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Caiada M, Valery KM, Felix S, Guionnet S, Tison E, Gonin M, Bonilla-Guerrero J, Destaillats JM, Pillaud N, Prouteau A. Stigmatizing intimate relationships in schizophrenia: a study comparing mental health professionals, health students and the general population. J Ment Health 2024:1-11. [PMID: 39159489 DOI: 10.1080/09638237.2024.2390378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/12/2024] [Accepted: 07/15/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Discrimination in intimate relationships (IR) is frequently reported among persons with schizophrenia. Despite ongoing effort of international organizations to combat mental illness stigma, there remain a limited understanding of specific IR-related stereotypes. AIMS The study aimed to i) identify the stereotypes related to IR of persons with schizophrenia held by Mental Health Professionals (MHP), health students and the general population, and ii) explore the effects of several factors associated with these stereotypes. METHODS This study used a mixed-methods approach. A survey developed collaboratively with persons with lived experience of mental health conditions (PWLE) was disseminated among MHP, health students and the general population. RESULTS The majority of the nine IR-related stereotypes previously identified by PWLE were endorsed by the participants (N = 532). PWLE were perceived as particularly incompetent in the domain of IR (e.g. to achieve couple project). Stereotypes endorsement varied among the groups. Continuum beliefs, perceived similarities and recovery beliefs were negatively associated with stereotype endorsement. CONCLUSIONS The general population, MHP and health students endorsed several stereotypes regarding IR of persons with schizophrenia. The results provide support for the role of theoretical beliefs in IR stigmatization, suggesting they may be relevant targets for evidence-based stigma reduction programs.
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Affiliation(s)
- Meryl Caiada
- Laboratory of Psychology, LabPsy UR 4139, University of Bordeaux, Bordeaux, France
| | - Kevin-Marc Valery
- Laboratory of Psychology, LabPsy UR 4139, University of Bordeaux, Bordeaux, France
| | - Simon Felix
- Laboratory of Psychology, LabPsy UR 4139, University of Bordeaux, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
| | - Sarah Guionnet
- Laboratory of Psychology, LabPsy UR 4139, University of Bordeaux, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
| | - Emma Tison
- Laboratory of Psychology, LabPsy UR 4139, University of Bordeaux, Bordeaux, France
- Project-Team Bivwac, Inria Center of Bordeaux University, Talence, France
| | - Maxime Gonin
- Faculty of Psychology, University of Bordeaux, Bordeaux, France
| | | | | | - Nicolas Pillaud
- Laboratory of Psychology, LabPsy UR 4139, University of Bordeaux, Bordeaux, France
| | - Antoinette Prouteau
- Laboratory of Psychology, LabPsy UR 4139, University of Bordeaux, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
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Caiada M, Felix S, Guionnet S, Valery KM, Bonilla-Guerrero J, Destaillats JM, Prouteau A. Promoting Intimate Relationships in Mental Illness: A Systematic Review of Interventions. Community Ment Health J 2024; 60:536-551. [PMID: 38015269 DOI: 10.1007/s10597-023-01204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
Although persons with Serious Mental Illness (SMI) express a need for intimate relations with others, they still suffer from a severe lack of social participation in this domain. However, these unmet needs have received little attention until recently. This study reviews interventions that aim to facilitate the development and the maintenance of intimate relationships (IR) of persons with schizophrenia, bipolar disorder and major depression. A systematic review following PRISMA guidelines was conducted. Studies published in Scopus, PubMed, EBSCO (Psych INFO, Psych ARTICLES, Psychology and Behavioral Sciences Collection) from January 1, 2000, to December, 2021, were screened. The search using terms referring to "schizophrenia", "bipolar disorder", "major depression", "IR" and "interventions" revealed 11 studies. Among them, 10 reported interventions for persons with depression, including 9 for couple therapy. Most interventions targeted satisfaction with couple relationships as the main therapeutic objective. Heterogeneity in study design precludes any firm conclusions about their efficacy. Interestingly, only one intervention focused on single persons interested in developing IR. The results highlight the lack of interventions: (i) aimed at promoting IR, (ii) designed for single persons, and (iii) targeting persons with psychotic disorders. This result may reflect the persisting stigmatization of persons with psychotic disorders, and the taboo associated with the IR and sexuality of persons with mental illness. Further studies are needed to develop inclusive interventions promoting the development of IR in persons with mental illness.
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Affiliation(s)
- Meryl Caiada
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France.
| | - Simon Felix
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
| | - Sarah Guionnet
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | - Kevin-Marc Valery
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | | | | | - Antoinette Prouteau
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
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Lyngdoh LAM, Antony S, Basavarajappa C, Kalyanasundaram JR, Ammapattian T. Marriage in persons with severe mental illness: A narrative review-based framework for a supported relationship. J Family Med Prim Care 2023; 12:3033-3041. [PMID: 38361907 PMCID: PMC10866282 DOI: 10.4103/jfmpc.jfmpc_797_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 02/17/2024] Open
Abstract
Background Studies in the past have shown the effect of mental illness on marriage in persons with severe mental illnesses (SMIs). Primary care and family physicians have a major role in addressing marriage-associated dilemmas in their life. Methods The literature search was conducted from databases such as PubMed, ProQuest, EBSCO, Scopus, and Google Scholar for understanding the context and the problem in-depth for bringing out the narrative-review based framework for addressing the dilemmas. Results Marriage rates in persons with SMI are high in Eastern countries. Marriage in persons with SMI enhances social support and prevents the stigma of being unmarried. Disability, unemployment, stigma, and disclosure-related issues are barriers to getting desirable alliances. Evidence based interventions are available to reduce the associated distress to an extent. Conclusion Published peer-reviewed literature has pointed out that marriage plays a significant role in the life of persons with SMI and their families, especially in Asian countries where marriage is an important social institution. It can have a positive impact or can lead to relapse, marital conflicts, and divorce based on contextual and clinical factors. Hence, there is a need to come up with tailor-made interventions to address marriage-related expectations in persons with SMI.
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Affiliation(s)
- Lavinia A. M. Lyngdoh
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Sojan Antony
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Janaki Raman Kalyanasundaram
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Thirumoorthy Ammapattian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
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White R, Haddock G, Haarmans M, Varese F. Being more satisfied with romantic relationship status is associated with increased mental wellbeing in people with experience of psychosis. Front Psychiatry 2023; 14:1232973. [PMID: 37840795 PMCID: PMC10569177 DOI: 10.3389/fpsyt.2023.1232973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Aims Romantic relationships represent one of the most salient sources of social support. In general population studies, they are associated with both physical and psychological benefits. Research suggests that for people with psychosis, romantic relationships may also have a positive impact on a range of outcomes, but the reasons for these associations are still unclear. This study aims to investigate whether satisfaction with romantic relationships status is associated with better wellbeing outcomes in people with experience of psychosis and explore three possible psychological mediators of this relationship. Methods Participants who had previously sought support for psychosis (n = 190) completed an online survey including measures of relationship status satisfaction (the Satisfaction with Relationship Scale) as well as measures of psychotic symptoms (the CAPE-42), general well-being (Short Warwick-Edinburgh Mental Wellbeing Scale) and several psychological variables relevant to the pathway between romantic relationships and well-being outcomes, namely loneliness, internalised stigma, self-esteem and attachment. Results Fearful attachment and partner criticism were negatively associated with relationship status satisfaction. Having a partner was positively associated with relationship status satisfaction. Higher levels of relationship status satisfaction were associated with lower psychotic symptoms and higher mental wellbeing. This relationship was mediated by loneliness, internalised stigma, and self-esteem. Conclusion Mental health services should be mindful of the associations between romantic relationship satisfaction and wellbeing. Service users with a fearful attachment style may particularly benefit from support in this area.
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Affiliation(s)
- Rebecca White
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Maria Haarmans
- Department of Sociology, School of Social Sciences, Faculty of Humanities, The University of Manchester, Manchester, United Kingdom
- School of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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Cloutier B, Lecomte T, Diotte F, Lamontagne J, Abdel-Baki A, Daneault JG, Gélineau Rabbath ME, de Connor A, Perrine C. Improving Romantic Relationship Functioning Among Young Men With First-Episode Psychosis: Impact of a Novel Group Intervention. Behav Modif 2023; 47:1170-1192. [PMID: 37496322 PMCID: PMC10403962 DOI: 10.1177/01454455231186586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Previous research has highlighted many of the challenges faced by individuals with psychosis in romantic relationships. The present study aimed to evaluate the impact of a novel group intervention for men with first-episode psychosis (FEP) on dating success, romantic and sexual functioning, self-esteem, self-stigma, mentalizing skills, and symptomatology, while using a repeated single-case experimental design and comparing results across two treatment modalities (i.e., in-person or online). Twenty-seven participants from five treatment sites completed a 12-week group intervention. Qualitative data was also collected to assess participants' subjective experiences with the program. In both modalities, significant improvements were observed for romantic functioning, mentalizing skills, and symptomatology, with effect sizes ranging from small to large. Several participants also attended more dates and entered committed relationships after the intervention. Most participants were satisfied with the program and many felt that they had learned new skills and gained confidence in dating. Future research should replicate these findings in larger and more inclusive samples.
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Affiliation(s)
| | | | | | | | - Amal Abdel-Baki
- Centre hospitalier de l’Université de Montréal, Clinique JAP, QC, Canada
| | | | | | - Alexandre de Connor
- Centre hospitalier universitaire de Montpellier, Centre de rétablissement et de réhabilitation Jean-Minvieille, Montpellier, France
| | - Cécile Perrine
- Établissement public de santé mentale Caen, Unité de réhabilitation psychosociale Ariane, Caen, France
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Helu-Brown P, Barrio C, Hernandez M. Stigma and the Intersection of Ethnicity, Gender, Romantic Relationships, and Serious Mental Illness: Perspectives from Latinxs with Schizophrenia and Their Family Members. STIGMA AND HEALTH 2023; 8:344-354. [PMID: 37867559 PMCID: PMC10588796 DOI: 10.1037/sah0000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Romantic relationships are a fundamental part of the human experience and contribute to quality of life and recovery of people with serious mental illness (SMI). However, few psychosocial interventions exist to address this issue among people with schizophrenia, and no existing intervention focuses on Latinxs. The intersectionality of being Latinx and having schizophrenia can create a unique experience regarding stigma, romantic relationships, and gender. Guided by intersectionality theory, this study used qualitative content analysis and an intersectionality template analysis to examine data from interviews with 22 participants-11 people with diagnosed schizophrenia and their identified primary family member. Overall, findings illustrate perspectives about romantic relationships in a sample of Latinxs with schizophrenia and highlight the stigma that people with schizophrenia and their families can experience. Five key themes emerged from the data: obstacles to romantic relationships, advantages of romantic relationships, disadvantages of romantic relationships, gender-role issues and satisfaction with life, and hope for the future. Participants reported that stigma related to schizophrenia and the lack of employment were the main obstacles to establishing and maintaining romantic relationships. These findings provide an insider perspective on romantic relationships in a sample of Latinxs with schizophrenia and elucidate the importance of using an intersectionality lens to guide culturally responsive approaches.
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Affiliation(s)
| | - Concepcion Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California
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Yahyavi S, Raisi F, Firoozikhojastefar R, Shahvari Z, Mirsepassi Z. Sex education for patients with severe mental illness in Iran: A qualitative study. PEC INNOVATION 2022; 1:100016. [PMID: 37213718 PMCID: PMC10194151 DOI: 10.1016/j.pecinn.2022.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 05/23/2023]
Abstract
Objective Patients with severe mental illness may experience cognitive deficits, impaired judgment or loss of skills. Therefore, they are prone to sexual health complications. Sex education can promote sexual health, and in many countries, it is integrated into other domains of education. The educational contents taught in western countries are not necessarily appropriate for developing countries.This study aims to address sex educational content for these patients in Iran. Methods We have conducted twenty-three face-to-face, deep and semi-structured interviews with patients, family members, psychiatrists, general practitioners, nurses and psychologists. We used the strategy of maximum diversity in selecting the participants. Results "Improving basic knowledge," "decreasing the risk of unsafe sex", "empowerment" and "persuading to ask for help" should be covered in the education. Conclusions Sexuality is not considered a priority for these patients. It is necessary to develop a training program with simple educational content for this high-risk group. Innovation Raising awareness and knowledge about the possible risks of social media on high-risk behaviours, developing social and behavioural skills, and encouraging patients to talk about their new challenges in sexual life is recommended. Cultural, spiritual and personal beliefs should be considered in designing the educational program.
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Affiliation(s)
- SeyyedTaha Yahyavi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Raisi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Shahvari
- Department of Nursing and Midwifery, Gachsaran Branch, Islamic Azad University, Gachsaran, Iran
| | - Zahra Mirsepassi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author at: Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Thana LJ, O'Connell L, Carne-Watson A, Shastri A, Saravanamuthu A, Budhwani N, Jayacodi S, Leeson VC, Munjiza J, Pappa S, Hughes E, Reilly J, Crawford MJ. Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial. BMC Psychiatry 2022; 22:545. [PMID: 35953808 PMCID: PMC9373458 DOI: 10.1186/s12888-022-04193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to recruit 216 participants over a two-year period, but recruitment was stopped after an extended 12-month pilot phase, during which we recruited only 10 participants. As part of a nested process evaluation, we conducted qualitative interviews with front-line clinicians to examine barriers to recruitment to the trial. METHODS We developed a semi-structured interview schedule to explore staff views on factors that influenced whether they referred potential participants to the study. We interviewed a purposive sample of 51 staff from four National Health Service (NHS) Trusts in England, ensuring a range of different backgrounds, seniority, and levels of involvement in the trial. Audio recordings of interviews were transcribed for verbatim, and data were analysed using an inductive approach to thematic analysis. RESULTS Nine interconnected themes were generated. Six themes concerned barriers to recruitment; including; prioritising patients' mental stability, mutual discomfort and embarrassment about discussing a "taboo" subject, and concerns about unintended consequences of asking people with psychosis about their sexual functioning. Three themes, including the quality of treatment relationships and strategies for opening dialogue suggested ways to improve recognition of these "hidden" side effects. CONCLUSION The identification and management of sexual dysfunction among people with psychosis are not priorities for mental health services in England at this time. Many staff working in front-line services feel unprepared and uncomfortable asking people with psychosis about these problems. While greater use of screening tools may improve the identification of sexual dysfunction among people with psychosis, the evaluation and implementation of interventions to manage them will continue to be challenging unless NHS leaders and senior clinicians demonstrate greater commitment to changing current clinical practice. TRIAL REGISTRATION Current Controlled Trials ISRCTN12307891.
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Affiliation(s)
- Lavanya J Thana
- Division of Psychiatry, Commonwealth Building, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Lesley O'Connell
- Division of Psychiatry, Commonwealth Building, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | | | | | | | | | - Sandra Jayacodi
- Central and North West London NHS Foundation Trust, London, UK
| | - Verity C Leeson
- Division of Psychiatry, Commonwealth Building, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Jasna Munjiza
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Elizabeth Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Joe Reilly
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Mike J Crawford
- Division of Psychiatry, Commonwealth Building, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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Urry K, Chur-Hansen A, Khaw C. 'It's Not Really a Part of Standard Practice': Institutional Silencing of Sexuality Within Australian Mental Health Settings. QUALITATIVE HEALTH RESEARCH 2022; 32:543-555. [PMID: 34904865 DOI: 10.1177/10497323211061340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research seeking to understand and improve sexuality-related practice in mental health settings has paid little attention to the institutional context in which clinicians' practice is embedded. Through a social constructionist lens, we used thematic analysis to examine how 22 Australian mental health clinicians implicated the wider institutional context when discussing and making sense of sexuality-related silence within their work. Interviews were part of a study exploring participants' perceptions of sexuality and sexual health in their work more generally. Broader silences that shaped and reinforced participants' perceptions and practice choices were situated in professional education; workplace cultures; and the tools, procedures and policies that directed clinical practice. We argue that sexuality-related silence in mental health settings is located in the institutional context in which clinicians learn and work, and discuss how orienting to this broader context will benefit research and interventions to improve sexuality-related practice across health settings.
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Affiliation(s)
- Kristi Urry
- School of Psychology, Faculty of Health and Medical Sciences, 1066University of Adelaide, Adelaide, SA, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, 1066University of Adelaide, Adelaide, SA, Australia
| | - Carole Khaw
- School of Medicine, Faculty of Health and Medical Sciences, 1066University of Adelaide, Adelaide, SA, Australia
- Adelaide Sexual Health Centre, Infectious Disease UnitRoyal Adelaide Hospital, Adelaide, SA, Australia
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