Social stigma is an underestimated contributing factor to unemployment in people with mental illness or mental health issues: position paper and future directions

"Because I Am a Female": Stigma and Safety Perspectives from Racially/Ethnically Diverse Women with Serious Mental Illnesses

Individuals with serious mental illnesses (SMIs) face safety risks related to their mental health conditions that are often compounded by experiences of trauma, victimization, residence in impoverished neighborhoods, and histories of homelessness. Stigma and safety challenges significantly impact community integration for individuals with SMIs, particularly women, who often bear a disproportionate burden of vulnerability, gender-based stigma, violence, and other inequalities. This study investigates how women with SMIs engage in the meaning-making of their safety and stigma experiences that, in turn, influence their community integration. From a large multi-site study exploring community experiences of racially/ethnically diverse participants with SMIs, a subsample of 28 cis and trans-gender women, who reported experiencing gendered stigma and a lack of safety, were chosen for the current study. The interviews were analyzed using modified principles of Interpretive Phenomenological Analysis (IPA) to understand how women with SMIs made meaning of their safety and stigma encounters in their families, communities, and neighborhoods. IPA analysis resulted in the emergence of themes within a broad category of safety that represented participants' meaning-making about their physical safety and stigma experiences. Specifically, we used the broad themes from an existing framework of safety called 'Navigating Safety' model as sensitizing concepts for our analysis. Physical and psychological aspects of safety for this study were experienced in tandem whereby the women made sense of how their experiences of a lack of physical safety in multiple contexts shaped their sense of self, internalized stigma, and their social relationships. Within the broad theme of physical safety, participants described unsafe neighborhoods, exposure to domestic and intimate partner violence, and vulnerability to sexual violence. Additionally, under psychological safety, we identified how gender-based norms, race and ethnicity, sources of stigma (internalized, familial, and societal), and social isolation contributed to their mental health and social relationships (particularly with family). These findings highlight how the compounding influence of the intersection of multiple stigmatized identities exerts safety challenges on the lives and community experiences of women with SMIs. Focusing on access and affordability of appropriate gender-responsive resources for women, including trauma-informed care, could reduce hospitalizations, mental health symptoms, and stigma so they can safely integrate into their communities.

The Job Demands and Accommodation Planning Tool (JDAPT): A Nine-Month Evaluation of Use, Changes in Self-efficacy, Presenteeism, and Absenteeism in Workers with Chronic and Episodic Disabilities

PURPOSE

Enhancing workplace communication and support processes to enable individuals living with disabilities to sustain employment and return to work is a priority for workers, employers, and community stakeholders. The objective of this study was to evaluate a new resource that addresses support challenges, the Job Demands and Accommodation Planning Tool (JDAPT), and assess its use, relevance, and outcomes over a nine-month follow-up period.

METHODS

Workers with physical and mental health/cognitive conditions causing limitations at work were recruited using purposive sampling. Online surveys were administered at baseline (prior to using the JDAPT), and at three and nine months post-baseline. Information was collected on demographics (e.g., age, gender) and work characteristics (e.g., job sector, organization size). Outcomes included assessing JDAPT use and relevance, and changes in self-efficacy, work productivity difficulties, employment concerns, difficulties with job demands, and absenteeism.

RESULTS

Baseline participants were 269 workers (66% women; mean age 41 years) of whom 188 (69.9%) completed all three waves of data collection. Many workers reported using JDAPT strategies at and outside of work, and held positive perceptions of the tool's usability, relevance, and helpfulness. There were significant improvements (Time 1-2; Time 1-3) in self-efficacy, perceived work productivity, and absenteeism with moderate to large effect sizes in self-efficacy and productivity (0.46 to 0.78). Findings were consistent across gender, age, health condition, and work context variables.

CONCLUSIONS

The JDAPT can enhance support provision and provide greater transparency and consistency to workplace disability practices, which is critical to creating more inclusive and accessible employment opportunities.

Place-Based FACT: Treatment Outcomes and Patients' Experience with Integrated Neighborhood-Based Care

Locating specialized mental healthcare services in the neighborhood of people with severe mental illnesses (SMI) has been suggested as a way of improving treatment outcomes by increasing patient engagement and integration with the local care landscape. The current mixed methods study aimed to examine patient experience and treatment outcomes in three Flexible Assertive Community Treatment (FACT) teams that relocated to the neighborhood they served, compared to seven teams that continued to provide FACT as usual from a central office. Routine Outcome Measurement (ROM) and care use data were analyzed to compare change in treatment outcomes for patients in place-based FACT (n = 255) and FACT as usual (n = 833). Additionally, retrospective in-depth interviews were conducted with twenty patients about their experience with place-based FACT. Quantitative analysis showed mental health admission days decreased more in place-based than FACT as usual, although this difference was small. Both groups showed improved quality of life, psychosocial functioning, and symptomatic remission rates, and decreased unmet and overall needs for care. There was no change over time in met needs for care, employment, and daily activities. Qualitative analysis showed that patients experienced place-based FACT as more accessible, a better safety net, a more personal approach, better integrated with other forms of care, involving their social network, and embedded in their neighborhood and daily environment. This study showed that location and integration matter to patients, and the long term impact of place-based FACT on treatment outcomes should be explored.

Mental Health Stigma in the Workplace and its Association with Possible Actions of Managers to Prevent Sickness Absence of Employees with Mental Health Problems in the Swedish Private Sector: a Video Vignette Study

PURPOSE

Mental health problems (MHPs) are subjected to workplace stigma and can deteriorate into common mental disorders (CMDs) and sickness absence (SA). Research has shown that personal stigmatizing attitudes limit managers' efforts towards employees with MHPs, but knowledge is lacking regarding stigma in social contexts (contextual stigma) and different types of possible preventive actions. This study investigates personal stigmatizing attitudes and three contextual stigma layers (employee, collegial, organizational) and different types of possible actions to prevent SA of employees with MHPs.

METHOD

Survey data of 2769 Swedish managers working in the private sector were analysed. Personal stigmatizing attitudes were measured with the managerial stigma towards employee depression scale and supplemented with four additional items capturing contextual stigma. Managers watched video vignettes and assessed which preventive actions (n  = 20) were possible to use in their organization. A sum score was calculated reflecting the 'number of actions'. Principal component analysis revealed three action types: adapt tasks and setting, involve experts, and social support. A score reflecting the 'possibilities to implement actions' was calculated for each type. Multiple linear regression analyses were conducted with the four stigma layers as independent variables for each of the three action variables.

RESULTS

Personal stigmatizing attitudes and contextual stigma were significantly associated with both 'number of actions' and 'possibilities for implementing actions' relating to all action types. Patterns of associations with contextual stigma were significant but varied between the different action types.

CONCLUSION

This study substantiated the role of personal stigmatizing attitudes and contextual stigma in relation to possible actions of managers to prevent SA of employees with MHPs. The results emphasize the role of contextual stigma. Implications for practice and research are discussed.

Investigating the impact of poverty on mental illness in the UK Biobank using Mendelian randomization

It is unclear whether poverty and mental illness are causally related. Using UK Biobank and Psychiatric Genomic Consortium data, we examined evidence of causal links between poverty and nine mental illnesses (attention deficit and hyperactivity disorder (ADHD), anorexia nervosa, anxiety disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder and schizophrenia). We applied genomic structural equation modelling to derive a poverty common factor from household income, occupational income and social deprivation. Then, using Mendelian randomization, we found evidence that schizophrenia and ADHD causally contribute to poverty, while poverty contributes to major depressive disorder and schizophrenia but decreases the risk of anorexia nervosa. Poverty may also contribute to ADHD, albeit with uncertainty due to unbalanced pleiotropy. The effects of poverty were reduced by approximately 30% when we adjusted for cognitive ability. Further investigations of the bidirectional relationships between poverty and mental illness are warranted, as they may inform efforts to improve mental health for all.

Examining the impact of self-stigma on workplace well-being: an empirical investigation of medical students with physical disabilities in China and the moderating role of trait mindfulness

BACKGROUND

As societal evolution unfolds in China, individuals with physical disabilities are increasingly provided opportunities in higher education, particularly in the field of medicine. However, these medical students often encounter bias in their work environments, including during internships, which fosters self-stigma and impedes their experience for workplace well-being (WWB). Such a decrease in WWB detrimentally affects not only their mental health in the workplace but also hinders their sense of personal worth and assimilation into broader society. This study aims to examine the challenges faced by medical students with physical disabilities in China as they aspire to achieve WWB, and to explore potential intervention strategies.

METHODS

Leveraging cognitive consistency theory (CCT), we introduces a conceptual framework to examine the relationships among self-stigma, perceived discrimination, and WWB. It also investigates the role of trait mindfulness as a potential mitigating factor in this dynamic. We employed the Internalized Stigma of Mental Illness Scale (ISMIS), Discrimination Perception Questionnaire (DPQ), Workplace Well-being Subscale (WWBS), and Mindful Attention Awareness Scale (MAAS) to survey 316 medical students with physical disabilities. Statistical analyses, including correlation, regression, and moderated mediation effect assessments, were conducted using SPSS 22.0 and AMOS 24.0.

RESULTS

A notable negative correlation exists between self-stigma and WWB (r = -0.56, p < 0.01). Perceived discrimination partially mediates the relationship between self-stigma and WWB. The direct effect of self-stigma and its mediating effect through perceived discrimination account for 60.71% and 21.43% of the total effect, respectively. Trait mindfulness moderates the latter part of this mediating pathway. Moderation models indicate that trait mindfulness has a significant negative moderating effect on the impact of perceived discrimination on WWB (β = -0.10, p < 0.001).

CONCLUSIONS

Self-stigma adversely affects the positive work experiences of medical students with physical disabilities by eliciting a heightened sensitivity to discriminatory cues, thereby undermining their WWB. Trait mindfulness can effectively counter the detrimental effects of perceived discrimination on WWB. Consequently, this study advocates for the systematic incorporation of mindfulness training into educational services and workplace enhancement programs for medical students with disabilities, aiming to foster an inclusive and supportive external environment.

Anticipated and experienced stigma and discrimination in the workplace among individuals with major depressive disorder in 35 countries: qualitative framework analysis of a mixed-method cross-sectional study

OBJECTIVES

Workplace stigmatisation and discrimination are significant barriers to accessing employment opportunities, reintegration and promotion in the workforce for people with mental illnesses in comparison to other disabilities. This paper presents qualitative evidence of anticipated and experienced workplace stigma and discrimination among individuals with major depressive disorder (MDD) in 35 countries, and how these experiences differ across countries based on their Human Development Index (HDI) level.

DESIGN

Mixed-method cross-sectional survey.

PARTICIPANTS, SETTING AND MEASURES

The qualitative data were gathered as part of the combined European Union Anti-Stigma Programme European Network and global International Study of Discrimination and Stigma Outcomes for Depression studies examining stigma and discrimination among individuals with MDD across 35 countries. Anticipated and experienced stigma and discrimination were assessed using the Discrimination and Stigma Scale version 12 (DISC-12). This study used responses to the open-ended DISC-12 questions related to employment. Data were analysed using the framework analysis method.

RESULTS

The framework analysis of qualitative data of 141 participants identified 6 key 'frames' exploring (1) participants reported experiences of workplace stigma and discrimination; (2) impact of experienced workplace stigma and discrimination; (3) anticipated workplace stigma and discrimination; (4) ways of coping; (5) positive work experiences and (6) contextualisation of workplace stigma and discrimination. In general, participants from very high HDI countries reported higher levels of anticipated and experienced discrimination than other HDI groups (eg, less understanding and support, being more avoided/shunned, stopping themselves from looking for work because of expectation and fear of discrimination). Furthermore, participants from medium/low HDI countries were more likely to report positive workplace experiences.

CONCLUSIONS

This study makes a significant contribution towards workplace stigma and discrimination among individuals with MDD, still an under-researched mental health diagnosis. These findings illuminate important relationships that may exist between countries/contexts and stigma and discrimination, identifying that individuals from very high HDI countries were more likely to report anticipated and experienced workplace discrimination.

Improving Work Participation Outcomes Among Unemployed People with Mental Health Issues/Mental Illness: Feasibility of a Stigma Awareness Intervention

PURPOSE

As stigma is a barrier to work participation of unemployed people with mental health issues/mental illness (MHI), a stigma awareness intervention can be helpful to make informed decisions about disclosing MHI. The aim of this process evaluation was to investigate the feasibility of a stigma awareness intervention, to explore experiences of clients and their employment specialists; and to give recommendations for further implementation.

METHODS

The intervention consisted of a stigma awareness training for employment specialists and a decision aid tool for their clients with (a history of) MHI. For the process evaluation, six process components of the Linnan & Stecklar framework were examined: recruitment, reach, dose delivered, dose received, fidelity and context. Using a mixed-methods design, quantitative and qualitative data were collected and analyzed.

RESULTS

The six components showed the intervention was largely implemented as planned. Questionnaire data showed that 94% of the clients found the tool useful and 87% would recommend it to others. In addition, more than half (54%) indicated the tool had been helpful in their disclosure decision. Qualitative data showed that participants were mainly positive about the intervention. Nevertheless, only a minority of clients and employment specialists had actually discussed the tool together. According to both, the intervention had increased their awareness of workplace stigma and the disclosure dilemma.

CONCLUSION

The implementation of a stigma awareness intervention was feasible and did increase stigma awareness. Experiences with the intervention were mainly positive. When implementing the tool, it is recommended to embed it in the vocational rehabilitation system, so that discussing the disclosure dilemma becomes a routine.

TRAIL REGISTER

The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).

Mental Health Treatment Utilization and Unmet Mental Health Needs Among Black Reproductive-Age Women in the United States

OBJECTIVE

Black women in the United States experience increased risk for mental disorders and are less likely to have access to appropriate mental health treatment compared with White women. To develop culturally responsive strategies to improve Black women's access to mental health treatment, the authors evaluated social determinants associated with mental health treatment utilization and unmet mental health needs among Black reproductive-age women with serious psychological distress.

METHODS

The authors performed a secondary analysis of data from the National Survey on Drug Use and Health. Data from 2009 to 2019 were pooled and restricted to Black women ages 18-44 years with serious psychological distress (N=4,171). Logistic regressions were conducted to identify personal and social determinants (e.g., education, employment status, poverty, and insurance status) of mental health treatment utilization, alternative mental health treatment utilization (e.g., spiritual support and self-help), and perceived unmet mental health needs.

RESULTS

Education and employment status were significantly associated with all three outcomes. Among the women who reported unmet mental health needs, opposition to treatment and cost were the highest endorsed barriers. Differences were found by pregnancy status, with pregnant women being significantly less likely to endorse cost (p<0.001) and more likely to endorse time and transportation as barriers (p<0.01) to receiving mental health treatment.

CONCLUSIONS

Strategies to improve mental health outcomes for Black women should focus on reducing cost and transportation barriers and on the development of culturally responsive intervention approaches that address Black women's concerns about mental health treatment.

Managers' attitudes to depression and the association with their rating of how work capacity is affected in employees with common mental disorders

OBJECTIVE

This explorative, cross-sectional study assessed the association between managers' attitudes to employee depression and their rating of how common mental disorders (CMDs) affect employee work capacity.

RESULTS

A principal component analysis was performed for the nine variables concerning managers' rating of how CMDs can affect work capacity among employees. The analysis resulted in two factors: task-oriented- and relational work capacity. The result of the multivariate analysis of covariance showed a p value of 0.014 (Pillai's trace) indicating a statistically significant association between managers' attitudes towards employee depression and managers' rating of how CMDs affect work capacity. The association was significant for both factors as indicated by the p value of 0.024 for task-oriented work capacity and the p value of 0.007 for relational work capacity. The R2 value was 0.022 for task-oriented work capacity and 0.017 for relational work capacity. We assumed that negative attitudes towards employee depression would be associated with a perception of decreased work capacity among employees with CMDs. The results showed a significant association; however, the effect (~ 2%) was small. Further studies of manager's attitudes and other possible determinants of managers' rating of CMD-related work capacity are needed to better understand these factors.

Empathy Amplified: Exploring the Transformative Potential of Understanding Auditory Hallucinations Through Staff Training

BACKGROUND

Stigmatization of individuals diagnosed with psychosis, especially those who experience auditory hallucinations, is a well-documented issue with negative outcomes on provision of care. Existing research has predominantly concentrated on experiential training for students, leaving a significant gap in knowledge regarding the training's impact on practicing psychiatric nurses and technicians.

AIMS

This study aims to address this gap by investigating the efficacy of a concise, 1-hour educational activity designed to improve empathy, confidence, competence, and knowledge in psychiatric professionals.

METHODS

Participants engaged in a 1-hour training session that included simulated activities while listening to distressing voices and completed pretraining and posttraining assessments.

RESULTS

Results demonstrated a notable increase in empathy toward individuals who hear voices, suggesting that the training had a positive effect. Furthermore, significant differences were observed in the participants' perceptions of the level of difficulty as well as increased levels of confidence and perceived competence in their ability to provide care.

CONCLUSIONS

The results underscore the practicality and effectiveness of brief hearing voices simulations as a means to enhance the skills of existing health care providers. This approach allows professionals to better express empathy and gain a deeper understanding of the experiences of voice hearers.

The Text-Picture Integration Scale for Perspectives on Mental Illness: Development and Validation

IMPORTANCE

Understanding the root cause of mental illness stigma is necessary to adopt effective management strategies.

OBJECTIVE

To establish a stable and effective text-picture integration rating scale to predict public perspectives on mental illness and to examine its reliability and validity.

DESIGN

Descriptive cross-sectional study using internet survey data.

SETTING

Online.

PARTICIPANTS

Two hundred volunteers.

RESULTS

The 10-item the Text-Picture Integration Scale for Perspectives on Mental Illness was developed. The authors conducted data analysis using SPSS to evaluate the reliability and criterion-related validity of the Mental Health Literacy Scale (MHLS). The Text-Picture Integration Scale's item-level content validity index ranged from 0.83 to 1.00, and the scale-level content validity index was 0.97. The scale demonstrated acceptable reliability (Cronbach's α = .80). The mean value of individual items ranged from 3.18 to 4.48, and the mean total score was 39.44 (SD = 8.47). The Text-Picture Integration Scale exhibited satisfactory criterion-related validity with the MHLS (r = .76, p < .001).

CONCLUSIONS AND RELEVANCE

Preliminary analyses support that the Text-Picture Integration Scale is a stable and effective rating scale to determine public perspectives on mental illness and is appropriate for evaluating destigmatization efforts. Plain-Language Summary: The study findings support the use of the Text-Picture Integration Scale as a stable and effective rating scale to determine public perspectives on mental illness. The scale is also appropriate for evaluating ways to address the stigmas that people associate with mental illness, which pose challenges for people in recovery. Occupational therapists can leverage their understanding of public perspectives on mental illness when choosing interventions to support the overall well-being of their clients with mental illness.

Experiences of returning to work in patients with schizophrenia after treatment: A longitudinal qualitative study

BACKGROUND

Returning to work (RTW) has always been regarded as one of the important indicators to evaluate the therapeutic effect of patients with schizophrenia. The existing studies on RTW in patients with schizophrenia are mostly focused on intervention measures, and the qualitative research on RTW is very limited. The purpose of this study was to evaluate the experience of the RTW after treatment in patients with schizophrenia.

METHOD

A longitudinal qualitative study was conducted involving 24 patients with schizophrenia in China. The interviews were held at three time-points during their RTW process, (1) when patients had improved and were close to discharge, (2) within 1 month post-discharge, and (3) 6 months post-discharge. The interview recordings were transcribed by the research team, and transcripts were independently analyzed by two independent coders using reflexive thematic analysis.

RESULTS

A total of 24 patients with schizophrenia participated in 72 personal interviews. The thematic framework based on the experience of patients with schizophrenia reveals a three-phases of the process of RTW: improved, being at a loss, and job crisis. The study identified one theme of the first phase: the expectation and optimism. Two themes in the second phase: (1) psychological distress of upcoming work; (2) expectation of assistance pre-work. And four themes in the third phase: (1) tremendous pressure of RTW; (2) lack of medical and social support; (3) social status and interpersonal relationships change; and (4) high level of financial pressure.

CONCLUSION

The experience of RTW is a dynamic process with great challenges in each phase, patients with schizophrenia have been deeply affected by what they have experienced. There is an urgent need to ensure that existing community and social support is integrated into daily care to support patients with schizophrenia to RTW successful. The findings of this study also suggest relevant departments and employers should be aware of the barriers to RTW for patients with schizophrenia, and take certain measures to change the current situation.

State-Federal Vocational Rehabilitation Services, Demographic Characteristics and Employment Outcomes for Native Americans with Mental Illnesses

There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9-11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed.

Professional stigma towards clients with methamphetamine use disorder - a qualitative study

Background

Methamphetamine use disorder (MUD) is associated with poor health outcomes. Pharmacists play a role in delivery of substance use treatment, with several studies having examined their attitudes to people with opioid use disorder, but little is known about their attitude towards people with MUD. This study aimed to explore pharmacists' perspectives on the provision of services to clients with MUD.

Methods

A convenience sampling strategy was used to recruit community pharmacists across Sydney, Australia. Semi structured interviews examined views and ideas of pharmacists surrounding the treatment and management of MUD, followed by coding of transcribed interview data by all members of the research team.

Results

Nineteen pharmacists completed the interviews. The main theme identified was stigma held by healthcare professionals. The almost unanimous perception amongst pharmacists was fear and apprehension towards people with MUD, including underlying assumptions of criminality, misinformation regarding people with MUD, and lack of education and knowledge surrounding MUD.

Conclusion

A substantial amount of stigma towards people with MUD was found in this study. Negative attitudes by healthcare professionals can perpetuate healthcare disparities and impede the accessibility of future treatment programs for people with MUD. Appropriate educational interventions on MUD for pharmacists are needed.

Effectiveness of a Stigma Awareness Intervention on Reemployment of People with Mental Health Issues/Mental Illness: A Cluster Randomised Controlled Trial

PURPOSE

A barrier for reemployment of people with mental health issues/mental illness (MHI) is workplace stigma and discrimination. In this RCT the effectiveness of a stigma-awareness intervention addressing finding work, retaining work and decisional stress were evaluated.

METHODS

A cluster RCT was conducted in 8 Dutch municipal practices. Randomisation took place at practice level. Participants were unemployed people with MHI, receiving social benefits. The intervention consisted of a decision aid for workplace disclosure for participants and a 2 × 3 h stigma-awareness training for their employment specialists. Primary outcomes were measured at baseline, 3-, 6- and 12-months. Multilevel analyses, containing random intercepts of participants nested in organizations, were conducted to analyse the effects of the intervention.

RESULTS

Participants (N = 153) were randomized to an experimental (n = 76) or control group (n = 77). At six months, significantly more participants of the experimental group (51%) had found work compared to the control group (26%). At twelve months, significantly more participants of the experimental group (49%) had retained work compared to the control group (23%). Intention-to-treat analyses showed that randomization to the experimental group was associated with finding (OR(95%CI) = 7.78(1.33-45.53), p = 0.02) and retaining (OR(95%CI) = 12.15(2.81-52.63), p < 0.01) work more often at twelve months. Analyses showed that the experimental and control group did not differ in decisional stress.

CONCLUSIONS

Our stigma awareness intervention was effective for finding and retaining work. As the percentage of people who found and retained work almost doubled, this suggests that on a societal level, a vast number of unemployed people could be reemployed with a relatively simple intervention.

TRIAL REGISTRATION

The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).

Conceptualising the social in mental health and work capability: implications of medicalised framing in the UK welfare system

PURPOSE

This paper asks whether the separation of mental health from its wider social context during the UK benefits assessment processes is a contributing factor to widely recognised systemic difficulties, including intrinsically damaging effects and relatively ineffective welfare-to-work outcomes.

METHODS

Drawing on multiple sources of evidence, we ask whether placing mental health-specifically a biomedical conceptualisation of mental illness or condition as a discrete agent-at the core of the benefits eligibility assessment process presents obstacles to (i) accurately understanding a claimant's lived experience of distress (ii) meaningfully establishing the specific ways it affects their capacity for work, and (iii) identifying the multifaceted range of barriers (and related support needs) that a person may have in relation to moving into employment.

RESULTS

We suggest that a more holistic assessment of work capacity, a different kind of conversation that considers not only the (fluctuating) effects of psychological distress but also the range of personal, social and economic circumstances that affect a person's capacity to gain and sustain employment, would offer a less distressing and ultimately more productive approach to understanding work capability.

CONCLUSION

Such a shift would reduce the need to focus on a state of medicalised incapacity and open up space in encounters for more a more empowering focus on capacity, capabilities, aspirations, and what types of work are (or might be) possible, given the right kinds of contextualised and personalised support.

A Thematic Analysis Investigating the Inaugural Psychosis REACH Family Ambassador Peer Training Program

Purpose

Caregivers of loved ones with psychosis are tasked with navigating a barren care landscape for their loved ones and for themselves. The dearth of resources they face has a negative impact on outcomes for caregivers and their loved ones. The Psychosis REACH program, based on principles from Cognitive Behavioral Therapy for psychosis was developed as a community-based resource for families to address this care gap. A role for family peers called the Psychosis REACH Family Ambassadors (pRFAs) was developed to reinforce skill learning for caregivers by utilizing a task-sharing approach. This qualitative study sought to better understand pRFAs' experiences in the inaugural training cohort of this program.

Patients and Methods

Eleven pRFAs participated in semi-structured interviews with research coordinators via teleconference. Questions assessed the quality of the training, challenges and facilitators experienced in their role, and ways in which the program could be improved and expanded. Using thematic analysis, members of the research team coded interviews individually, discussed codes until consensus was reached, and iteratively developed themes based on codes that clustered based on meaning or content.

Results

This process identified 5 key themes: The development of hope and recovery, the development of solidarity networks, the challenges of navigating boundaries, preferred pedagogical strategies, and the need for more support.

Conclusion

Overall, the themes developed from this qualitative analysis demonstrate the value and feasibility of developing a caregiver peer network of pRFAs trained in recovery-oriented care and CBTp-informed skills to support other caregivers. Additionally, they highlight the challenges associated with being in the role of a pRFA and further efforts needed to align training content and learning management systems to the needs of pRFA trainees. These findings highlight the importance of expanding access to family peer training programs for the wellbeing of caregivers and loved ones with psychosis alike.

Patterns of self-care decision-making and associated factors: A cross-sectional observational study

OBJECTIVE

The aim of this study was to identify for the first time patterns of self-care decision-making (i.e. the extent to which participants viewed contextual factors influencing decisions about symptoms) and associated factors among community-dwelling adults with chronic illness.

METHODS

This was a secondary analysis of data collected during the development and psychometric evaluation of the 27-item Self-Care Decisions Inventory that is based on Naturalistic Decision-Making (n = 430, average age = 54.9 ± 16.2 years, 70.2 % female, 87.0 % Caucasian, average number of chronic conditions = 3.6 ± 2.8). Latent class mixture modeling was used to identify patterns among contextual factors that influence self-care decision-making under the domains of external, urgency, uncertainty, cognitive/affective, waiting/cue competition, and concealment. Multivariate multinomial regression was used to identify additional socio-demographic, clinical, and self-care behavior factors that were different across the patterns of self-care decision-making.

RESULTS

Three patterns of self-care decision-making were identified in a cohort of 430 adults. A 'maintainers' pattern (48.1 %) consisted of adults with limited contextual influences on self-care decision-making except for urgency. A 'highly uncertain' pattern (23.0 %) consisted of adults whose self-care decision-making was largely driven by uncertainty about the cause or meaning of the symptom. A 'distressed concealers' pattern (28.8 %) consisted of adults whose self-care decision-making was highly influenced by external factors, cognitive/affective factors and concealment. Age, education, financial security and specific symptoms were significantly different across the three patterns in multivariate models.

CONCLUSION

Adults living with chronic illness vary in the extent to which contextual factors influence decisions they make about symptoms, and would therefore benefit from different interventions.

Stigma Related to Observable Symptoms, But Not Stimulant Medication Use, in Young Women With ADHD

OBJECTIVE

ADHD is associated with stigma, but whether stimulant medication use contributes to this is unknown. We examined how perception of a young woman may be influenced by visible ADHD symptoms and/or prescribed stimulant medication use (PSMU).

METHOD

Three-hundred-fourteen undergraduates were randomly assigned to watch one of four videos: a woman portraying (a) neither symptoms of ADHD nor PSMU, (b) no ADHD symptoms but disclosing PSMU, (c) ADHD symptoms but no PSMU, or (d) both ADHD symptoms and PSMU. Participants then completed measures of their liking of and desire for affiliation with the woman.

RESULTS

Analyses suggest that visible symptoms of ADHD were perceived negatively and are associated with less liking and desire for affiliation. PSMU was associated with negligible additive stigma.

CONCLUSION

This supports that noticeable ADHD symptoms may be the primary driver of the stigma associated with the disorder, and specifically that directed at young women with ADHD.

Beyond conventional healthcare for mental health problems: Experiences of existential group conversations

BACKGROUND

Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare.

AIMS

To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare.

MATERIALS AND METHODS

Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis.

RESULTS

The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures.

CONCLUSION

Existential conversations in group may contribute to a more reflected doing in accordance with one's own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual's own preferences.

SIGNIFICANCE

This study contributes to understanding of coping with MHP in everyday life from an existential perspective.

Is there any job for me? Qualitative exploration of support needs among young Swedish adults with psychosis envisioning productive activities

BACKGROUND

Unemployment is high not only among people with mental illness, but also among young adults in general. The combination of having a severe mental illness and being young entails a particularly problematic situation for young people with psychosis. This study aimed to understand how this group envision their future possibilities for entering the labour market or engaging in other productive activities.

OBJECTIVE

To explore how young adults with psychosis perceive their possibilities, wishes and support needs for gaining employment or engaging in other productive activities.

METHODS

A descriptive design with qualitative individual in-depth interviews was used. Eighteen young adults with psychosis, aged 18-30 years, were interviewed. Data was analysed with qualitative content analysis.

RESULTS

Four categories based on the experiences of the participants as being vital for having work or other productive activities were generated: "Wishing for a role in the community", "Being my own coach", "Needing personal support" and "Having a supportive workplace". Each of them included sub-categories.

CONCLUSION

The young adults with psychosis were a long way from having paid work, but they desired to have a worker role in the community. They are a heterogeneous group, which entails that it is important that professionals and employers have a person-centered and holistic approach, listening to the individuals themselves.

Occupational burnout and public stigma associated with employee mental well-being: A multi-industry, cross-sectional study during COVID-19

BACKGROUND

While mental illness (e.g., depression, anxiety) has been examined frequently in the workplace, the COVID-19 pandemic has only increased the attention towards mental illness. Mental well-being views mental health as a continuum from ill health to thriving. Few studies have examined factors associated with mental well-being in the workplace. Public stigma for mental illness, the general population's negative attitude towards mental illness, and occupational burnout are examined.

OBJECTIVE

The purpose of this study was to examine the relationship between burnout and public stigma on mental well-being in a sample of employees across industries in the United States.

METHODS

Employees surveyed from 16 companies from various industries were assessed. Room Here, a non-profit organization whose goal is to improve employee mental fitness, gathered data from these companies located in the western mountain region of the U.S. Data were collected during the pandemic. Across this portfolio of companies, 259 employees were included in the sample. Survey assesses respondents' mental well-being, stigma towards mental illness, and occupational burnout. Ordinary least squares (OLS) regression was used in this cross-sectional study on secondary data.

RESULTS

Results suggested occupational burnout was associated with a decrease in mental well-being, while public stigma was associated with an improvement in mental well-being.

CONCLUSION

This study sought to examine the relationship between mental well-being, burnout, and public stigma. Employee burnout and public stigma were related to mental well-being. Implications for burnout and stigma reduction programs are discussed as well as future research.

Telehealth and the Psychiatric Mental Health Nurse Practitioner: Beyond the COVID-19 Pandemic

OBJECTIVE

Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic.

METHODS

Review current evidence, standards of practice, and education for the PMHNP.

RESULTS

Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study.

CONCLUSIONS

Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education standards.

Relationship between mental health literacy and professional psychological help-seeking attitudes in China: a chain mediation model

BACKGROUND

Mental health literacy is considered an important factor in promoting professional psychological help-seeking attitudes. However, it is important to clarify the emotional and behavioral factors that underlie this association. Drawing from the ABC model of attitudes and the Health Disclosure Decision-Making Model, this study aimed to examine the mediating role of psychological help-seeking stigma and distress disclosure in the relationship between mental health literacy and professional psychological help-seeking attitudes.

METHODS

We collected data from 827 participants in seven regions of China (597 female; Mage = 26.019, SD = 5.592 years old) using self-report measures, including the Mental Health Literacy Scale, Questionnaire of Stigma for Seeking Professional Psychological Help, Distress Disclosure Index, and Attitudes Toward Seeking Professional Psychological Help-Short Form. A chain mediation model was built to examine the relationships among mental health literacy, psychological help-seeking stigma, distress disclosure, and professional psychological help-seeking attitudes.

RESULTS

The results of the analyses showed a positive association between mental health literacy and professional psychological help-seeking attitudes, with psychological help-seeking stigma and distress disclosure playing mediating roles in this relationship. Furthermore, even after controlling for participants' age, gender, and education, the chain mediation effect of psychological help-seeking stigma and distress disclosure on the relationship between mental health literacy and professional psychological help-seeking attitudes was observed among the Chinese population.

CONCLUSIONS

These findings underscore the significance of mental health literacy in shaping professional psychological help-seeking attitudes, while emphasizing the need to account for psychological help-seeking stigma and distress disclosure when examining this association. Additionally, the model proposed in this study provides a valuable framework for promoting the utilization of professional mental health services.

The influence of meaningful work on the mental health of SME employees in the COVID-19 era: can coping strategies mediate the relationship?

BACKGROUND

Stress, depression, and anxiety are prevalent issues among SME employees during the COVID-19 pandemic. Even while having meaningful work that expressively contributes to individual growth has been related to improving mental health, employees' work may also need to adopt coping strategies to increase outcomes. The purpose of this study was to examine the relationship between meaningful work (positive meaning, meaning-making, and greater good motivations) and mental health, as well as coping strategies (problem-focused and emotion-focused) as a mediator of this relationship.

METHODS

Meaningful work, coping strategies, and mental health were evaluated in empirical research based on a sample of 462 SME employees working in Malaysia. Structured questionnaires were used to collect the data and analyze it through Structural Equation Modelling (SEM) using AMOS 21.0.

RESULTS

The findings of the study show the importance of meaningful work in influencing the mental health of SME employees, particularly during a crisis like the COVID-19 pandemic. This suggests that the more they value and see their work as meaningful, the more capable they are of dealing with limitations and mental health problems associated with crises. The study also discovered a partial mediating role for coping strategies between employees' mental health and meaningful work.

CONCLUSION

This study encourages employees to constantly feel connected and discover continued possibilities to work and learn even during crisis situations. In order to improve human resource efficiency in emerging markets, managers and owners of SMEs must implement the model developed by the researchers.

The Social Context: Social and Behavioral Factors That Affect Health Outcomes

To achieve understanding and best care, screening and treating patients should consider the patient's social environment. Social and behavioral factors influence both positive and negative health behaviors that influence mental and physical health. Primary care providers continually navigate barriers faced by patients and seek solutions that take into consideration social and behavioral factors. The role of the PCP begins with an understanding of common barriers and community resources, then by assessing and responding to the patient's own challenges, and finally by advocating in the clinic and public for changes to the underlying social and structural causes of morbidity and mortality.

Expectations of Leaders' Mental Health

Understanding the causes and consequences of varying mental health experiences in the workplace has gained significant research attention, yet little is known about the assumptions people hold about mental health at work, especially with regard to the expectations people may have of their leaders' mental health. Given people tend to romanticize organizational leaders and have expectations regarding prototypical leader attributes, we consider whether people also hold expectations of leaders' mental health. Drawing on implicit leadership theories, we propose that people will expect leaders experience better mental health compared to those occupying other organizational roles (e.g., subordinates). Using mixed methods, Study 1 (n = 85) showed that people expect that those in leadership roles enjoy higher well-being and experience less mental illness than those in non-leadership roles. Using vignettes in which an employee's health was manipulated, Study 2 (n = 200) demonstrated that mental illness is incongruent with leadership prototypes. Using vignettes in which organizational role was manipulated, Study 3 (n = 104) showed that compared to subordinates, leaders are perceived as having more job resources and demands, but people expect that it is leaders' greater access to organizational resources that facilitates their well-being and inhibits mental illness. These findings extend the occupational mental health and leadership literatures by identifying a novel attribute upon which leaders are evaluated. We conclude by considering the consequences of leader mental health expectations for organizational decision-makers, leaders, and employees aspiring to lead.

Does meaningful work mediate the relationship between empowering leadership and mental health? Evidence from Malaysian SME employees

Introduction

In Malaysia, small and medium enterprises (SMEs) account for more than half of all employment and 98.7% of all businesses. There is little research on empowering behaviors in SMEs, despite leadership empowerment being often practiced. Therefore, the study aims to investigate how empowering leadership affects employees' mental health. The study also reveals meaningful work's role in mediating the relationship between empowering leadership and employees' mental health.

Methods

A stratified random sample approach was used to collect data from 516 employees of Malaysian SMEs. The data was analyzed, and the hypothesis was tested using structural equation modeling (AMOS 21.0) with bootstrap confidence intervals computed to evaluate the mediating effect.

Results

The results demonstrate that empowering leadership significantly improves employees' mental health. Furthermore, the association between empowering leadership and mental health is partially mediated by meaningful work.

Discussion

This study contributes to the present empowering leadership-meaningful work-mental health model for SME employees, which reduces stress and anxiety at the workplace and positively impacts psychological empowerment and their capacity to control their overall emotions in instances of success.

How to measure mental illness stigma at work: development and validation of the workplace mental illness stigma scale

Introduction

The study objective was to design a new theoretically driven multidimensional scale for the use in the empirical measurement of stigmatizing attitudes towards persons with mental illness within the return-to-work process as this integral part of vocational reintegration has been widely neglected by scholars so far.

Methods

Therefore, we developed and validated a 21-item instrument to comprehensively measure the three-factorial structure of stigmatizing attitudes (affect, cognition, behavior) across two studies (overall N = 251).

Results

In both studies the new scale proved to be highly internally consistent, and its proposed three-factor structure was equally supported across the two studies. Convergent and discriminant validity were demonstrated by moderate and high correlations or zero correlations with pertinent measures. Furthermore, construct validity of the new scale was supported by significant positive associations with relevant personality characteristics within stigma research.

Discussion

The WMISS is the first instrument to measure mental health stigma specifically within the return-to-work-process and demonstrates strong psychometric properties. Inclusion of this scale in future research can help facilitate understanding of mental illness stigma within the occupational sector and assist with targeted intervention development.

Dutch workers' attitudes towards having a coworker with mental health issues or illness: a latent class analysis

Introduction

Workplace mental health stigma is a major problem as it can lead to adverse occupational outcomes and reduced well-being. Although workplace climate is largely determined by managers and co-workers, the role of co-workers in workplace stigma is understudied. Therefore, the aims are: (1) to examine knowledge and attitudes towards having a coworker with Mental Health Issues or Illness (MHI), especially concerning the desire for social distance, (2) to identify distinct subgroups of workers based on their potential concerns towards having a coworker with MHI, and (3) to characterize these subgroups in terms of knowledge, attitudes, and background characteristics.

Materials and methods

A cross-sectional survey was conducted among a nationally representative internet panel of 1,224 Dutch workers who had paid jobs and did not hold management positions. Descriptive statistics and a three-step approach Latent Class Analysis (LCA) were used to address the research aims.

Results

Concerning the desire for social distance, 41.9% of Dutch workers indicated they did not want to have a close colleague with MHI, and 64.1% did not want to work for a higher-ranking manager who had MHI. In contrast however, most workers did not have negative experiences with interacting with coworkers with MHI (92.6%). Next, five distinct subgroups (SG) of workers were identified: two subgroups with few concerns towards having a coworker with MHI (SG1 and SG2; 51.8% of the respondents), one subgroup with average concerns (SG3; 22.7% of the respondents), and two subgroups with more concerns (SG4 and SG5; 25.6% of the respondents). Four out of five subgroups showed a high tendency towards the desire for social distance. Nevertheless, even in the subgroups with more concerns, (almost) half of the respondents were willing to learn more about how to best deal with coworkers with MHI. No significant differences were found between the subgroups on background characteristics.

Discussion

The high tendency to the desire for social distance seems to contrast with the low number of respondents who personally had negative experiences with workers with MHI in the workplace. This suggests that the tendency to socially exclude this group was not based on their own experience. The finding that a large group of respondents indicated to want to learn more about how to deal with a co-worker with MHI is promising. Destigmatizing interventions in the workplace are needed in order to create more inclusive workplaces to improve sustained employment of people with MHI. These interventions should focus on increasing the knowledge of workers about how to best communicate and deal with coworkers with MHI, they do not need to differentiate in background variables of workers.

Compassion-focused therapy (CFT) for the reduction of the self-stigma of mental disorders: the COMpassion for Psychiatric disorders, Autism and Self-Stigma (COMPASS) study protocol for a randomized controlled study

BACKGROUND

People with mental disorders face frequent stigmatizing attitudes and behaviors from others. Importantly, they can internalize such negative attitudes and thus self-stigmatize. Self-stigma is involved in diminished coping skills leading to social avoidance and difficulties in adhering to care. Reducing self-stigma and its emotional corollary, shame, is thus crucial to attenuate the negative outcomes associated with mental illness. Compassion-focused therapy (CFT) is a third-wave cognitive behavioral therapy that targets shame reduction and hostile self-to-self relationship and allows for symptom improvement while increasing self-compassion. Although shame is a prominent part of the concept of self-stigma, the efficacy of CFT has never been evaluated in individuals with high levels of self-stigma. The purpose of this study is to evaluate the efficacy and acceptability of a group-based CFT program on self-stigma, compared to a psychoeducation program for self-stigma (Ending Self-Stigma) and to treatment as usual (TAU). We hypothesize that diminished shame and emotional dysregulation and increased self-compassion will mediate the relationship between self-stigma improvements post-therapy in the experimental group.

METHODS

This seven-center trial will involve 336 participants diagnosed with a severe mental illness and/or autism spectrum disorder and reporting high levels of self-stigma. Participants will be randomized into one of three treatment arms: 12 week-treatment of compassion-focused therapy (experimental arm), 12 week-treatment of Psychoeducation (active control arm), and TAU (treatment as usual-passive control arm). The primary outcome is the decrease of self-stigma scores on a self-report scale, i.e., ISMI, at 12 weeks. Secondary endpoints include sustainability of self-stigma scores (ISMI) and self-reported scores regarding target psychological dimensions, e.g., shame and emotional regulation, social functioning, and psychiatric symptoms. Assessments are scheduled at pretreatment, post-treatment (at 12 weeks), and at 6-month follow-up. Acceptability will be evaluated via (i) the Credibility and Expectancy Questionnaire at T0, (ii) the Consumer Satisfaction Questionnaire for Psychotherapeutic Services posttreatment and at 6-month follow-up, (iii) attendance, and (iv) dropout rates.

DISCUSSION

This study will evaluate the potential efficacy and acceptability of a group-based CFT program on the decrease of self-stigma and thereby contribute to the continuing development of evidence-based therapeutic interventions for the internalized stigma of mental and neurodevelopmental disorders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05698589. Registered on January 26, 2023.

Workplace Mental Health Disclosure, Sustainable Employability and Well-Being at Work: A Cross-Sectional Study Among Military Personnel with Mental Illness

Purpose Disclosure of mental illness to a supervisor can have positive (e.g. supervisor support) and negative consequences (e.g. stigma). However, research on the association between disclosure and sustainable employability and well-being at work is scarce. The aim of this study was to investigate the association between the disclosure decision (yes/no), experiences with the decision (positive/negative) and sustainable employment and well-being at work among military personnel with mental illness (N = 323). Methods A cross-sectional questionnaire study was conducted. Descriptive and regression (linear and ordinal) analyses were performed. Comparisons were made between those with positive and negative disclosure experiences. Results Disclosure decision (yes/no) was not significantly associated with any of the measures of sustainable employability and well-being at work. However, positive disclosure experiences were significantly associated with higher scores on almost all measures of sustainable employability and well-being at work. Those with negative disclosure experiences reported significantly more shame (M_pos = 2.42, M_neg = 2.78, p < .05) and discrimination (M_pos = 1.70, M_neg = 2.84, p < .001). Those with a positive disclosure experience, reported significantly more supervisor support (M_pos = 3.20, M_neg = 1.94, p < .001). Conclusion We did not find evidence that the disclosure decision itself is related to measures of sustainable employment and well-being at work. In contrast, how participants had experienced their (non-)disclosure decision was significantly related to almost all measures. This emphasizes the importance of the work environments reactions to disclosure and mental illness in the workplace. Future research and interventions should focus on increasing the likelihood of positive disclosure experiences through creating a more inclusive work environment, with more supervisor support and less stigma.

Affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia in rural China

BACKGROUND

Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China.

AIMS

This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China.

METHODS

A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden.

RESULTS

Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden.

CONCLUSIONS

The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services.

Mental health issues and illness and substance use disorder (non-)disclosure to a supervisor: a cross-sectional study on beliefs, attitudes and needs of military personnel

OBJECTIVES

Research suggests that military personnel frequently delay disclosing mental health issues and illness (MHI), including substance use disorder, to supervisors. This delay causes missed opportunities for support and workplace accommodations which may help to avoid adverse occupational outcomes. The current study aims to examine disclosure-related beliefs, attitudes and needs, to create a better understanding of personnel's disclosure decision making.

DESIGN

A cross-sectional questionnaire study among military personnel with and without MHI. Beliefs, attitudes and needs regarding the (non-)disclosure decision to a supervisor were examined, including factors associated with (non-)disclosure intentions and decisions. Descriptive and regression (logistic and ordinal) analyses were performed.

SETTING

The study took place within the Dutch military.

PARTICIPANTS

Military personnel with MHI (n=324) and without MHI (n=554) were participated in this study.

OUTCOME MEASURE

(Non-)disclosure intentions and decisions.

RESULTS

Common beliefs and attitudes pro non-disclosure were the preference to solve one's own problems (68.3%), the preference for privacy (58.9%) and a variety of stigma-related concerns. Common beliefs and attitudes pro disclosure were that personnel wanted to be their true authentic selves (93.3%) and the desire to act responsibly towards work colleagues (84.5%). The most reported need for future disclosure (96.8%) was having a supervisor who shows an understanding for MHI. The following factors were associated both with non-disclosure intentions and decisions: higher preference for privacy (OR (95% CI))=(1.99 (1.50 to 2.65)_intention, 2.05 (1.12 to 3.76)_decision) and self-management (OR (95% CI))=(1.64 (1.20 to 2.23)_intention, 1.79 (1.00 to 3.20)_decision), higher stigma-related concerns (OR (95% CI))=(1.76 (1.12 to 2.77)_intention, 2.21 (1.02 to 4.79)_decision) and lower quality of supervisor-employee relationship (OR (95% CI))=(0.25 (0.15 to 0.42)_intention, 0.47 (0.25 to 0.87)_decision).

CONCLUSION

To facilitate (early-)disclosure to a supervisor, creating opportunities for workplace support, interventions should focus on decreasing stigma and discrimination and align with personnels' preference for self-management. Furthermore, training is needed for supervisors on how to recognise, and effectively communicate with, personnel with MHI. Focus should also be on improving supervisor-employee relationships.

The Social Determinants of Mental Illness: A Rapid Review of Systematic Reviews

Previous research agendas have prioritised the role of biological determinants in mental illness aetiology. This is of particular concern, as endorsing biological determinants has been shown to promote negative attitudes towards people with mental illness. The aim of this review was to provide an overview of high-quality evidence of the social determinants of mental illness. A rapid review of systematic reviews was conducted. Five databases were searched: Embase, Medline, Academic Search Complete, CINAHL Plus, and PsycINFO. Systematic reviews or meta-analyses that described any social determinant of mental illness, were published in peer-review journals in English, and focussed on human participants were included. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were applied for the selection procedure. Thirty-seven systematic reviews were deemed eligible for review and narrative synthesis. Determinants identified included conflict, violence and maltreatment, life events and experiences, racism and discrimination, culture and migration, social interaction and support, structural policies and inequality, financial factors, employment factors, housing and living conditions, and demographic factors. We recommend that mental health nurses ensure adequate support be provided to those affected by the evidenced social determinants of mental illness.

Attitudes of Physicians and Individuals Toward Digital Mental Health Tools: Protocol for a Web-Based Survey Research Project

BACKGROUND

Digital transformation is impacting health care delivery. Great market dynamism is bringing opportunities and concerns alike into public discussion. Digital health apps are a vibrant segment where regulation is emerging, with Germany paving the way with its DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health apps) program. Simultaneously, mental ill-health constitutes a global health concern, and prevalence is expected to worsen due to the COVID-19 pandemic and its containment measures. Portugal and its National Health System may be a useful testbed for digital health interventions.

OBJECTIVE

The paper outlines the protocol for a research project on the attitudes of physicians and potential users toward digital mental health apps to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health.

METHODS

Web surveys will be conducted to acquire data from the main stakeholders (physicians and the academic community). Data analysis will replicate the statistical analysis performed in the studies from Dahlhausen and Borghouts to derive conclusions regarding the relative acceptance and likelihood of successful implementation of digital mental health apps in Portugal.

RESULTS

The findings of the proposed studies will elicit important information on how physicians and individuals perceive digital mental health app interventions to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. Data collection ran between September 26 and November 6, 2022, for the first study and September 20 and October 20, 2022, for the second study. We obtained 160 responses to the first study's survey and 539 answers to the second study's survey. Data analysis is concluded, and both studies' results are expected to be published in 2023.

CONCLUSIONS

The results of the studies projected in this research protocol will have implications for researchers and academia, industry, and policy makers concerning the adoption and implementation of digital health mental apps and associated interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41040.

Psychiatric Morbidity, Utilization and Quality of Mental Health Care in Long-Term Unemployed People

Research has shown complex interactions between unemployment and mental health. However, the prevalence of specific mental disorders, utilization of mental health care services and influences on help-seeking behavior have been investigated surprisingly little in the past. In this study, we investigated a sample of long-term unemployed people in a cooperation program of the local unemployment agency and a psychiatric university hospital in a larger city in Germany. Mental disorders, treatment history, accordance of treatment to national treatment guidelines and factors influencing previous treatment were assessed. Participants (n = 879; male 56%, female 44%, mean age 43.9 years) showed a high psychiatric morbidity, mostly with diagnoses from the ICD-10 categories F1 (22%), F3 (61%) and F4 (68%). Currently, 18% were in psychiatric treatment, 6% were in psychotherapeutic treatment, and 28% received psychopharmacological treatment. Mostly young men underutilized the psychiatric-psychotherapeutic system, with middle-aged men and women being most frequently in psychopharmacological treatment. Of those treated, only about 10% of the subjects currently received a treatment according to national guidelines. The utilization of psychotherapeutic treatment was strikingly poor. This study identified high psychiatric morbidity and severe treatment gaps in unemployed people. These results can help to target subjects with specific needs for interventions and to modify counseling programs.

Managers' sick leave recommendations for employees with common mental disorders: a cross-sectional video vignette study

BACKGROUND

To better understand the initial phases of sickness absence due to common mental disorders (CMD), the aim of the present video vignette study was to test the following three hypotheses: (1) Managers who have negative attitudes towards employees with CMD will not recommend sick leave. (2) Managers with experience of CMD recommend sick leave to a significantly higher extent than managers lacking this experience. (3) Managers with previous experience of recommending sick leave for people with CMD will recommend sick leave to a significantly higher extent also based on the vignettes.

METHODS

An online survey, including a CMD-labelled video vignette, was sent to 4737 Swedish managers (71% participated, n  = 3358). For aims (1) and (2), a study sample consisting of 2714 managers was used. For aim (3), due to the design of the survey questions, a subsample (n  = 1740) was used.

RESULTS

There was no significant association between negative attitudes towards employee depression and managers' recommendation of employee sick leave with the vignette case. The bivariate analysis showed that personal experience of CMD was associated with managers' recommendation of employee sick leave. In the adjusted regression model, it became non-significant. Previous experience of recommending sick leave to one employee and to several employees was associated with recommending sick leave, also when adjusting for gender, level of education, years of managerial experience, and management training on CMDs CONCLUSIONS: The likelihood of a manager recommending sick leave after watching a CMD-labelled video vignette was higher if the manager had previous experience of this situation in real life. This study highlights the importance of including managerial behaviours and attitudes to better understand sick leave among employees with CMD.

Evidence for the effectiveness of interventions to reduce mental health related stigma in the workplace: a systematic review

OBJECTIVES

Increasing access to mental health support is a key factor for treating mental disorders, however, important barriers complicate help-seeking, among them, mental health related stigma being most prominent. We aimed to systematically review the current evidence for interventions focusing on reducing stigma related to mental health problems in small and medium enterprises (SMEs).

DESIGN

Systematic review with a focus on interventions targeting mental health related stigma in the workplace in accordance with PRISMA guidelines. The methodological quality of included articles was assessed using the Quality Assessment Tool for Quantitative Studies Scale.

DATA SOURCES

PubMed, Ovid Medline, PsycINFO, Scopus, and Cochrane databases and Google Scholar were searched from January 2010 until November 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included experimental or quasi-experimental studies about workplace interventions aiming to reduce stigma, where the outcomes were measured in terms of stigmatisation against depression, anxiety and/or other mental health problems.

DATA EXTRACTION AND SYNTHESIS

Records were screened by two independent reviewers after inspecting titles and abstracts and a full-text read of the articles to assess whether they meet inclusion criteria. The results were synthesised narratively.

RESULTS

We identified 22 intervention studies, 3 with high quality, 13 with moderate quality and 6 with weak quality. Only 2 studies included SMEs, but no study focused on SMEs exclusively . The mode of delivery of the intervention was face to face in 15 studies, online in 4 studies and mixed in 3 studies. We found a significant reduction in stigmatising attitudes in almost all studies (20/22), using 10 different instruments/scales. Effects seemed to be independent of company size. Online interventions were found to be shorter, but seemed to be as effective as face-to-face interventions.

CONCLUSIONS

Although we did not find interventions focusing exclusively on SMEs, it is likely that antistigma interventions also will work in smaller workplaces.

TRIAL REGISTRATION

PROSPERO: ID: CRD42020191307.

Mental Health Literacy and Stigma in a Municipality in the North of Portugal: A Cross-Sectional Study

Portugal has Europe's second-highest prevalence of psychiatric illnesses, and this is the reason why mental health literacy (MHL) and stigma should be addressed. This study aimed to investigate the mental health literacy and stigma levels among different groups of people from Póvoa de Varzim, a municipality in the north of Portugal. Students, retired people, and professionals (education, social, and healthcare fields) were recruited using a convenience sample from June to November 2022. Participants' MHL levels were evaluated using the Mental Health Promoting Knowledge Scale (MHPK), Mental Health Literacy Measure (MHLM) and Mental Health Knowledge Schedule (MAKS). Stigma levels were evaluated using Community Attitudes towards Mental Illness (CAMI) and the Reported and Intended Behaviour Scale (RIBS). A total of 928 questionnaires were filed. The respondents included 65.70% of women, a mean age of 43.63 (±26.71) years and 9.87 (±4.39) years of school education. MHL increased with age, education level and was higher in women (p < 0.001). A higher level of MHL was seen in health professionals (p < 0.001). Findings revealed that older people stigmatized people with mental illness more (p < 0.001), and the female gender stigmatize less (p < 0.001). In addition, results showed that stigma decreased with higher mental health literacy (r between 0.11 and 0.38; p < 0.001). To conclude, specific campaigns that promote mental health literacy should be tailored to specific profiles within this population to address those that have more stigma.

Restoring the missing person to personalized medicine and precision psychiatry

Precision psychiatry has emerged as part of the shift to personalized medicine and builds on frameworks such as the U.S. National Institute of Mental Health Research Domain Criteria (RDoC), multilevel biological "omics" data and, most recently, computational psychiatry. The shift is prompted by the realization that a one-size-fits all approach is inadequate to guide clinical care because people differ in ways that are not captured by broad diagnostic categories. One of the first steps in developing this personalized approach to treatment was the use of genetic markers to guide pharmacotherapeutics based on predictions of pharmacological response or non-response, and the potential risk of adverse drug reactions. Advances in technology have made a greater degree of specificity or precision potentially more attainable. To date, however, the search for precision has largely focused on biological parameters. Psychiatric disorders involve multi-level dynamics that require measures of phenomenological, psychological, behavioral, social structural, and cultural dimensions. This points to the need to develop more fine-grained analyses of experience, self-construal, illness narratives, interpersonal interactional dynamics, and social contexts and determinants of health. In this paper, we review the limitations of precision psychiatry arguing that it cannot reach its goal if it does not include core elements of the processes that give rise to psychopathological states, which include the agency and experience of the person. Drawing from contemporary systems biology, social epidemiology, developmental psychology, and cognitive science, we propose a cultural-ecosocial approach to integrating precision psychiatry with person-centered care.

Mental Health Public Stigma in US Jewish Communities

Stigma is a multifaceted barrier for individuals living with mental illness, contributing to negative stereotypes, prejudice, and discrimination, and is underinvestigated in minority ethnic groups. This study examines the stigma within the US Jewish communities, specifically the following: a) differences in public stigma dimensions based on mental illness ( e.g. , major depressive disorder, anxiety disorder, schizophrenia, or alcohol use disorder) and sex; and b) whether participant characteristics influence the public stigma. A community-based sample of 317 self-identified Jewish individuals participated in an experimental randomized vignette survey on stigma and help-seeking beliefs toward various mental illness. Findings indicate differences in stigma based on stigmatized individuals' sex and diagnosis as well as participants' demographics. Schizophrenia and alcohol use disorder were stigmatized similarly, with lower stigma for depression and the least stigma toward anxiety. Of interest, younger males have the most treatability and professional efficacy stigma, and tailored stigma-reducing interventions are recommended.

Mental health professionals' expectations and efforts to include employment for people with moderate to severe mental illness in treatment settings

BACKGROUND

Research suggests that employment is an important factor for recovery and improved quality of life for people with mental illnesses. Mental health professionals often serve as gatekeepers for employment interventions, yet little is known about their expectations about employment for people with mental illness in Norway. The purpose of this study is to examine mental health professionals' expectations and efforts to include employment for people with moderate to severe mental illness in treatment settings.

METHODS

Two hundred seven mental health professionals were recruited from municipal mental health services, specialized clinics, social media, and professionals' networks across Norway. Participants completed a survey package comprising demographic questions, current practices and a revised version of the self-reported measure Expectations for the Employability of People with Serious Mental Illness (EESMI), a validated measure consisting of three subscales.

RESULTS

Results suggested overall favorable expectations of employment for people with moderate to severe mental illness. Analyses revealed that patients participating more frequently in collaborative meetings predicted more favorable expectations about employment among mental health professionals compared to less frequent meetings. In addition, findings suggest that psychiatrist hold more negative expectations about employment in comparison to the other educational groups. Lastly, more than half of mental health professionals reported that they have integrated discussions about employment, and routines to address work-oriented activity in consultations with patients, however, there are substantial variations in routines for addressing work or work-oriented activity as a topic in consultations with patients.

CONCLUSIONS

These results suggest that efforts are being made to integrate employment in treatment settings for people with mental illness in Norway; however, more work is needed to remove barriers and facilitate evidence-based approaches.

Mental illness stigma and employer evaluation in hiring: Stereotypes, discrimination and the role of experience

Mental illness stigma can constitute a significant barrier to entering employment. Drawing on 20 interviews with Norwegian employers, this article investigates how mental illness stigma affects employer evaluation of jobseekers who disclose a history of mental illness. It also explores how employers use accounts of their previous experience with employees with mental illness in their evaluations. Prior to the interviews, the employers received pairs of fictitious applications in which one of the candidates disclosed a history of mental illness. Thus, the interview data were paired with behavioural data on how the employers responded to mental illness disclosure in a genuine recruitment situation. The analysis reveals common stereotypes of people with mental illness as fragile and unreliable. Furthermore, discriminating and inclusive employers are juxtaposed in their approach to mental health stigma, characterised by either taboo and avoidance or empathetic dialogue. The findings indicate how negative experience is coupled with negative attitudes and behaviour and how positive experience is coupled with positive attitudes and behaviour. A central argument is that experience is something that employers play an active part in constructing by choosing to either engage or not engage in a two-way dialogue with employees struggling with mental illness.

Disclosure dilemmas: how people with a mental health condition perceive and manage disclosure at work

PURPOSE

Little research has explored the process of disclosure decision-making from antecedents to outcomes. This paper presents a model of decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace shortly after starting a new job.

METHODS

A qualitative descriptive design was employed to explore participants' experiences of the disclosure decision-making process, the disclosure event itself (if applicable), and their perceptions of the impact of the decision on personal, interpersonal, and organizational outcomes. The transcripts were coded and analyzed using directed content analysis.

RESULTS

Twenty-eight participants were purposively selected to represent different disclosure decisions, sex, diagnoses, and maintenance of employment. Analysis identified goals and conditions/context were important antecedents for the disclosure decision. All participants discussed concerns about prejudice and discrimination if they disclosed, and, for those who chose to disclose, high stress and anxiety were described during the disclosure event; however, supervisor reactions were generally described as positive.

CONCLUSIONS

Regardless of the disclosure strategy adopted, participants reported that their disclosure decision helped to support their self-acceptance and recovery. For those who disclosed, most perceived a positive response by their supervisor. However, the pervasive concerns of prejudice indicate there is still much work to be done.IMPLICATIONS FOR REHABILITATIONDecision-making about disclosure of a mental health condition to the immediate supervisor in the workplace is a complex process.Disclosure goals, the relationship with the supervisor and the workplace context are important antecedents to the disclosure decision.Careful consideration should be given to the planning of disclosure, particularly related to what information will be shared, how it will be shared, and an appropriate level of emotional content to enhance the likelihood of a positive response from the supervisor.Disclosure planning should take the supervisor's style and organizational norms into account.

Expectations of Mental Illness Disclosure Outcomes in the Work Context: A Cross-Sectional Study Among Dutch Workers

Purpose The decision whether to disclose mental illness at work can have important positive and negative consequences for sustainable employment and well-being. The aim of the study is (1) to examine workers' expectations of outcomes of mental illness disclosure in the workplace and to evaluate their expectations regarding which factors are of influence on these outcomes, (2) to identify distinct subgroups of workers, and (3) to characterize these subgroups in terms of personal, sociodemographic, and work-related characteristics. Methods In this cross-sectional survey study, a sample of 1224 Dutch workers was used. Latent Class Analysis (LCA) was used to identify classes of workers based on expected workplace mental illness outcomes. A three-step approach LCA was chosen to investigate whether the classes differed in characteristics. Results The majority of workers expected predominantly positive outcomes of workplace mental illness disclosure (e.g., being able to be one's authentic self; 82.4%), even though they simultaneously expected disclosure to lead to advancement-related discrimination (e.g., lower chances of contract renewal; or getting a promotion; 68.4% and 57%, respectively). Six distinct subgroups of workers were identified based on expected workplace mental illness disclosure outcomes: two positive classes (50.1%), two negative classes (33.3%), and two classes who indicated not to know what the outcomes would be (16.7%). Significant differences between the classes were found on personal experience, work-related association with mental illness, gender, educational level, and workplace atmosphere. Conclusion The disclosure process is complex, as most workers were optimistic (i.e., expected generally positive outcomes) whilst simultaneously expecting workplace discrimination. Subgroup differences in expectations regarding workplace mental illness disclosure outcomes were found.

Psychometric properties of the Internalized Stigma of Mental Illness (ISMI-10) scale in a Dutch sample of employees with mental illness

BACKGROUND

Internalized stigma can have numerous negative effects on the well-being and employment of people with mental illness. Brief, valid, and reliable measures are needed to get a better understanding of self-stigmatization. The aim of this study is to translate the brief version of the Internalized Stigma of Mental Illness (ISMI-10) scale into a Dutch version and to assess the reliability and validity of this Dutch version in a sample of employees with mental illness.

METHODS

The ISMI-10 was translated into Dutch using the forward-backward translation procedure. The sample consisted of 161 employees with mental illness. Internal consistency was evaluated and the retest reliability was tested with 68 respondents. The construct validity was evaluated by testing convergent and divergent validity.

RESULTS

The Dutch ISMI-10 showed good internal consistency (α = 0.83) and good test-retest reliability (r = 0.73). The Dutch ISMI-10 demonstrated excellent convergent validity; high correlations were found between the Dutch ISMI-10 and hope (r = -0.54), anxiety and depression (r = 0.59), self-esteem (r = -0.56), and empowerment (r = - 0.59). Acceptable divergent validity was indicated; small correlations were found between the Dutch ISMI-10 and the physical functioning subscale (r = -0.27) and the role limitation due to physical problems subscale (r = -0.21), and medium correlations were found between the Dutch ISMI-10 and the general health subscale (r = -0.36).

CONCLUSION

The Dutch ISMI-10 demonstrated adequate psychometric properties for assessing internalized stigma and can be used by researchers in Dutch speaking countries to get a better understanding of self-stigmatization among people with mental illness.

How threatening are people with mental disability? it depends on the type of threat and the disability

There is clear evidence that people with mental disability suffer from discrimination at school, at work, and in society. Less is known about the psychological processes and perceptions that guide such behaviors and even less if these perceptions vary according to the type of disability. Our objective was to build on well-established social psychological models and investigate the perceptions (i.e., stereotypes, perceived threats, and emotions) of people towards different types of mental disability. Participants from two francophone countries completed a questionnaire measuring their perceptions towards 18 mental disabilities and their familiarity with disability (N = 560). As expected, results revealed heterogeneous perceptions across groups. Moreover, perceived threats mediated the link between the stereotype of warmth and emotions. Surprisingly, greater familiarity with mental disability went along with greater derogation. This research nuances the overly generalized perceptions often associated with mental disability. We discuss implications for the reduction of discrimination against people with mental disability.