Stigmatising attitudes of undergraduates towards their peers with depression: a cross-sectional study in Sri Lanka

Diabetes-related social stigma among university students in Saudi Arabia: A cross-sectional study

Diabetes-related stigma encompasses stereotypes, discrimination, and blame, significantly influencing diabetes management and overall well-being. Despite high diabetes-related stigma prevalence in various contexts, there is limited research in Saudi Arabia, especially that perceived/enacted by non-diabetics, the so-called social stigma. This cross-sectional study aimed to assess diabetes-related social stigma (DRSS) and to identify correlates among university students in Jazan, Saudi Arabia. A convenience sampling was employed to collect responses from 536 Jazan University students using an online questionnaire. After excluding participants with diabetes mellitus (n = 17), data from 519 individuals were analyzed. The DRSS questionnaire comprised 2 scales: social distancing and negative attitudes and stereotyping. The study found mixed results regarding the student population's attitude toward diabetic patients. Most students displayed favorable answers on social distancing scale statements, with the majority of statements showing willingness to engage in different social aspects with diabetics getting a positive response from at least 96% of respondents. The study identified various types of negative attitudes and stereotyping, for example, 46% of the sample agreed that dealing with a diabetic is upsetting or tiring. Correlates of social distancing included academic year, rural residence, and nonmedical field of specialty, while predictors of negative attitude and stereotyping included female gender and higher family income. The findings indicate a need to improve attitudes related to diabetics among university students in Saudi Arabia, with a particular focus on negative attitude stereotyping. Raising awareness about DRSS, especially among future healthcare professionals, is essential. Further refinement of the DRSS measurement scales is recommended through broader testing among the general population to enhance our understanding of this important issue.

Effectiveness and types of interventions to reduce mental illness-related stigma among Medical university students: A literature review (1997-2020)

There is a high prevalence of stigma among medical students towards mental illness, which can have far reaching negative consequences. It is essential to intervene and modify their preconceptions in order to fight against stigma.

"Doctor, my back hurts and I cannot sleep." Depression in primary care patients: Reasons for consultation and perceived depression stigma

Background

General practitioners (GPs) play a significant role in depression care. Recognition of depression is crucial for adequate treatment but is impeded by a high portion of depressed patients only reporting physical symptoms to their GP. Among the many reasons for this phenomenon is mental health stigma. We investigated how patients with depression differed from patients without depression regarding the types and number of complaints presented to their GP, as well as their depression stigma. For the subgroup of patients with depression, potential associations between perceived depression stigma and number and types of presented complaints were investigated to see if these might reflect the patient’s intention to conceal mental health symptoms due to fear of being stigmatized by others. Further, we investigated if perceived depression stigma is related to depression treatment.

Methods

Data on depressive symptoms (assessed by the Depression Screening Questionnaire; DSQ), depression stigma (assessed by the Depressions Stigma Scale; DSS), type of complaints reported to the GP and treatment-related factors were collected from 3,563 unselected primary care patients of 253 GPs in a cross-sectional epidemiological study (“VERA study”) in six different German regions. Data of a total of 3,069 patients was used for analysis on complaints reported to the GP (subsample of the VERA study), and for 2,682 out of 3,069 patients data on a stigma questionnaire was available.

Results

Nearly half of the primary care patients with depression (42.2%) reported only physical complaints to their GP. Compared to patients without a depression diagnosis, patients with depression reported twice as many complaints to their GP with a mean of 2.02 (1.33) vs. 1.2 (0.69), including a more frequent combination of physical and mental symptoms (28.8% vs. 3.5%). Patients with depression showed higher total stigma compared to patients without depression, Mdn = 48 (IQR 40–54) vs. Mdn = 46.3 (IQR 29–53), due to higher perceived stigma, Mdn = 27 (IQR 21–32) vs. Mdn = 25.9 (IQR 20–29). Perceived stigma was associated with male gender (beta -.14, p = .005) and a lack of pharmacological treatment (beta -.14, p = .021) in patients with a depression diagnosis.

Conclusion

The number of complaints presented to the GP might function as a marker to actively explore depression in primary care patients, in particular when both physical and mental symptoms are reported. Perceived depression stigma should also be addressed especially in male patients. Further research should clarify the role of perceived stigma as a potential inhibitor of pharmacological treatment of depression in primary care.

Stigma toward mental and physical illness: attitudes of healthcare professionals, healthcare students and the general public in Pakistan

BACKGROUND

The evidence base for stigma in mental health largely originates from high-income countries.

AIMS

This study from Pakistan aimed to address the gap in literature on stigma from low- and middle-income countries.

METHOD

This cross-sectional study surveyed 1470 adults from Karachi, Pakistan. Participants from three groups (healthcare professionals, healthcare students and the general public) completed the adapted Bogardus Social Distance Scale (SDS) as a measure of stigma.

RESULTS

All three groups reported higher scores of stigma toward mental disorders compared with physical disorders. SDS scores for mental illness in the general public were significantly higher than in healthcare students (mean difference (MD) 6.93, 95% CI 5.45-8.45, P < 0.001) and healthcare professionals (MD 6.93, 95% CI 5.48-8.38, P < 0.001). However, SDS scores between healthcare students and healthcare professionals were not significantly different (MD 0.003, 95% CI -1.14-1.14, P > 0.99). Being female was associated with lower stigma scores and being over the age of 30 years was associated with higher stigma scores.

CONCLUSIONS

Stigma campaigns in Pakistan need to target the general population. However, evidence of negative attitudes toward mental illness in healthcare students and healthcare professionals supports the need for stronger emphasis on psychiatric education within undergraduate and postgraduate training in Pakistan.

The prevalence and associated factors of depression among medical students of Saudi Arabia: A systematic review

The main purpose of our review study was to estimate depression prevalence among Saudi Arabian medical students according to the published articles and try to reveal the main associated factors. A systematic search was performed through PubMed/Medline and Google Scholar databases. A review of 18 studies published between January 2010 and March 2019 was composed of the following selection of necessary articles approved by PICO (population, intervention, control, and outcomes) criteria. The prevalence of depression among medical students of Saudi Arabia ranged from 30.9% to 77.6% with a mean prevalence of 51.5%. Depression severity was evaluated by various questionnaires, so we summarized the extracted data and revealed that medical students tend to have moderate to severe depression to a greater extent than mild depressive symptoms (33.27% vs 29.9%). The findings of this review suggest a high incidence of depression among medical students and the influence of associate sociodemographic factors. Females are considered to be at a higher risk of depression. First-year medical students are the most susceptible to develop depressive symptoms. Smoking is strongly associated with depression severity. Marital status, eating habits, usage of stimulants, and sleep disturbances are within significant findings of our review study.

Changes in Attitudes toward Mental Illness in Healthcare Professionals and Students

Mental-illness-related stigma not only exists in the public but also in healthcare systems. Healthcare providers (HCPs) who have stigmatizing attitudes or behaviors might be thought of as a key barrier to mental health service use, and influence the quality of healthcare. Although cumulative projects have been conducted to reduce stigma related to mental illness among HCPs around the world, little is known about whether the attitudes of HCPs toward mental illness have changed over time. Research on this topic is mixed with respect to whether attitudes of HCPs toward mental illness have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on the Social Distance Scale (SDS), Opinions about Mental Illness (OMI), and Community Attitudes towards Mental Illness (CAMI) measures among health care professionals and students (N = 15,653) from 1966 to 2016. Our results indicated that both social distance (β = -0.32, p < 0.001) and attitudes (β = 0.43, p = 0.007) of HCPs toward mental illness have become increasingly positive over time. These findings provide empirical evidence to support that the anti-stigma programs and courses have positive effects on HCPs and can inform future anti-stigma programs focusing on improving the attitudes of HCPs toward mental illness, thereby improving the quality of healthcare provided.

Attitudes toward disabilities among students in college settings: A multidimensional scaling analysis with biplot

We investigated attitudes toward 10 specific groups of individuals with disabilities among students in college settings. These groups comprised major depression, substance use disorder (SUD), anxiety disorder, autism spectrum disorder (ASD), cerebral palsy, hearing impairment, learning disability, visual impairment, spinal cord injury, and cancer survivor. The multidimensional scaling (MDS) analysis revealed a two-dimension space representing participants’ attitudes toward those disabilities. The MDS biplot further indicated higher levels of perceived dangerousness from the groups with SUD, major depression, anxiety disorder, and ASD. The hierarchical cluster analysis revealed that cluster A (SUD and major depression) was rated as having the highest level of social distance (i.e., negative attitudes). The implications for research and practice in rehabilitation counseling were discussed.

Evaluation of perceptions and knowledge of mental illness in the United States through crowdsourcing

Introduction

Crowdsourcing is a method of data collection with possible benefits in assessing perceptions of mental illness in a large US population.

Methods

The objective was to describe perceptions and trends of stigma surrounding mental illness in the United States using crowdsourcing. An online survey was conducted evaluating adults in the United States recruited via the online resource Amazon Mechanical Turk. Questions evaluated demographics and perceptions of mental illness. Survey data were adjusted for demographic variables and compared via logistic regression.

Results

Respondents (n = 1422) were predominately 18 to 30 years of age (n = 743; 52.3%) and white (n = 1101; 77.4%). Over half reported an individual close to them had mental illness (n = 932; 65.5%), and more than one quarter (n = 397; 27.9%) reported having a current or previous mental illness. Non-whites were less likely to agree that: medications are effective (odds ratio [OR] 0.63); they would be comfortable around a coworker with mental illness (OR 0.66); and mental illness is inheritable (OR 0.74). They are also more likely to agree that mental illness is preventable (OR 1.49). Individuals reporting mental illness were more likely to agree that medications (OR 1.34; 95% confidence interval 1.03 to 1.74) and talk therapy (OR 1.46; 95% confidence interval 1.12 to 1.90) are effective. Those reporting some or no college were more likely to agree that the United States has good access to mental health treatment.

Discussion

Crowdsourcing may be an effective way to obtain information regarding demographics, stigma, and mental illness. Personal experiences with mental illness, ethnicity, and educational level appear to continue to impact perceptions of mental illness.

Predicting intentions to seek help for depression among undergraduates in Sri Lanka

BACKGROUND

Studies have found that although there are high rates of depression among university students, their help-seeking practices are poor. It is important to identify students who are less likely to seek the necessary help, to encourage better help-seeking among them. This study, which was conducted among undergraduates in Sri Lanka, examined the associations between personal characteristics of the undergraduates and their intentions to seek help for depression.

METHODS

This was a cross-sectional study in which 4461 undergraduates (Male: n = 1358, 30.4%, Female: n = 3099, 69.5%; Mean age = 22.18; SD = 1.47) indicated their intentions to seek help if personally affected by depression, which was described in a hypothetical vignette about a peer experiencing depression symptomatology. The predictors of the undergraduates' help-seeking intentions, including their sociodemographic characteristics, prior exposure to and recognition of the problem, and their stigma towards those with depression were examined using binary logistic regression analyses models.

RESULTS

The undergraduates' ability to recognise the problem was one of the strongest predictors of their intentions to seek professional help. Those with higher levels of stigma were less likely to seek both professional and informal help. While females were less likely to consider professional help, they were more likely to consider the help of informal help-providers and to consider religious strategies. Medical undergraduates and those who had sought help for personal experiences of the problem were also more likely to consider informal help. However, all these associations resulted in small effect sizes, except for those between recognition of the problem and the undergraduates' intentions to seek professional help, where medium to very large effect sizes were observed in the case of some the associations examined.

CONCLUSIONS

Improvement of problem-recognition may be a key strategy for improving help-seeking among these undergraduates. Reduction of stigma may also be associated with better depression-related help-seeking of undergraduates. Females and medical undergraduates need to be educated about the importance of seeking appropriate types of help, and their informal social networks must be educated about how best to help them.

Stigma towards people with mental disorders and its components - a perspective from multi-ethnic Singapore

AIMS

The current study aimed to: (i) describe the extent of overall stigma as well as the differences in stigma towards people with alcohol abuse, dementia, depression, schizophrenia and obsessive compulsive disorder, as well as (ii) establish the dimensions of stigma and examine its correlates, in the general population of Singapore, using a vignette approach.

METHODS

Data for the current study came from a larger nation-wide cross-sectional study of mental health literacy conducted in Singapore. The study population comprised Singapore Residents (Singapore Citizens and Permanent Residents) aged 18-65 years who were living in Singapore at the time of the survey. All respondents were administered the Personal and Perceived scales of the Depression Stigma scale and the Social Distance scale to measure personal stigma and social distance, respectively. Weighted mean and standard error of the mean were calculated for continuous variables, and frequencies and percentages for categorical variables. Exploratory structural equation modelling and confirmatory factor analysis were used to establish the dimensions of stigma. Multivariable linear regressions were conducted to examine factors associated with each of the stigma scale scores.

RESULTS

The mean age of the respondents was 40.9 years and gender was equally represented (50.9% were males). The findings from the factor analysis revealed that personal stigma formed two distinct dimensions comprising 'weak-not-sick' and 'dangerous/unpredictable' while social distance stigma items loaded strongly into a single factor. Those of Malay and Indian ethnicity, lower education, lower income status and those who were administered the depression and alcohol abuse vignette were significantly associated with higher weak-not-sick scores. Those of Indian ethnicity, 6 years of education and below, lower income status and those who were administered the alcohol abuse vignette were significantly associated with higher dangerous/unpredictable scores. Those administered the alcohol abuse vignette were associated with higher social distance scores.

CONCLUSION

This population-wide study found significant stigma towards people with mental illness and identified specific groups who have more stigmatising attitudes. The study also found that having a friend or family member with similar problems was associated with having lower personal as well as social distance stigma. There is a need for well-planned and culturally relevant anti-stigma campaigns in this population that take into consideration the findings of this study.

Helping intentions of undergraduates towards their depressed peers: a cross-sectional study in Sri Lanka

BACKGROUND

Despite showing high rates of depression, university students prefer to seek assistance for their depression from informal sources, such as their friends, rather than seeking professional assistance. Therefore, the helping behaviours of those who provide informal help to these students need examination. This study examines the helping intentions of undergraduates in Sri Lanka towards their depressed peers and the correlates of their helping intentions.

METHOD

The undergraduates were presented with a vignette of a hypothetical depressed undergraduate. A total of 4442 undergraduates responded to an open-ended question about how the person in the vignette should be helped if this person was someone they knew well. Their responses were coded in reference to established mental health first aid guidelines. Logistic and linear regression models were used to examine the predictors of their helping intentions.

RESULTS

The undergraduates' most common helping intentions were to listen/talk and support their peer. Only around a third considered the need for professional help. The overall quality of their helping intentions was poor, but better among those who recognised the problem as depression and those who had less stigmatising attitudes. There was some evidence that certain helping intentions of the undergraduates which were person-oriented or social network-related were better among females, those in higher years of study and among certain non-medical student groups. Intentions to encourage professional help were better among those who recognised the problem, but poorer among those with personal experiences of this problem and among those who perceived this problem to be a weakness and not a sickness.

CONCLUSIONS

Although the undergraduates may attempt to support their distressed peers, they may not show appropriate helping actions and may not encourage the use of professional assistance. Hence, they need to be educated on how best to respond to their distressed peers. Those with higher levels of stigma and inability to recognise the problem may be at greater risk of showing poorer helping responses towards their distressed peers.

Quantifying and predicting depression literacy of undergraduates: a cross sectional study in Sri Lanka

BACKGROUND

The high rates of depression and low rates of related help-seeking among undergraduates are matters for concern. In response to the need to examine their knowledge about depression and its management, and the dearth of such research from non-western developing countries, this study examined the depression literacy of undergraduates in Sri Lanka.

METHODS

A questionnaire was administered among 4671 undergraduates to examine their depression literacy relating to problem-recognition, measured using a vignette of a depressed undergraduate, and their treatment beliefs measured by assessing their perceptions about the helpfulness of various options of help for the presented problem. Responses for the latter aspect were quantified using a scale comprising the options of help endorsed by Sri Lankan mental health professionals. Regression analysis models were used to identify the correlates of these aspects of depression literacy.

RESULTS

Females, medical undergraduates and those in higher years of study (compared to first-years) were more likely to recognise the problem as depression. The undergraduates obtained a mean percentage score of 76% on the constructed Depression Treatment Beliefs Scale. Scores on this scale were higher among females, medical undergraduates, those who got help for the problem after trying to deal with it alone and those who recognised the problem as depression, as well as those who used other mental health-related labels for this purpose. Scores were lower among undergraduates in years 2-4 (compared to first-years), those with family or friends with the problem and those with higher stigma on a Social Distance Scale. However, the effect sizes of these relationships were small.

CONCLUSIONS

As factors such as gender, discipline, year of study, exposure to depression and stigma are associated with differences in the depression literacy of these undergraduates, concerning their ability to recognise the problem and their related treatment beliefs, these must be considered when designing related educational initiatives. Recognising the problem as depression or the use of other mental health-related labels is associated with better treatment beliefs as per expert consensus, indicating that such labelling could have value for appropriate help-seeking.