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Jordan G, Bassetto S, DeLuca J, Dobbs MF, Florence A, Allemang B, O'Keeffe D, Basile M, Funaro MC, Davidson L, Ben-David S, Shah J. Personal Recovery Among People at Risk for Developing Serious Mental Health Problems: A Qualitative Systematic Review. Psychiatr Serv 2024:appips20230133. [PMID: 38410038 DOI: 10.1176/appi.ps.20230133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Personal recovery refers to a person's pursuit of a full, meaningful life despite the potentially debilitating impact of a mental illness. An evidence base describing personal recovery among people at risk for developing a mental illness is lacking, limiting the potential for mental health services to support personal recovery. To address this gap, the authors synthesized the extant research describing personal recovery among people at risk for developing a mental illness. METHODS A systematic search of several literature databases (MEDLINE, Embase, APA PsycInfo, Web of Science Core Collection, and Cochrane Library) was conducted to retrieve qualitative and case studies and first-person accounts. The Joanna Briggs Institute guidelines for systematic reviews were followed. Included studies reported on participants at variable risk for developing a schizophrenia spectrum, bipolar, major depressive, or borderline personality disorder. Articles were retrieved through a librarian-assisted search and through use of additional strategies (e.g., expert consultation). Abstracts were screened by the research team, and themes were developed by using thematic synthesis. RESULTS The 36 included articles were synthesized, and six themes were generated: difficulties and challenges; establishing an understanding of, and finding ways to cope with, one's mental health challenges; reestablishing a sense of agency and personhood; receiving support from people and services, as well as restoring relationships; reestablishing hope, meaning, and purpose; and overcoming stigma and destigmatizing mental illness in others. CONCLUSIONS These findings provide a conceptual foundation that can guide future research on personal recovery and clinical interventions that foster it among people at risk for mental illness.
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Affiliation(s)
- Gerald Jordan
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Stella Bassetto
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Joseph DeLuca
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Matthew F Dobbs
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Ana Florence
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Brooke Allemang
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Donal O'Keeffe
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Mikaela Basile
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Melissa C Funaro
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Larry Davidson
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Shelly Ben-David
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Jai Shah
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
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Evans L, Chang A, Dehon J, Streb M, Bruce M, Clark E, Handal P. The relationships between perceived mental illness prevalence, mental illness stigma, and attitudes toward help-seeking. Curr Psychol 2023:1-10. [PMID: 37359578 PMCID: PMC9975862 DOI: 10.1007/s12144-023-04329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 03/05/2023]
Abstract
Previous research suggests that, despite the commonality of mental illness in the United States, the majority of U.S. individuals with mental illness do not seek treatment. One important factor that contributes to this lack of treatment utilization is mental illness stigma. Such stigma may result, in part, from many individuals in the U.S. underestimating the prevalence of mental illness. To test whether this is the case, 638 adults from across the U.S. completed measures related to perceived prevalence of mental illness, private stigma, perceived public stigma, and help-seeking. Findings indicated participants significantly underestimated the given-year prevalence rate of mental illness. The perceived given-year prevalence rate was significantly correlated with lower private stigma and more positive attitudes towards help-seeking. Personal stigma significantly predicted attitudes towards help-seeking. Findings also suggested that individuals who have received mental health services have a higher perceived prevalence rate of mental illness, as well as lower levels of personal stigma and more positive attitudes towards help-seeking. These findings support the notion that helping the general public recognize the true prevalence rate of mental illness could reduce personal mental illness stigma and facilitate help-seeking behaviors. However, future experimental studies are needed to test this hypothesis.
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Affiliation(s)
- Luke Evans
- Department of Psychology, Saint Louis University, 63108 Saint Louis, MO United States
- Understanding Minds Psychological Services , Saint Louis, United States
| | - Alexander Chang
- Department of Psychology, Saint Louis University, 63108 Saint Louis, MO United States
| | - Jewell Dehon
- Department of Psychology, Saint Louis University, 63108 Saint Louis, MO United States
| | - Madison Streb
- Department of Psychology, Saint Louis University, 63108 Saint Louis, MO United States
| | - Madeline Bruce
- Department of Psychology, Saint Louis University, 63108 Saint Louis, MO United States
| | - Eddie Clark
- Department of Psychology, Saint Louis University, 63108 Saint Louis, MO United States
| | - Paul Handal
- Department of Psychology, Saint Louis University, 63108 Saint Louis, MO United States
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Hsia SL, Brooks J, Yao E, Gruenberg K, Finley P. Impact of an auditory hallucination simulation coupled with a speaker diagnosed with schizophrenia on mental illness stigma in pharmacy students. Curr Pharm Teach Learn 2022; 14:1397-1403. [PMID: 36117122 DOI: 10.1016/j.cptl.2022.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/05/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Hallucination simulations improve student empathy but increase desired social distance from individuals with schizophrenia, while direct contact reduces social distance. This study describes the implementation of combining an auditory hallucination simulation with a speaker diagnosed with schizophrenia and its impact on mental illness stigma. METHODS Pharmacy students in their last year of didactic instruction (N = 346) attended a presentation by a speaker diagnosed with schizophrenia then participated in a hallucination simulation. Mental illness stigma was measured before and after the intervention using the Opening Minds Survey for Health Care Professionals (OMS-HC). Related-samples Wilcoxon-signed rank tests were used to evaluate changes in OMS-HC scores. An inductive qualitative analysis was conducted on student perceptions of patients with psychosis. RESULTS OMS-HC total scores were reduced by an average of 2.0 ± 5.6 (P = .005) for the first-year pilot and 2.3 ± 7.0 (P < .001) for the subsequent year. OMS-HC attitudes (P = .005) and disclosure/help-seeking (P < .005) subscales decreased both years. There was no significant change in the social distance subscale (P = .205) the first year and a significant decrease (P = .015) the second year. The themes identified from the open-ended comments were increased awareness, sympathy, empathy, inspiration/admiration, discomfort, and change to patient care. CONCLUSIONS The combination of a speaker with schizophrenia and auditory hallucination simulation effectively reduced mental illness stigma. The combination is likely effective for reducing stigmatizing attitudes and willingness to disclose mental illness with variable reduction in desired social distance.
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Affiliation(s)
- Stephanie L Hsia
- Clinical Pharmacy, University of California, San Francisco School of Pharmacy, 505 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Jordan Brooks
- Clinical Pharmacology and Therapeutics Fellow, University of California, San Francisco School of Pharmacy, 505 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Emily Yao
- PGY-2 Pharmacy Resident, San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121, United States.
| | - Katherine Gruenberg
- Clinical Pharmacy, University of California, San Francisco School of Pharmacy, 505 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Patrick Finley
- Clinical Pharmacy, University of California, San Francisco School of Pharmacy, 505 Parnassus Ave, San Francisco, CA 94143, United States.
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Villatoro AP, DuPont-Reyes MJ, Phelan JC, Link BG. 'Me' vs. 'Them': How Mental Illness Stigma Influences Adolescent Help-Seeking Behaviors for Oneself and Recommendations for Peers. Stigma Health 2022; 7:300-310. [PMID: 36776352 PMCID: PMC9910848 DOI: 10.1037/sah0000392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mental illness stigma is a significant barrier to utilizing mental health services for young populations. Few studies have evaluated how specific stigma dimensions relate to help-seeking and recommendations among adolescents. We examined how the stigma dimensions of labeling, stereotypes, and separation/discrimination influenced self-reported help-seeking behaviors of adolescents and recommendations for hypothetical peers with a mental health problem. Longitudinal data (four assessments) from a study evaluating the effectiveness of three anti-stigma interventions (curriculum, contact, materials, versus control) among adolescents were analyzed (n=396). Help-seeking outcomes comprised services in formal (e.g., doctor), informal (e.g., friend), or school-based (e.g., school counselor) settings. Generalized estimating equations tested associations of labeling, stereotypes, and separation/discrimination on help-seeking for a personal problem and recommendations for vignette characters described as having bipolar depression or social anxiety disorder. Adolescents were more likely to make help-seeking recommendations for peers with mental health problems than they were to seek help for a problem of their own. Labeling was a strong predictor of self-reported help-seeking and recommendations. Mental health literacy, an indicator for low negative stereotypes, was related to increased recommendations but not self-reported help-seeking. Positive stigma action and awareness-high cognizance of stigma and how to engage in proactive behaviors towards treating and destigmatizing mental illness-increased help-seeking in formal and informal settings for oneself. Finally, separation/discrimination did not prevent self-reported help-seeking, but it did increase peer recommendations in certain settings. Stigma did not always influence or interfere with help-seeking in the same way when the help-seeker was oneself versus a peer.
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Affiliation(s)
| | | | - Jo C. Phelan
- Department of Sociomedical Sciences, Columbia University
| | - Bruce G. Link
- School of Public Policy and Department of Sociology, University of California, Riverside
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5
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Mayer L, Corrigan PW, Eisheuer D, Oexle N, Rüsch N. Attitudes towards disclosing a mental illness: impact on quality of life and recovery. Soc Psychiatry Psychiatr Epidemiol 2022; 57:363-374. [PMID: 33895868 PMCID: PMC8784363 DOI: 10.1007/s00127-021-02081-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The decision whether to disclose a mental illness has individual and social consequences. Secrecy may protect from stigma and discrimination while disclosure can increase social support and facilitate help-seeking. Therefore, disclosure decisions are a key reaction to stigma. The first aim of this study was to test a newly developed scale to measure disclosure attitudes, the Attitudes to Disclosure Questionnaire (AtDQ). The second aim was to examine the impact of attitudes towards disclosing a mental illness on quality of life and recovery. METHODS Among 100 participants with mental illness, disclosure attitudes, quality of life, recovery, benefits of disclosure, secrecy, social withdrawal, self-stigma, and depressive symptoms were assessed at weeks 0, 3 and 6. Psychometric properties of the AtDQ were analysed. Longitudinal associations between disclosure attitudes at baseline and quality of life and recovery after 6 weeks were examined in linear regressions. RESULTS The analyses of the AtDQ indicated one-factor solutions, high acceptability, high internal consistency, and good retest reliability for the total scale and the subscales as well as high construct validity of the total scale. Results provided initial support for sensitivity to change. More positive disclosure attitudes in general and in particular regarding to family at baseline predicted better quality of life and recovery after 6 weeks. CONCLUSION The current study provides initial support for the AtDQ as a useful measure of disclosure attitudes. Disclosing a mental illness, especially with respect to family, may improve quality of life and recovery of people with mental illness.
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Affiliation(s)
- Lea Mayer
- Section of Public Mental Health, Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstr. 11, Ulm, Germany.
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, USA
| | - Daniela Eisheuer
- Section of Public Mental Health, Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstr. 11, Ulm, Germany
| | - Nathalie Oexle
- Section of Public Mental Health, Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstr. 11, Ulm, Germany
| | - Nicolas Rüsch
- Section of Public Mental Health, Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstr. 11, Ulm, Germany
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Abstract
The US Hispanic population is large and rapidly growing, with serious healthcare disparities. Alarmingly, 67% of Hispanic adults with a mental illness go untreated. Attempts to increase treatment rates have had limited success, likely partly due to stigma beliefs. There is an urgent need to develop and utilize a Spanish language stigma assessment tool. The current study is the first to do so, translating the Beliefs Toward Mental Illness (BTMI; Hirai et al., 2018) scale into Spanish (S-BTMI). Our psychometric findings with English-Spanish bilingual Latinx undergraduate students suggest that the S-BTMI can be a reliable measure of mental illness stigma. The BTMI's 4-factor solution was confirmed by the S-BTMI. Language invariance tests for the S-BTMI and BTMI demonstrated metric invariance and partial scalar invariance. The S-BTMI's factors produced strong internal consistency and two-week test-retest reliability. A previous Latinx sample's BTMI scores were similar to the current S-BTMI scores, except for greater endorsement of incurability beliefs for the Spanish version. Average stigma levels were fairly low in the current sample. Use of the BTMI-S can improve our understanding of stigma, and its relationships to language, culture, acculturation, and treatment-seeking in Latinx communities.
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Affiliation(s)
- Michiyo Hirai
- Department of Psychological Science, University of Texas Rio Grande Valley, 1201 W. University Drive, Edinburg, TX 78539.
| | | | | | - George A Clum
- Virginia Polytechnic Institute and State University, Blacksburg, VA
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Riffel T, Chen SP. Stigma in Healthcare? Exploring the Knowledge, Attitudes, and Behavioural Responses of Healthcare Professionals and Students toward Individuals with Mental Illnesses. Psychiatr Q 2020; 91:1103-1119. [PMID: 32789718 DOI: 10.1007/s11126-020-09809-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Individuals with mental illnesses are often stigmatized by healthcare professionals and students, shaping the quality of care that such clients receive. This study examines the knowledge, attitudes, and behavioural responses of healthcare professionals and students toward individuals with mental illnesses. The seven-phase meta-ethnography was utilized to complete this study: getting started, deciding relevance, reading the studies, determining how the studies are related, translating the studies into one another, synthesizing translations, and expressing the synthesis. The meta-synthesis yielded five core themes. Two themes described insight into positive and negative perceptions and behaviours of healthcare professionals and students toward individuals with mental illnesses. Three themes addressed the factors, including insufficiencies in the healthcare system, contact experiences, and other biological and social influences, that impact the perceptions and behaviours. Understanding these humiliating perceptions and behaviours and the factors that shape them is the first step toward diminishing mental health stigma in the healthcare system.
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Affiliation(s)
- Taylor Riffel
- Children's Autism Services of Edmonton, Edmonton, AB, Canada
| | - Shu-Ping Chen
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-30 Corbett Hall, Edmonton, AB, T6G2G4, Canada.
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Lien YY, Lin HS, Lien YJ, Tsai CH, Wu TT, Li H, Tu YK. Challenging mental illness stigma in healthcare professionals and students: a systematic review and network meta-analysis. Psychol Health 2020; 36:669-684. [PMID: 33017193 DOI: 10.1080/08870446.2020.1828413] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Stigma among healthcare professionals may lead to poor quality of healthcare services for patients with mental illness. This study conducts a network meta-analysis to estimate the relative efficacy between different types of anti-stigma interventions for healthcare professionals. DESIGN Network meta-analysis. MAIN OUTCOME MEASURES The attitudes and behavior intension of healthcare professionals toward mental illness. RESULTS A total of 18 studies (22 trials) from 9 countries are included in the analysis. In the network meta-analysis, rank probabilities show interventions with indirect contact plus lecture (SUCRA = 81.5%), direct contact plus problem-based learning workshop (SUCRA = 77.4%), and indirect contact (SUCRA = 72.2%) having the highest probability of being ranked first, second, and third, respectively. CONCLUSION Our findings suggest that education combining social contact is the most effective anti-stigma intervention, which can be implemented in clinical practices to help reduce this stigma and improve healthcare services for patients with mental illness.
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Affiliation(s)
- Yin-Yi Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hui-Shin Lin
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chi-Hsuan Tsai
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Ting-Ting Wu
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hua Li
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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DuPont-Reyes MJ, Villatoro AP, Phelan JC, Painter K, Link BG. Media language preferences and mental illness stigma among Latinx adolescents. Soc Psychiatry Psychiatr Epidemiol 2020; 55:929-939. [PMID: 31642967 PMCID: PMC7702296 DOI: 10.1007/s00127-019-01792-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Media-a powerful influence on mental illness stigma-varies by language and culture. Nevertheless, recent meta-analyses have demonstrated scant attention to Spanish language media as well as historically low Latinx participation in mental illness anti-stigma intervention. To better inform how to improve equity in mental health service utilization, this study assessed how language preferences in mass media influence stigma among Latinx adolescents, compared to family language and social preferences. METHODS Sixth-graders self-identifying as Latinx self-completed assessments of mental illness knowledge/positive attitudes and desired separation from peers and adolescent vignette characters experiencing mental illness (N = 179; Texas, U.S., 2011-2012). Participants also responded to measures of language preferences (any Spanish versus only English) for consuming media (film/television, music/radio) and speaking with family (parents/grandparents), and social preferences for parties or social gatherings (Latinx versus Anglo persons). Linear regression models adjusting for student and household factors examined the associations between media and family language and social preferences on mental illness stigma. RESULTS Latinx adolescents preferring any Spanish versus English-only media reported less mental illness knowledge/positive attitudes and greater social separation from peers and vignette characters with a mental illness, net of all covariates. Family language and social preferences were not associated with any mental illness stigma outcomes. CONCLUSIONS Spanish media preference is associated with greater stigma suggesting more stigmatization may exist in Spanish- versus English-media. Ensuring anti-stigma messaging in Spanish media may reduce disparities in mental illness stigma among Latinx adolescents. These findings have implications for populations with other non-English media preferences.
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Affiliation(s)
- Melissa J DuPont-Reyes
- School of Public Health, Texas A&M University, 212 Adriance Lab Road, Suite 217, College Station, TX, 77843-1266, USA.
| | - Alice P Villatoro
- Latino Research Institute, The University of Texas at Austin, Austin, USA
| | - Jo C Phelan
- Mailman School of Public Health, Columbia University, New York, USA
| | - Kris Painter
- The University of Texas at Arlington, Arlington, USA
| | - Bruce G Link
- School of Public Policy, University of California, Riverside, USA
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Eylem O, de Wit L, van Straten A, Steubl L, Melissourgaki Z, Danışman GT, de Vries R, Kerkhof AJFM, Bhui K, Cuijpers P. Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health 2020; 20:879. [PMID: 32513215 PMCID: PMC7278062 DOI: 10.1186/s12889-020-08964-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is a strong stigma attached to mental disorders preventing those affected from getting psychological help. The consequences of stigma are worse for racial and/or ethnic minorities compared to racial and/or ethnic majorities since the former often experience other social adversities such as poverty and discrimination within policies and institutions. This is the first systematic review and meta-analysis summarizing the evidence on the impact of differences in mental illness stigma between racial minorities and majorities. METHODS This systematic review and meta-analysis included cross-sectional studies comparing mental illness stigma between racial minorities and majorities. Systematic searches were conducted in the bibliographic databases of PubMed, PsycINFO and EMBASE until 20th December 2018. Outcomes were extracted from published reports, and meta-analyses, and meta-regression analyses were conducted in CMA software. RESULTS After screening 2787 abstracts, 29 studies with 193,418 participants (N = 35,836 in racial minorities) were eligible for analyses. Racial minorities showed more stigma than racial majorities (g = 0.20 (95% CI: 0.12 ~ 0.27) for common mental disorders. Sensitivity analyses showed robustness of these results. Multivariate meta-regression analyses pointed to the possible moderating role of the number of studies with high risk of bias on the effect size. Racial minorities have more stigma for common mental disorders when compared with majorities. Limitations included moderate to high risk of bias, high heterogeneity, few studies in most comparisons, and the use of non-standardized outcome measures. CONCLUSIONS Mental illness stigma is higher among ethnic minorities than majorities. An important clinical implication of these findings would be to tailor anti-stigma strategies related with mental illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach.
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Affiliation(s)
- Ozlem Eylem
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
- Centre for Psychiatry, Queen Mary University of London, London, UK.
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | | | - Gözde Topgüloğlu Danışman
- Faculty of Social Sciences, Centre for Family and Couple Therapy, Özyeğin University, İstanbul, Turkey
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ad J F M Kerkhof
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Kamaldeep Bhui
- Centre for Psychiatry, Queen Mary University of London, London, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
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Mannarini S, Rossi A, Munari C. How do education and experience with mental illness interact with causal beliefs, eligible treatments and stigmatising attitudes towards schizophrenia? A comparison between mental health professionals, psychology students, relatives and patients. BMC Psychiatry 2020; 20:167. [PMID: 32295581 PMCID: PMC7161111 DOI: 10.1186/s12888-020-02580-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The main purpose of this study was to investigate the perception of schizophrenia in different categories of persons (directly and/or indirectly) involved with it. Hypotheses were made concerning the definition of a multi-class structure where each class should identify a profile characteristic of each respondent's specific role, (e.g.: mental health professional, relative, patient, and student) and specific indicators of schizophrenia (e.g.: causal beliefs, eligible treatments, social distance, perceived dangerousness and public avoidance). METHODS This study involved 577 participants all in contact with schizophrenia with different roles. A Latent Class Analysis (LCA) was applied to define a latent structure of schizophrenia aspects. Such structure was expected be affected by the interaction between respondents' roles, as external variable, and schizophrenia indicators as manifest variables. RESULTS A four-latent-class structure representing the four respondents' roles was evidenced, further each class was characterized by schizophrenia indicators representing a profile for each role. Analogies and differences of views and preferences of the respondents' roles concerning schizophrenia emerged clearly. CONCLUSIONS The four groups of people involved with schizophrenia with different roles demonstrated to interact significantly with specific indicators of schizophrenia shedding new lights on the understanding of schizophrenia in its complexity.
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Affiliation(s)
- Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy. .,Interdepartmental Center for Family Research, University of Padova, Padova, Italy.
| | - Alessandro Rossi
- grid.5608.b0000 0004 1757 3470Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy ,grid.5608.b0000 0004 1757 3470Interdepartmental Center for Family Research, University of Padova, Padova, Italy
| | - Cristina Munari
- grid.5608.b0000 0004 1757 3470Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy ,grid.5608.b0000 0004 1757 3470Interdepartmental Center for Family Research, University of Padova, Padova, Italy
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12
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González-Sanguino C, Potts LC, Milenova M, Henderson C. Time to Change's social marketing campaign for a new target population: results from 2017 to 2019. BMC Psychiatry 2019; 19:417. [PMID: 31881957 DOI: 10.1186/s12888-019-2415-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Since 2009 Time to Change has included among its strategies a social marketing campaign to tackle the stigma surrounding mental health problems. At the start of its third phase (2016-2021) the target group of the campaign was kept as people aged between mid-twenties and mid-forties but changed to middle-low income groups and the content was focused on men. METHODS Participants (n = 3700) were recruited through an online market research panel, before and after each burst of the campaign. They completed an online questionnaire evaluating knowledge (Mental Health Knowledge Schedule, MAKS); attitudes (Community Attitudes toward Mental Illness, CAMI); and desire for social distance (Intended Behaviour subscale of the Reported and Intended Behaviour Scale, RIBS). Socio-demographic data and awareness of the campaign were also collected. RESULTS For each of the 3 bursts, significant pre-post awareness differences were found (OR = 2.83, CI = 1.90-4.20, p < 0.001; OR = 1.72, CI = 1.22-2.42, p = 0.002; OR = 1.41, CI = 1.01-1.97, p = 0.043), and awareness at the end of the third burst was 33%. Demographic factors associated with awareness for one or more bursts included having children, familiarity with mental illness, male sex, being Black, Asian or other ethnic minorities and living in London or the East Midlands regions. An improvement across bursts in the "living with" subscale item of the RIBS, and in the "recover" and "advice to a friend" MAKS items were found. Familiarity with mental illness had the strongest association with all outcome measures, while the awareness of the campaign was also related with higher scores in MAKS and RIBS. CONCLUSIONS These interim results suggest that the campaign is reaching and having an impact on its new target audience to a similar extent as did the TTC phase 1 campaign. While over the course of TTC we have found no evidence that demographic differences in stigma have widened, and indeed those by age group and region of England have narrowed, those for socioeconomic status, ethnicity and sex have so far remained unchanged. By targeting a lower socioeconomic group and creating relatively greater awareness among men and in Black and ethnic minority groups, the campaign is showing the potential to address these persistent differences in stigma.
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13
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Guzmán EM, Cha CB, Ribeiro JD, Franklin JC. Suicide risk around the world: a meta-analysis of longitudinal studies. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1459-1470. [PMID: 31485691 DOI: 10.1007/s00127-019-01759-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/20/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Suicidal thoughts and behaviors (STBs) have been a persistent problem worldwide. Identifying risk factors for STBs across distinct areas of the world may help predict who or where requires the greatest attention. However, risk factors for STBs are infrequently explored cross-nationally. The present study examined whether psychopathology prospectively predicts STBs across different areas of the world, and whether certain country-level factors moderate the degree of risk conferred. METHODS We conducted a meta-analysis of 71 longitudinal studies from 30 different countries that featured psychopathology-related variables predicting STB outcomes. Meta-regression was used to evaluate whether the following country-level factors modified risk: geographic region, income level, and degree of mental health structural stigma. RESULTS Over 90% of studies had been conducted in North America and Europe. When assessed by country income level, it was found that only one longitudinal study on psychopathology and STB was conducted outside of a high-income country. Moreover, less than 10% of studies were conducted in high structural stigma contexts. Meta-regression findings revealed that the variation in risk effect sizes across studies was not explained by models including country-level factors. CONCLUSIONS Our findings show critical underrepresentation of low- and middle-income countries, which account for a large proportion of global suicide deaths. This reveals a need to broaden the scope of longitudinal research on STB risk, such that countries across more regions, income levels, and degrees of structural stigma are fully accounted for. Such lines of research will improve generalizability of findings, and more precisely inform prevention efforts worldwide.
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Affiliation(s)
- E M Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA
| | - C B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA.
| | - J D Ribeiro
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahasee, FL, 32306, USA
| | - J C Franklin
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahasee, FL, 32306, USA
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Pingani L, Sampogna G, Evans-Lacko S, Gozzi B, Giallonardo V, Luciano M, Galeazzi GM, Fiorillo A. How to Measure Knowledge About Mental Disorders? Validation of the Italian Version of the MAKS. Community Ment Health J 2019; 55:1354-1361. [PMID: 31124008 DOI: 10.1007/s10597-019-00416-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 05/16/2019] [Indexed: 11/24/2022]
Abstract
The aim of this study is to validate the Italian version of the Mental Health Knowledge Schedule (MAKS-I). The validation process included: linguistic validation; analysis of the feasibility; face validity; internal consistency; floor and the ceiling effects; divergent validity. Multiple linear regression was performed to examine the relationship between mental health knowledge and independent variables. MAKS-I was administered to 453 people. The linguistic validation was successful and face validity of the questionnaire showed no critical issues. The estimated composite reliability was 0.638. Divergent validity was supported by lack of statistical significant correlation between MAKS-I and RIBS-I with a positive correlation index. Participation in seminars or conferences related to the issue of mental health stigma, gender, qualification and having a first or second-degree relatives with a psychiatric disorder can be considered possible predictors of the MAKS-I score. MAKS-I is a reliable questionnaire to assess mental health knowledge and familiarity with psychiatric clinical conditions in Italian language.
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Affiliation(s)
- Luca Pingani
- Human Resources Department, Azienda USL - IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy. .,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
| | - Sara Evans-Lacko
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Benedetta Gozzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
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Schlier B, Lincoln TM. The stigma of mental illness: Testing for the implicit bias in diagnostic labels. Psychiatry Res 2019; 275:221-227. [PMID: 30928725 DOI: 10.1016/j.psychres.2019.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/16/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
Several models that attempt to explain stigmatization of people with mental illness emphasize the relevance of social categorization. However, research on illness-based social categories has been limited to explicit self-report measures. In this study, we explored whether implicit social categorization based on mental illness labels can be assessed with the "Who-Said-What" (WSW)-paradigm. In this paradigm, participants have to allocate a large number of statements to individuals who belong to different social groups (e.g., mentally ill vs. healthy). Due to the amount of statements, errors in allocation are to be expected. A disproportionate amount of erroneous allocation to individuals within a social group is interpreted to indicate implicit social categorization. In three studies, we (1) pilot-tested a WSW-paradigm for mental illness categorization (n = 24), (2) replicated these findings in an independent, larger sample (n = 85), and (3) aimed to rule out alternative explanations for the implicit categorization effects with a modified WSW-task and novel stimulus material (n = 137). We found consistent implicit categorization effects with overall medium to large effect sizes (range: 0.41 ≤ d ≤ 1.01). Implicit components of mental illness based social categorization can be assessed with the WSW-paradigm. Future research needs to explore the interrelations of implicit categorization, implicit vs. explicit stigmatization and discriminating behavior.
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Affiliation(s)
- Björn Schlier
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania M Lincoln
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
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16
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Abstract
This study examined public gambling stigma by testing stigmatization of those diagnosed with a gambling disorder, as specified by the DSM-5 (American Psychiatric Association in Diagnostic and statistical manual of mental disorders, 2013. https://doi.org/10.1176/appi.books.9780890425596.dsm16 ). The researchers hypothesized that the magnitude of stigmatization would fall in this order, from most stigmatized to least: (a) the target labelled and described in ways consistent with moderate gambling disorder (b) the target described in ways consistent with moderate gambling disorder, (c) the target described in ways consistent with recreational gambling, (d) and control. Participants were randomly presented with one of the four descriptions, then completed measures of cognitive, affective, and behavioral reactions. Results showed that those labelled with gambling disorder evoked slightly more social distance than those meeting criteria for the disorder with no label. However, both groups meeting criteria were more stigmatized than those who gamble without meeting criteria and those who do not gamble. Those described who gamble without meeting criteria were no more stigmatized than those who do not gamble, giving a more total picture of what gambling stigma is by indicating what it is not. Findings and implications are discussed.
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17
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Lagger N, Amering M, Sibitz I, Gmeiner A, Schrank B. Stability and mutual prospective relationships of stereotyped beliefs about mental illness, hope and depressive symptoms among people with schizophrenia spectrum disorders. Psychiatry Res 2018; 268:484-489. [PMID: 30145505 DOI: 10.1016/j.psychres.2018.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/30/2018] [Accepted: 08/05/2018] [Indexed: 11/28/2022]
Abstract
Internalized stigma, hope and depressive symptoms are important variables in the recovery process of people with schizophrenia spectrum disorders, but little is known about their stability or relationship among each other over time. This study aims to unravel the longitudinal stability and relationships of these variables. 99 participants were included in this prospective study assessing internalized stigma, hope and depressive symptoms at baseline, with a first follow-up after three months and a second follow-up after six months. Multilevel models examined if the variables changed over time and a correlation coefficient was conducted to show their relationship to each other. Hope stayed stable over time, whereas internalized stigma and depressive symptoms significantly decreased over the study period. The correlation coefficient showed that internalized stigma and depressive symptoms influenced each other moderately over time. Thus, while hope was a stable construct over time, internalized stigma and depressive symptoms changed significantly and were correlated to each other positively. This implies that participants may adjust to their chronic condition over time, and recovery focused interventions should target both psychological dimensions at the same time.
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Affiliation(s)
- Nina Lagger
- Doctoral student of the Medical University of Vienna, Austria.
| | - Michaela Amering
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ingrid Sibitz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Andrea Gmeiner
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Beate Schrank
- Karl Landsteiner University of Health Sciences, Krems/Donau, Austria
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Wong EC, Collins RL, Cerully JL, Yu JW, Seelam R. Effects of contact-based mental illness stigma reduction programs: age, gender, and Asian, Latino, and White American differences. Soc Psychiatry Psychiatr Epidemiol 2018; 53:299-308. [PMID: 29196773 DOI: 10.1007/s00127-017-1459-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE Mental illness stigma disproportionately affects help seeking among youth, men, and ethnic minorities. As part of a comprehensive statewide initiative to reduce mental illness stigma and discrimination in California, a broad set of contact-based educational programs were widely disseminated. This study examined whether the effects of contact-based educational programs varied depending on the age, gender, and race-ethnicity of participants. METHODS Participants (N = 4122) attended a contact-based educational program that was delivered as part of the statewide initiative to reduce mental illness stigma and discrimination. Self-administered surveys assessing beliefs, attitudes, and intentions toward mental illnesses and treatment were conducted immediately before and after participation in contact-based educational programs. RESULTS Participant age, gender, and race-ethnicity significantly moderated pre-post changes in mental illness stigma. Although all groups exhibited significant pre-post changes across most of the stigma domains assessed, young adults, females, and Asian and Latino American participants reported larger improvements compared to older adults, males, and Whites, respectively. CONCLUSIONS Findings suggest that contact-based educational programs can achieve immediate reductions in mental illness stigma across a variety of sociodemographic groups and may particularly benefit young adults and racial-ethnic minorities. Further research is needed to assess whether contact-based educational programs can sustain longer-term changes and aid in the reduction of disparities in mental illness stigma and treatment.
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Affiliation(s)
- Eunice C Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | | | | | - Jennifer W Yu
- SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
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Subramaniam M, Abdin E, Picco L, Pang S, Shafie S, Vaingankar JA, Kwok KW, Verma K, Chong SA. Stigma towards people with mental disorders and its components - a perspective from multi-ethnic Singapore. Epidemiol Psychiatr Sci 2017; 26:371-82. [PMID: 27018715 DOI: 10.1017/S2045796016000159] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS The current study aimed to: (i) describe the extent of overall stigma as well as the differences in stigma towards people with alcohol abuse, dementia, depression, schizophrenia and obsessive compulsive disorder, as well as (ii) establish the dimensions of stigma and examine its correlates, in the general population of Singapore, using a vignette approach. METHODS Data for the current study came from a larger nation-wide cross-sectional study of mental health literacy conducted in Singapore. The study population comprised Singapore Residents (Singapore Citizens and Permanent Residents) aged 18-65 years who were living in Singapore at the time of the survey. All respondents were administered the Personal and Perceived scales of the Depression Stigma scale and the Social Distance scale to measure personal stigma and social distance, respectively. Weighted mean and standard error of the mean were calculated for continuous variables, and frequencies and percentages for categorical variables. Exploratory structural equation modelling and confirmatory factor analysis were used to establish the dimensions of stigma. Multivariable linear regressions were conducted to examine factors associated with each of the stigma scale scores. RESULTS The mean age of the respondents was 40.9 years and gender was equally represented (50.9% were males). The findings from the factor analysis revealed that personal stigma formed two distinct dimensions comprising 'weak-not-sick' and 'dangerous/unpredictable' while social distance stigma items loaded strongly into a single factor. Those of Malay and Indian ethnicity, lower education, lower income status and those who were administered the depression and alcohol abuse vignette were significantly associated with higher weak-not-sick scores. Those of Indian ethnicity, 6 years of education and below, lower income status and those who were administered the alcohol abuse vignette were significantly associated with higher dangerous/unpredictable scores. Those administered the alcohol abuse vignette were associated with higher social distance scores. CONCLUSION This population-wide study found significant stigma towards people with mental illness and identified specific groups who have more stigmatising attitudes. The study also found that having a friend or family member with similar problems was associated with having lower personal as well as social distance stigma. There is a need for well-planned and culturally relevant anti-stigma campaigns in this population that take into consideration the findings of this study.
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Noblett J, Caffrey A, Deb T, Khan A, Lagunes-Cordoba E, Gale-Grant O, Henderson C. Liaison psychiatry professionals' views of general hospital care for patients with mental illness: The care of patients with mental illness in the general hospital setting. J Psychosom Res 2017; 95:26-32. [PMID: 28314546 DOI: 10.1016/j.jpsychores.2017.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Explore the experiences of liaison psychiatry professionals, to gain a greater understanding of the quality of care patients with mental illness receive in the general hospital setting; the factors that affect the quality of care; and their insights on interventions that could improve care. METHODS A survey questionnaire and qualitative in depth interviews were used to collect data. Data collection took place at the Royal College of Psychiatrists Faculty of Liaison Psychiatry Annual conference. Qualitative analysis was done using thematic analysis. RESULTS Areas of concern in the quality of care of patients with co-morbid mental illness included 'diagnostic overshadowing', 'poor communication with patient', 'patient dignity not respected' and 'delay in investigation or treatment'. Eleven contributing factors were identified, the two most frequently mentioned were 'stigmatising attitudes of staff towards patients with co-morbid mental illness' and 'complex diagnosis'. The general overview of care was positive with areas for improvement highlighted. Interventions suggested included 'formal education' and 'changing the liaison psychiatry team'. CONCLUSION The cases discussed highlighted several areas where the quality of care received by patients with co-morbid mental illness is lacking, the consequences of which could be contributing to physical health disparities. It was acknowledged that it is the dual responsibility of both the general hospital staff and liaison staff in improving care.
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Painter K, Phelan JC, DuPont-Reyes MJ, Barkin KF, Villatoro AP, Link BG. Evaluation of Antistigma Interventions With Sixth-Grade Students: A School-Based Field Experiment. Psychiatr Serv 2017; 68:345-352. [PMID: 27842475 PMCID: PMC5816981 DOI: 10.1176/appi.ps.201600052] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE School-based interventions for preadolescents provide the opportunity, in a ubiquitous institutional setting, to attack stigmatizing attitudes before they are firmly entrenched, and thus they may reduce mental illness stigma in the overall population. This study evaluated the effectiveness of classroom-based interventions in reducing stigma and increasing understanding of mental illness and positive attitudes toward treatment seeking among sixth-grade students. METHODS In an ethnically and racially diverse sample (N=721), 40% of participants were Latino, 26% were white, and 24% were African American; the mean age was 11.5. In a fully crossed design, classrooms from a school district in Texas were randomly assigned to receive all three, two, one, or none of the following interventions: a PowerPoint- and discussion-based curriculum, contact with two college students who described their experiences with mental illness, and exposure to antistigma printed materials. Standard and vignette-based quantitative measures of mental health knowledge and attitudes, social distance, and help-seeking attitudes were assessed pre- and postintervention. RESULTS Printed materials had no significant effects on outcomes and were grouped with the control condition for analysis. For eight of 13 outcomes, the curriculum-only group reported significantly more positive outcomes than the control group; the largest between-group differences were for stigma awareness and action, recognition of mental illness in the vignettes, and positive orientation to treatment. The contact-alone group reported significantly more positive outcomes on three vignette-based measures. CONCLUSIONS Results were most promising for a classroom-based curriculum that can be relatively easily disseminated to and delivered by teachers, offering the potential for broad application in the population.
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Affiliation(s)
- Kirstin Painter
- Dr. Painter is with the Center for Mental Health Services, Division of Service and Systems Improvement, Substance Abuse and Mental Health Services Administration, Rockville, Maryland . Dr. Phelan is with the Department of Sociomedical Sciences and Ms. Dupont-Reyes and Dr. Villatoro are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. Ms. Barkin is with MHMR of Tarrant County, Fort Worth, Texas. Dr. Link is with the Department of Sociology and School of Public Policy, University of California Riverside
| | - Jo C Phelan
- Dr. Painter is with the Center for Mental Health Services, Division of Service and Systems Improvement, Substance Abuse and Mental Health Services Administration, Rockville, Maryland . Dr. Phelan is with the Department of Sociomedical Sciences and Ms. Dupont-Reyes and Dr. Villatoro are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. Ms. Barkin is with MHMR of Tarrant County, Fort Worth, Texas. Dr. Link is with the Department of Sociology and School of Public Policy, University of California Riverside
| | - Melissa J DuPont-Reyes
- Dr. Painter is with the Center for Mental Health Services, Division of Service and Systems Improvement, Substance Abuse and Mental Health Services Administration, Rockville, Maryland . Dr. Phelan is with the Department of Sociomedical Sciences and Ms. Dupont-Reyes and Dr. Villatoro are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. Ms. Barkin is with MHMR of Tarrant County, Fort Worth, Texas. Dr. Link is with the Department of Sociology and School of Public Policy, University of California Riverside
| | - Kay F Barkin
- Dr. Painter is with the Center for Mental Health Services, Division of Service and Systems Improvement, Substance Abuse and Mental Health Services Administration, Rockville, Maryland . Dr. Phelan is with the Department of Sociomedical Sciences and Ms. Dupont-Reyes and Dr. Villatoro are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. Ms. Barkin is with MHMR of Tarrant County, Fort Worth, Texas. Dr. Link is with the Department of Sociology and School of Public Policy, University of California Riverside
| | - Alice P Villatoro
- Dr. Painter is with the Center for Mental Health Services, Division of Service and Systems Improvement, Substance Abuse and Mental Health Services Administration, Rockville, Maryland . Dr. Phelan is with the Department of Sociomedical Sciences and Ms. Dupont-Reyes and Dr. Villatoro are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. Ms. Barkin is with MHMR of Tarrant County, Fort Worth, Texas. Dr. Link is with the Department of Sociology and School of Public Policy, University of California Riverside
| | - Bruce G Link
- Dr. Painter is with the Center for Mental Health Services, Division of Service and Systems Improvement, Substance Abuse and Mental Health Services Administration, Rockville, Maryland . Dr. Phelan is with the Department of Sociomedical Sciences and Ms. Dupont-Reyes and Dr. Villatoro are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. Ms. Barkin is with MHMR of Tarrant County, Fort Worth, Texas. Dr. Link is with the Department of Sociology and School of Public Policy, University of California Riverside
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Reavley NJ, Jorm AF, Morgan AJ. Beliefs about dangerousness of people with mental health problems: the role of media reports and personal exposure to threat or harm. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1257-64. [PMID: 27048265 DOI: 10.1007/s00127-016-1215-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 03/21/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the associations between beliefs about the dangerousness of people with mental health problems and exposure to media reports of violence or personal experiences of fear, threat or harm. METHODS Telephone interviews were carried out with 5220 Australians aged 18+. Respondents heard a vignette of a person with depression or early schizophrenia and were asked whether they believed him to be dangerous. Other questions covered past 12-month recall of media reports of violence and mental health problems, contact with and experiences of fear, threat or harm by people with mental health problems. Multinomial logistic regression was used to assess the associations between beliefs about dangerousness and media and these types of contact with people with mental health problems. RESULTS For the early schizophrenia vignette, recall of media reports and having felt afraid of someone were associated with beliefs about dangerousness. For the depression vignette, media reports about violence and mental health problems or the experiences of feeling afraid or having been threatened or harmed were not strongly associated with beliefs about dangerousness. For both vignettes, knowing someone with a mental health problem and having a higher level of education were associated with less belief in dangerousness. CONCLUSIONS Media reports may play a greater role in forming attitudes in low prevalence disorders and further efforts to reduce any adverse impact of media reporting should focus on these disorders. The study also supports the effectiveness of contact with people with mental health problems in reducing beliefs about dangerousness.
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Affiliation(s)
- N J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Melbourne, VIC, 3010, Australia.
| | - A F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Melbourne, VIC, 3010, Australia
| | - A J Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Melbourne, VIC, 3010, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Abstract
Reducing the stigma and discrimination associated with mental illness is becoming an increasingly important focus for research, policy, programming and intervention work. While it has been well established that the healthcare system is one of the key environments in which persons with mental illnesses experience stigma and discrimination there is little published literature on how to build and deliver successful anti-stigma programs in healthcare settings, towards healthcare providers in general, or towards specific types of practitioners. Our paper intends to address this gap by providing a set of theoretical considerations for guiding the design and implementation of anti-stigma interventions in healthcare.
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Affiliation(s)
- Thomas Ungar
- North York General Hospital, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Knaak
- Mental Health Commission of Canada, 320, 110 Quarry Park Blvd, Calgary, AB, T2C 3G3, Canada.
| | - Andrew C H Szeto
- Mental Health Commission of Canada, 320, 110 Quarry Park Blvd, Calgary, AB, T2C 3G3, Canada
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
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Ndetei DM, Mutiso V, Maraj A, Anderson KK, Musyimi C, McKenzie K. Stigmatizing attitudes toward mental illness among primary school children in Kenya. Soc Psychiatry Psychiatr Epidemiol 2016; 51:73-80. [PMID: 26154242 DOI: 10.1007/s00127-015-1090-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 06/29/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Literature describing stigmatizing attitudes towards people with mental illness by children in the developing world is lacking. Children's mental health issues in the Kenyan context are especially pertinent due to the increased likelihood of exposure to risk factors and the high prevalence of mental disorders. The objective of the current study was to examine socio-demographic factors associated with the endorsement of stigmatizing attitudes towards people with mental illness among Kenyan school children. METHODS We analyzed cross-sectional survey data from 4585 primary school-aged children in standards one through seven in the Eastern Province of Kenya. We examined relationships between the endorsement of stigmatizing attitudes and age, gender, district, religion, being in the standard appropriate for one's age, and parental employment status. RESULTS Stigma scores decreased with increasing age (β = -0.83; 95 % CI = -0.99 to -0.67). Boys had higher stigma scores compared to girls (β = 1.55; 95 % CI = 0.86-2.24). Students from the rural district had higher average stigma scores as compared to those from the peri-urban district (β = 1.14; 95 % CI = 0.44-1.84). Students who were not in the standard appropriate for their age had lower stigma scores than those who were in the standard typical for their age (β = -1.60; 95 % CI = -2.43 to -0.77). CONCLUSIONS Stigmatizing attitudes toward the mentally ill exist among primary school children in Kenya; thus, anti-stigma interventions are needed, and our findings highlight particular subgroups that could be targeted.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Anika Maraj
- Medical Director & Director of Health Equity, Centre for Addiction and Mental Health, 80 Workman Way, 6th Floor, Rm. 6302, Toronto, ON, M6J 1H4, Canada.
| | - Kelly K Anderson
- Medical Director & Director of Health Equity, Centre for Addiction and Mental Health, 80 Workman Way, 6th Floor, Rm. 6302, Toronto, ON, M6J 1H4, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | | | - Kwame McKenzie
- Medical Director & Director of Health Equity, Centre for Addiction and Mental Health, 80 Workman Way, 6th Floor, Rm. 6302, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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