion of individuals with ASD have below average intelligence, while only few individuals with ASD may have an IQ above average. This picture changed over time with broadening the spectrum view. Within the present perspective article, we discuss discrepancies in IQ profiles between epidemiological and clinical studies and identify potential underlying aspects, for example, the influence of external factors such as sample biases or differences in availability of autism health services. Additionally, we discuss the validity and reciprocal influences of ASD diagnostics and IQ measurement. We put the impact of these factors for diagnostic as well as care and support situations of patients into perspective and want to encourage further research to contribute to the conceptualization of "autism" more comprehensively including the IQ as well as to examine broader (life) circumstances, interacting factors and diagnostic requirements of given diagnoses in childhood as compared to adulthood.

A systematic review on autistic people's experiences of stigma and coping strategies

Autism can be understood as a concealable stigmatized identity. This is the first systematic review to synthesize the literature on autistic people's experiences of stigma and coping strategies. 2877 studies were screened and 27 were included in this review. The reviewed literature demonstrates that autistic individuals are acutely aware of being stereotyped, judged, and discriminated by others. Autistic people also show signs of internalizing stigma, rendering them more vulnerable to low self-worth and poorer mental health. To manage the impact of stigma, the included studies suggest that autistic individuals may use these strategies: concealment and camouflaging, selective disclosure and self-advocacy, as well as positive reframing and reconstructing identity. However, the evidence is limited and mixed in terms of how helpful and effective these strategies are. Future studies should include autistic populations with a wider range of intellectual abilities and explore interventions that can support autistic people in managing stigma to supplement interventions that seek to reduce stigma towards autistic people. The power of language in perpetuating and challenging stigma also has important implications for research and practice, underscoring the need for researchers and practitioners to reflect carefully on the messages they are communicating about autism.

Health care providers and people with mental illness: An integrative review on anti-stigma interventions

BACKGROUND

Health care providers are an important target group for anti-stigma interventions because they have the potential to convey stigmatizing attitudes towards people with mental illness. This can have a detrimental impact on the quality and effectiveness of care provided to those affected by mental illness.

AIMS AND METHODS

Whittemore & Knafl's integrative review method (2005) was used to analyze 16 studies investigating anti-stigma interventions targeting health care providers.

RESULTS

The interventions predominantly involved contact-based educational approaches which ranged from training on mental health (typically short-term), showing videos or films (indirect social contact) to involving people with lived experiences of mental illness (direct social contact). A few studies focused on interventions involving educational strategies without social contact, such as mental health training (courses/modules), distance learning via the Internet, lectures, discussion groups, and simulations. One study investigated an online anti-stigma awareness-raising campaign that aimed to reduce stigmatizing attitudes among health care providers.

CONCLUSION

Anti-stigma interventions that involve social contact between health care providers and people with mental illness, target specific mental illnesses and include long-term follow-up strategies seem to be the most promising at reducing stigma towards mental illness among health care providers.

Knowledge mediates attitude in autism spectrum disorders? Data from Malaysia

Limited efforts have been made in middle- and low-income countries to raise public awareness of autism spectrum disorders (ASD) over the past ten years. We report data from a general population survey exploring the relationship between awareness, knowledge, and attitudes regarding autism in Malaysia. A questionnaire consisting of items related to awareness, knowledge, and attitudes regarding ASD was distributed. The scores of knowledge of ASD and attitude towards ASD were 6.87 (SD = 4.17; with a total possible score of 12) and 6.39 (SD = 2.77; with a total possible score of 9), respectively, indicating that, on average, the participants had moderate levels of knowledge and attitude. Structural equation modeling showed that improving awareness and knowledge about ASD will enhance more positive attitudes towards ASD. Efforts should be geared towards disseminating information about ASD, in order to increase acceptance of the disorder.

Awareness and Stigma of Autism Spectrum Disorders in Undergraduate Students

BACKGROUND

Social stigma is a barrier for students with autism on college campuses. The purpose of this study is to examine the relationship between autism knowledge and autism stigma endorsement.

METHOD

144 college undergraduate students were asked to complete the Autism Stigma and Knowledge Questionnaire as well as a brief demographic questionnaire. The relationship between stigma endorsement and ASD knowledge in the areas of diagnosis and symptoms, etiology, and treatment were evaluated using a multiple linear regression. Two independent-sample t-tests were conducted to investigate group differences between participants who know someone with autism and those who do not as well as between male and female participants.

RESULTS

A significant regression equation was found (F(3,140) = 51.35, p = .000), with an R² of .52. While Treatment and Etiology subscale scores significantly predicted Stigma subscale scores, Diagnosis/Symptom subscale score was not. In terms of knowing someone with an autism diagnosis, there was a significant difference in ASD diagnosis and symptom knowledge (t(142) = 4.16, p = .000), etiology knowledge (t(142) = 3.51, p = .001), treatment knowledge (t(62.99) = 3.54, p = .001), and stigma endorsement (t(142) = 3.03, p = .003). No significant differences were found between male and female participants.

CONCLUSIONS

Contrary to past studies, gender was not associated with ASD knowledge or stigma endorsement. This study suggests that an intervention designed to increase ASD knowledge, particularly in the areas of etiology and treatment, and to increase contact with students diagnosed with autism would be effective in reducing ASD stigma.

Knowledge about Autism among Graduate Students in Togo

Graduate students in healthcare or education programs should have adequate knowledge about autism as they could become professionals in that field. However, we were unable to locate any published studies that examined knowledge about autism among graduate students in francophone sub-Saharan Africa. Thus, the goal of this study was to describe knowledge about autism among 254 graduate psychology, medical, and education students in Togo. Results suggested that only 5% of graduate students had good knowledge about autism. Although graduate psychology students achieved higher scores than others, all subgroups had inadequate knowledge about specific characteristics of autism. The findings highlight the necessity of passing public policies to promote autism research and training in local universities in Togo.

The presentation, recognition and diagnosis of autism in women and girls

Purpose

Autistic women and girls have received comparatively less attention within clinical practice and research. Research suggests women tend to be diagnosed later than men, and are more likely to experience misdiagnosis.

Design/methodology/approach

This paper aims to report a narrative literature review that examines research on the presentation, recognition, and diagnosis of autistic women and girls.

Findings

Findings suggest that autistic females present differently to males and highlight low recognition of the female presentation of autism among the general public, in social spheres, educational, clinical and forensic settings. This lack of recognition appears to affect the likelihood of females being referred for diagnosis, the reliability of diagnostic assessments and subsequent access to support.

Originality/value

Recommendations for clinical practice focus on initiatives to increase awareness of the female presentation of autism, improving the diagnostic process for females, increasing female representation within autism training and for future research to support these goals.

Validation of the ASKSG with a Parent Sample in the United States

Parents play a critical role in the early identification of ASD because of their experiential knowledge and frequent observations of their children. Being knowledgeable about ASD may help parents recognize early signs and symptoms, know to which professionals to express their concerns, and better navigate systems of care. An appropriate measure of ASD knowledge for parents is essential to further understand the importance of ASD knowledge in this population. This study sought to validate the Autism Spectrum Knowledge Scale-General Population Version (ASKSG) with a sample of parents with children under the age of 18 years in the United States. Results indicate that the ASKSG is a valid and reliable measure for use with parents.

Association between Work Environments and Stigma towards People with Schizophrenia among Mental Health Professionals in Japan

This study aimed to examine the association between control over practice in work environments and stigma toward people with schizophrenia among mental health professionals. We conducted secondary analyses on data from a self-administered questionnaire survey. The sample in the initial study included mental health professionals from two psychiatric hospitals, 56 psychiatric clinics, and community service agencies in Japan. The Ethics Committee of the University of Tokyo, approved this study. Data from 279 participants were used for secondary analyses (valid response rate = 58.7%). The hierarchical multiple regression analysis was used to determine the association between control over practice and stigma. We performed subgroup analyses among nurses (n = 121) and psychiatric social workers (n = 92). Control over practice was negatively associated with stigma among mental health professionals (β = −0.162, p < 0.01). The subgroup analyses among nurses indicated that control over practice, educational history and recovery knowledge were associated with stigma. However, these variables were not associated with stigma among psychiatric social workers. Control over practice might help to reduce stigma among mental health professionals. Factors related to stigma might differ by occupation. Therefore, further comprehensive studies among various professionals would further our understanding of these factors.

Autism in Australia: Community Knowledge and Autistic People's Experiences

This paper presents two studies that explored community attitudes to autism in Australia; and autistic people and their families' perspectives of community attitudes. In Study One 2424 (primarily non-autistic) people completed a survey on autism-related knowledge and attitudes; identifying a number of misperceptions and knowledge gaps in the general community. In Study Two 1353 people (primarily parents and carers of autistic people) completed a survey on autism-related experiences; identifying that the community's awareness of autism does not appear to extend to understanding how to support autistic people. There is a need for more research which integrates the perspectives of both autistic people and the broader community; and the development of communication and education interventions, with rather than about autistic people.

Chinese Validation of the Multidimensional Attitude Scale toward Persons with Disabilities (MAS): Attitudes toward Autism Spectrum Disorders

The literature on tools of attitudes towards ASD was limited. This study is the first to examine the factor structure and psychometric properties of the multidimensional attitudes scale toward persons with disabilities (MAS) in a sample of Chinese college students (N = 1002, 32.10% males). Confirmatory factor analysis supported the G-MAS-R model's 4-factor structure: calm, negative affect, positive cognitions and behavioral avoidance. The results suggest that the Chinese version of the MAS has satisfactory internal consistency. Pearson correlation analysis showed that the MAS scores were significantly correlated with the Social Distance Scale and Autism Stigma and Knowledge Questionnaire scores. Overall, the findings indicate that the MAS is appropriate for assessing attitudes toward people with ASD in a Chinese context.

Cultural Variations in Public Beliefs about Mental Disorders: A Comparison between Tunisia and Germany

Background

In recent years there is a growing interest in public beliefs about mental disorders. Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa.

Objective

To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences.

Methods

Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression.

Results

In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany.

Conclusion

Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for.

Schizophrenia stigma in mental health professionals and associated factors: A systematic review

BACKGROUND

The consequences of schizophrenia stigma are numerous and highly damaging to individuals, their families, the health care system and society. Mental health professionals (MHP) are considered to be one of the main sources of stigmatization.

OBJECTIVES

To identify the characteristics of MHP stigma in schizophrenia in comparison with other psychiatric disorders, the specificities of MHP compared with other social groups, and associated factors.

METHODS

Following PRISMA guidelines, we systematically searched multiple electronic databases for articles: (i) reporting original data published in English in peer-reviewed journals, (ii) reporting quantitative data with statistical analysis, (iii) assessing stigma in a broad sense, and (iv) including samples composed only of MHP.

RESULTS

A total of 38 articles published from 1999 to 2019 and involving 10,926 MHP fulfilled our inclusion criteria. Studies showed that schizophrenia is the most stigmatized mental illnesses in MHP, despite recent results suggesting that borderline personality disorder and substance abuse may be more stigmatized. In comparison with other social groups, MHP reported less dangerousness beliefs and more positive beliefs regarding pharmacological treatment. Nevertheless, results were less consistent regarding prognosis and desire for social distance. Age, education level, type of mental health profession, or length of practice were associated factors that showed inconsistent relations with stigma. Work setting and biological causal beliefs were more clearly associated with MHP stigma.

CONCLUSION

These findings provide strong support for the need to conduct specific research on schizophrenia stigma in MHP and the importance of controlling for several variables to identify predictors of stigma.

Factors Influencing Participation in Biospecimen Research among Parents of Youth with Mental Health Conditions

INTRODUCTION

Biospecimens are tools that have the potential to improve early identification and treatment for autism spectrum disorders (ASD) and bipolar disorders (BPD). Unfortunately, most biobanks lack racial/ethnic diversity. One challenge to including a diverse sample of youth is recruiting and engaging families.

OBJECTIVE

We sought to better understand facilitators and barriers to participation in biospecimen research among a diverse group of parents of youth with ASD and BPD.

METHODS

The current study involved 3 Mental Health Research Network sites. At each site, parents participated in an interview that explored attitudes and beliefs about genetic research. Interviews were audio-recorded, and audio files were transcribed and coded using content analysis.

RESULTS

A total of 58 interviews were conducted. Four challenges emerged: (1) contacting and engaging potential research participants, (2) motivating potential participants to read recruitment and consent materials, (3) motivating participation in research, in general, and (4) motivating participation in research involving biospecimen donation, specifically.

CONCLUSIONS

Participants were eager to participate as long as the research process involved trust, clarity, and flexibility. Future research involving youth with mental health conditions would benefit from implementing multimodal strategies for recruitment and data collection and sharing knowledge gained by the research with study participants.

What Contributes to Stigma Towards Autistic University Students and Students with Other Diagnoses?

Little remains known about the degree to which autistic university students are stigmatized relative to students with other diagnoses. We conducted an online survey with students in New York City (n = 633) and Beirut (n = 274). Students with diagnoses that were perceived as dangerous (e.g., psychopathy) were more stigmatized than students with diagnoses that were perceived as less dangerous (e.g., autism). Disruptive autistic behaviors (described via vignettes) evoked more stigma than withdrawn behaviors. Perceived dangerousness predicted autism stigma. Greater acceptance of inequality, less openness, and lower cognitive empathy co-occurred with heightened stigma towards most conditions. Diagnostic labels were typically less stigmatized than behaviors. Findings suggest that interventions are needed to decrease stigma towards varied diagnoses in collegiate communities.

Should Autism Spectrum Conditions Be Characterised in a More Positive Way in Our Modern World?

In a special issue that focuses on complex presentations related to Autism, we ask the question in this editorial whether an Autism Spectrum Condition without complexity is a disorder, or whether it represents human diversity? Much research into Autism Spectrum Conditions (ASCs) over the years has focused on comparisons between neuro-typical people and people with Autism Spectrum Conditions. These comparisons have tended to draw attention to ‘deficits’ in cognitive abilities and descriptions of behaviours that are characterised as unwanted. Not surprisingly, this is reflected in the classification systems from the World Health Organisation and the American Psychiatric Association. Public opinion about ASC may be influenced by presentations in the media of those with ASC who also have intellectual disability. Given that diagnostic systems are intended to help us better understand conditions in order to seek improved outcomes, we propose a more constructive approach to descriptions that uses more positive language, and balances descriptions of deficits with research finding of strengths and differences. We propose that this will be more helpful to individuals on the Autism Spectrum, both in terms of individual self-view, but also in terms of how society views Autism Spectrum Conditions more positively. Commentary has also been made on guidance that has been adjusted for people with ASC in relation to the current COVID-19 pandemic.

Segen oder Fluch? Das Internet als Informationsquelle über Autismus und Asperger-Syndrom

Zusammenfassung. Fragestellung: Sehr viele Menschen informieren sich heutzutage über gesundheitsrelevante Themen im Internet, wobei die Qualität dieser Informationen fraglich ist. In der vorliegenden Studie soll beispielhaft für ein psychisches Störungsbild (Autismus-Spektrum-Störung) die Qualität der Informationsquelle Internet sowie die sich daraus ergebenden Implikationen diskutiert werden. Methodik: Es wurde eine systematische Auswertung von 96 deutschsprachigen Internetseiten durchgeführt mit dem Ziel, neben konkreten Charakteristika der Internetseiten auch die Zuverlässigkeit der Publikationen, die Informationsdarstellung sowie die Gesamtqualität der Internetseiten zu bewerten und die sich aus der Darstellung ergebenden klinischen Implikationen zu analysieren. Ergebnisse: Nur bei 39 % der Internetseiten ließen sich Referenzen für wissenschaftlich fundierte Informationen feststellen, Werbung war hingegen auf 53 % der Internetseiten vorhanden. Die meisten falschen Informationen wurden im Bereich der „Behandlung“ (17 %) verbreitet. Bei 75 % der Internetseiten traf die Vollständigkeit nicht zu. Lediglich 10 % der Internetseiten thematisierte die Beeinträchtigung bzw. Belastung der Familien. Die Qualität der Seiten wurde bei 30 % als ungenügend, bei 41 % als mangelhaft und nur bei 6 % als gut beurteilt. Schlussfolgerungen: Ähnlich wie durch die bereits vorliegenden Analysen zu englischsprachigen Internetseiten festgestellt, können für viele der deutschsprachigen Seiten deutliche Qualitätsmängel konstatiert werden. Die Implikationen in Bezug auf Bestätigungsfehler, Stigmatisierung, Überidentifikation, Ingroup-Outgroup-Effekte, Kontrast- und Schneeballeffekte werden diskutiert.

Self-stigma in serious mental illness and autism spectrum disorder: Results from the REHABase national psychiatric rehabilitation cohort

Background.

Self-stigma is a major issue in serious mental illness (SMI) and is negatively associated with patient outcomes. Most studies have been conducted in schizophrenia (SZ). Less is known about self-stigma in other SMI and autism spectrum disorder (ASD). The objectives of this study are: (i) to assess the frequency of self-stigma in a multicentric nonselected psychiatric rehabilitation SMI and ASD sample; and (ii) to investigate the correlates of elevated self-stigma in different SMI conditions and in ASD.

Methods.

A total of 738 SMI or ASD outpatients were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluations included sociodemographic data, illness characteristics, and standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, personal recovery, a large cognitive battery, and daily functioning assessment.

Results.

31.2% of the total sample had elevated self-stigma. The highest prevalence (43.8%) was found in borderline personality disorder and the lowest (22.2%) in ASD. In the multivariate analysis, elevated self-stigma was best predicted by early stages of personal recovery (moratorium, p = 0.001, OR = 4.0 [1.78–8.98]; awareness, p = 0.011, OR = 2.87 [1.28–6.44]), history of suicide attempt (p = 0.001, OR = 2.27 [1.37–3.76]), insight (p = 0.002, OR = 1.22 [1.08–1.38]), wellbeing (p = 0.037, OR = 0.77 [0.60–0.98]), and satisfaction with interpersonal relationships (p < 0.001, OR = 0.85 [0.78–0.93]).

Conclusions.

The present study has confirmed the importance of addressing self-stigma in SMI and ASD patients enrolled in psychiatric rehabilitation. The effectiveness of psychiatric rehabilitation on self-stigma and the potential mediating effects of changes in self-stigma on treatment outcomes should be further investigated.

Explicit Associations with Autism and Disability

Objectives

Autistic people call for greater acceptance even though the general public has greater awareness of the autism spectrum. This study investigated explicit or conscious attitudes toward the autism spectrum and disability in college students and the general population. We hypothesized that both samples would associate "a person on the autism spectrum" with more negative attributes than other types of people except for "a person with a disability."

Methods

In Phase 1, participants generated 10 word associations for 8 labels: a person on the autism spectrum, a person not on the autism spectrum, a person with a disability, a person without a disability, a college student, a professor, a child, and a parent. In Phase 2, participants rated the 10 most common words for each label (type of person) in Phase 1 on a 7-point Likert scale from extremely negative to extremely positive. Ninety-nine undergraduate students and 106 adults recruited through Amazon Mechanical Turk completed Phase 1. One hundred twenty-two undergraduate students and 101 adults recruited through Amazon Mechanical Turk completed Phase 2.

Results

Only "a person with a disability" in the general population sample was rated as having significant negative associations. However, the associations of "a person with a disability" were rated more negatively than all other labels in both samples, and the associations of "a person on the autism spectrum" were rated as second most negative in the general population sample.

Conclusion

Explicit associations toward disability and autism were somewhat mixed. Adults in the general population tended to have more negative explicit associations with disability, and to a lesser extent autism. These results underscore the need to examine attitudes in samples more representative of the general population. Furthermore, evidence of possible explicit negative associations is concerning and highlights the imperative need to confront ableism.

Lay summary

Why was this study done?: The general public claims to be aware of the autism spectrum and recent research suggests that they have greater knowledge about the autism spectrum than they did in the past. However, as autistic individuals have articulated, autism awareness is not the same as autism acceptance. In order for autistic individuals to be fully included into society, we must move to autism acceptance. One way researchers examine potential discrimination is by studying attitudes.What was the purpose of this study?: This study examines people's explicit attitudes toward the autism spectrum and to disability. Explicit attitudes are attitudes that are conscious and controllable.What did the researchers do?: Two groups of adults participated in the study: a group of college students and a noncollege sample of adults designed to better represent the general population of adults. Participants completed an online study wherein they were asked to list word associations for different types of people including "a person on the autism spectrum" and "a person with a disability." In a second study, participants then rated the most common associations from extremely negative to extremely positive.What were the results of the study?: The results were somewhat mixed. Only the set of associations of "a person with a disability" were rated by participants in the noncollege group as negative. However, the associations of "a person with a disability" were rated more negatively than all other types of people in both groups, and the associations of "a person on the autism spectrum" were rated as second most negative in the noncollege sample.What do these findings add to what was already known?: The majority of research on explicit attitudes toward autism has focused on children, including how interventions may improve attitudes toward autistic children. Therefore, this research provides much needed information on the state of attitudes toward autistic individuals more generally. This research also provides a comparison of attitudes toward autism, disability, and other groups. Furthermore, research assessing attitudes toward autism in adults has largely focused on college students, whereas this research considered both college students and a noncollege sample.What are the potential weaknesses in the study?: These findings may not extend to a more diverse population as both groups had relatively high education levels, were primarily White non-Hispanic and were living in the United States. Furthermore, participants may have generated more positive associations for "a person on the autism spectrum" and "a person with a disability" because they wanted to be viewed in a favorable light. This is known as a social desirability bias.How will these findings help autistic adults now or in the future?: Unfortunately, possible explicit negative associations with the autism spectrum and with disability are concerning as they reflect people's conscious and controllable attitudes. These results highlight a need for action and also support autistic individuals' demand for actions toward autism acceptance.

Destigmatizing psychosis: Investigating the effectiveness of a school-based programme in Hong Kong secondary school students

AIM

Although the reasons behind the stigmatization of psychosis are manifold, poor mental health literacy among the general public is likely to be a major factor. In Hong Kong, the Early Psychosis Foundation (EPISO) was established in 2007 to tackle this issue by providing educational and mental health promotional activities, among other aims and services. The current study evaluated the effectiveness of a school-based interventional programme, the School Tour, developed by EPISO.

METHODS

The School Tour differentiates itself from other interventional programmes by supplementing a traditional psychoeducational talk with 2 additional elements: an engaging drama performance and exercise demonstrations. Twelve secondary schools, with a total of 4520 students, participated in the study. Knowledge and attitudes towards psychosis were evaluated before and after the school programme.

RESULTS

The School Tour was found to improve both students' knowledge of psychosis (P < .001) and their attitude (P < .001) towards the illness.

CONCLUSIONS

Its effectiveness in reducing the stigma towards psychosis validates the use of novel strategies like drama performances to engage adolescent students, and urges the government to support increased student participation in the programme by providing funding to the relevant organizations.