The Role of Mental Health Stigma in University Students' Satisfaction With Web-Based Stress Management Resources: Intervention Study

BACKGROUND

University students frequently report elevated levels of stress and mental health difficulties. Thus, the need to build coping capacity on university campuses has been highlighted as critical to mitigating the negative effects of prolonged stress and distress among students. Since the COVID-19 pandemic, web-based stress management resources such as infographics and web-based workshops have been central to supporting university students' mental health and well-being. However, there is a lack of research on students' satisfaction with and uptake of these approaches. Furthermore, mental health stigma has been suggested to have not only fueled the emergence of these web-based approaches to stress management but may also influence students' help-seeking behaviors and their satisfaction with and uptake of these resources.

OBJECTIVE

This study explored potential differences in students' satisfaction and strategy use in response to an interactive infographic (an emerging resource delivery modality) presenting stress management strategies and a web-based workshop (a more common modality) presenting identical strategies. This study also examined the relative contribution of students' strategy use and family-based mental health stigma in predicting their sustained satisfaction with the 2 web-based stress management approaches.

METHODS

University students (N=113; mean age 20.93, SD 1.53 years; 100/113, 88.5% women) completed our web-based self-report measure of family-based mental health stigma at baseline and were randomly assigned to either independently review an interactive infographic (n=60) or attend a synchronous web-based workshop (n=53). All participants reported their satisfaction with their assigned modality at postintervention (T1) and follow-up (T2) and their strategy use at T2.

RESULTS

Interestingly, a 2-way mixed ANOVA revealed no significant group × time interaction or main effect of group on satisfaction. However, there was a significant decrease in satisfaction from T1 to T2, despite relatively high levels of satisfaction being reported at both time points. In addition, a 1-way ANOVA revealed no significant difference in strategy use between groups. Results from a hierarchical multiple regression revealed that students' strategy use positively predicted T2 satisfaction in both groups. However, only in the web-based workshop group did family-based mental health stigma predict T2 satisfaction over and above strategy use.

CONCLUSIONS

While both approaches were highly satisfactory over time, findings highlight the potential utility of interactive infographics since they are less resource-intensive than web-based workshops and students' satisfaction with them is not impacted by family-based mental health stigma. Moreover, although numerous intervention studies measure satisfaction at a single time point, this study highlights the need for tracking satisfaction over time following intervention delivery. These findings have implications for student service units in the higher education context, emphasizing the need to consider student perceptions of family-based mental health stigma and preferences regarding delivery format when designing programming aimed at bolstering students' coping capacity.

Representations of hallucinations and dissociation in young adult literature: using literature to challenge stigma about psychosis

This paper explores the role that sensitively portrayed literary representations of hallucinations and dissociation may have in counteracting stigma associated with these experiences. In it, we focus on narratives of young people experiencing hallucinatory and dissociative phenomena in two award-winning, young adult novels: How It Feels to Float by Helena Fox and A Monster Calls by Patrick Ness. We identify and discuss three literary devices in these two novels that promote empathy for the characters and their experiences. The narrative accounts in both novels challenge conceptions of hallucinations and dissociation as unknowable and unrelatable experiences with their empathic portrayals of relatable characters that create comprehensible accounts of adolescents grappling with their sense of reality. Importantly, they highlight the potential role that literature can play in stigma reduction by positively shaping young peoples' understandings of unfamiliar mental health experiences.

Attitudes and Stigma Toward Seeking Psychological Help Among the General Population of Makkah, Saudi Arabia

Background and objective Depression and anxiety are among the most common mental health conditions globally, and, according to the World Health Organization (WHO), roughly 25% of people worldwide suffer from them. Serious mental diseases can cause a great deal of suffering and incapacity, lowering people's quality of life. Stigma and unfavorable attitudes toward mental illness often discourage people from seeking psychological assistance and achieving recovery from mental problems. This observational cross-sectional study aimed to investigate the attitudes of the general population of Makkah, Saudi Arabia, toward seeking psychological help, and to determine the degree to which stigma prevents individuals from seeking help. Methods An online, self-administered survey was distributed via social media platforms among the general population of Makkah between September and December 2023. Males and females over the age of 18 years living in Makkah were included. The exclusion criteria were participants who declined to participate in the study or those who were below 18 years of age. Results A total of 495 eligible participants completed the study survey. Of them, 378 (76.4%) were female, and most (390, 78.8%) were Saudi Arabian nationals. A total of 341 (68.9%) participants had symptoms of anxiety, and 319 (64.4%) had symptoms of depression. Regarding unfavorable attitudes, the scores were significantly higher among participants over 40 years of age (1.81 ± 0.46; p<0.05) and those with relatively low levels of education (1.93 ± 0.65; p<0.05). As for stigma, the scores were significantly higher among male participants (2.38 ± 0.83; p<0.05) and those with low levels of education (2.54 ± 0.8; p<0.05). Conclusion A significant negative correlation between participants' attitudes toward seeking psychological help and stigma was observed. However, in contrast, the psychological symptom scores did not significantly correlate with the participants' attitudes. Stigma scores showed significant positive correlations with depression and overall symptom scores. This research showed that stigma has a significant impact on attitudes toward help-seeking.

What Do Farmers Need for Suicide Prevention: Considerations for a Hard-to-Reach Population

Purpose

Farmers have suicide rates much higher than the general population, with elevated mental health symptoms and high stress levels. Farmers are a hard-to-reach population due to occupational demands and a culture where conversations about mental health are often stigmatizing. This study explored ways to tailor suicide prevention strategies to unique characteristics of farmers by speaking with groups close to farmers who were open to discussing stress and suicide prevention: women married to farmers and agricultural Extension agents.

Methods

Focus groups with women married to farmers (N=29) and interviews with agricultural agents from the university's local Cooperative Extension offices (N=13) from rural Georgia counties explored effective ways outreach and education about suicide prevention, mental health, and coping could be provided to farmers. Using a thematic analysis approach, qualitative coding was completed by two researchers (Cohens kappa=0.86), with initial codes collapsed into common themes.

Results

Four themes were identified: 1) Barriers due to the nature of farming, including time demands of farming and cultural stigma in help-seeking; 2) Acceptable messaging, including framing conversations as part of general health; 3) Make information accessible by making it brief, clear, and omnipresent through multiple media; and 4) Elements of effective information and education, including emphasizing "you're not alone" and connection, how to access supports and crisis services, educating people close to farmers, and motivating farmers by emphasizing that they could help another farmer with the information.

Conclusion

Due to farmers' stoic identities and reluctance to admit mental health struggles, speaking with those close to farmers may help us better understand what is needed to tailor farmer suicide prevention strategies. The insights shared by participants suggest that culturally responsive outreach and education strategies, strengthening relationships through peer support, and gatekeeper training with specific trusted others are important ways to tailor suicide prevention strategies for this hard-to-reach group.

Dyadic effects of stigma on quality of life in people with schizophrenia and their family caregivers: Mediating role of patients' perception of caregivers' expressed emotion

Schizophrenia, as a stressful diagnosis, profoundly impacts the whole family, especially people with schizophrenia and their caregivers. This study tested the potential mediating role of expressed emotion in the association between mental health stigma and quality of life in caregiver-patient dyads. Using a 2-wave longitudinal design with a 6-month interval between assessments, 161 dyads of patients with schizophrenia and their family caregivers (one patient and one caregiver) completed measures of mental health stigma, expressed emotion, and quality of life. The results showed that patients' self-stigma had no significant actor or partner effect on expressed emotion or quality of life. In contrast, caregivers' stigmatizing attitudes toward patients had a significant partner effect on patients' perception of caregivers' expressed emotion and quality of life. The mediating effect of patients' perception of caregivers' expressed emotion in the association between caregivers' stigmatizing ideas toward patients and patients' quality of life was significant. By focusing on the interdependence of patients and their caregivers, this study highlights the role of caregivers' stigmatizing attitudes toward patients and patients' perception of caregivers' expressed emotion on patients' quality of life. Psychoeducation and interventions should not only aim to reduce the self-stigma of people with schizophrenia but also their caregivers' stigmatizing ideas toward patients. Family interventions targeted at reducing the EE level of caregivers and patients' perception of caregivers' EE would also benefit the adaptation and quality of life of people with schizophrenia and their caregivers.

'It's not everybody's snapshot. It's just an insight into that world': A qualitative study of multiple perspectives towards understanding the mental health experience and addressing stigma in healthcare students through virtual reality

Objective

The resurgence of virtual reality (VR) technologies has led to their increased use in contemporary healthcare education. One promising application is simulating the experiences of individuals with mental health conditions (MHCs) to reduce stigma among future healthcare professionals. This study set out to explore what those impacted by, or involved in, the education of healthcare students think about using VR in this way.

Methods

One individual interview and five focus groups were conducted with healthcare students (n = 7), healthcare educators (n = 6), and lived experience experts (n = 5). Before sharing their perspectives, participants familiarised themselves with VR equipment and immersive materials simulating MHCs. The constant comparative method and thematic analysis were used to analyse the data.

Results

Participants recognised the acceptability and utility of VR for addressing mental health stigma in healthcare students, emphasising the immersive nature of this technology. However, some participants raised concerns about the limited insight VR could provide into the experiences of patients with the same MHCs and its potential emotional impact on users. Participants recommended the incorporation of interactive, realistic environments with a person-centred focus into future VR-based stigma reduction interventions while stressing the importance of providing healthcare students with opportunities for reflection and support.

Conclusions

Healthcare students, healthcare educators, and lived experience experts highlighted both advantages and barriers associated with using VR to understand the experience of patients with MHCs. Furthermore, the recommendations put forward can inform the design, content, and delivery of VR-based stigma reduction interventions in healthcare education.

Experiences of racial microaggression among immigrant and Canadian-born young adults: Effects of double stigma on mental health and service use

BACKGROUND

Significant disparities in utilization of mental health services exist among immigrant and Canadian-born populations. These gaps may be associated with a 'double stigma' - stigma related to being from a racialized background exacerbated by mental health stigma. Immigrant young adults may be particularly susceptible to this phenomenon, given developmental and social transitions from adolescence to adulthood.

AIMS

To investigate the joint effects of racial microaggression and mental health stigma on mental health and service use among first-generation immigrant and Canadian-born university students.

METHOD

We conducted an online cross-sectional study among first-generation immigrant and Canadian-born university students (N = 1,280, Mage = 19.10, SD = 1.50).

RESULTS

Despite no differences in anxiety or depression symptoms, first-generation (foreign-born) immigrants were less likely to have received therapy and to have taken medication for mental health issues compared to Canadian-born participants. First-generation immigrants also reported experiencing higher levels of racial microaggression and stigma toward service use. Results suggest the presence of a double stigma, mental health stigma and racial microaggression, each explained significant additional variance in symptoms of anxiety and depression and medication use. No effects of double stigma for therapy use were found - while higher mental health stigma predicted lower use of therapy, racial microaggression did not predict unique variance in therapy use.

CONCLUSIONS

Our findings highlight the joint effects of racial microaggression and stigma toward mental health and service as barriers to help-seeking among immigrant young adults. Mental health intervention and outreach programmes should target overt and covert forms of racial discrimination while incorporating culturally sensitive anti-stigma approaches to help reduce disparities in mental health service use among immigrants in Canada.

The Design and Implementation of a Novel Mental Health Literacy Educational Intervention Program in Gaelic Footballers

CONTEXT

Lack of education, stigma, and negative self-attitudes are key barriers to help-seeking in Gaelic footballers. With the prevalence of mental health issues in Gaelic footballers and the increased risk of experiencing mental health challenges after injury, mental health literacy (MHL) interventions are necessary.

OBJECTIVES

To design and implement a novel MHL educational intervention program in Gaelic footballers.

DESIGN

Controlled laboratory study.

SETTING

Online.

PATIENTS OR OTHER PARTICIPANTS

Elite and subelite Gaelic footballers divided into intervention (n = 70; age = 25.1 ± 4.5 years) and control (n = 75; age = 24.4 ± 6.0 years) groups. In the intervention group, 85 participants were recruited, but 15 dropped out after completing baseline measures.

INTERVENTIONS

A novel educational intervention program, "GAA [Gaelic Athletic Association] and Mental Health-Injury and a Healthy Mind," was designed to address the key components of MHL and was underpinned by the Theory of Planned Behavior and the Help-Seeking Model. The intervention was implemented online via a brief 25-minute presentation.

MAIN OUTCOME MEASURES

Measures of stigma, help-seeking attitudes, and MHL were completed by the intervention group at baseline, immediately after viewing the MHL program, and at 1 week and 1 month after the intervention. The control group completed the measures at similar time points.

RESULTS

Stigma decreased, and attitudes toward help-seeking and MHL increased in the intervention group from baseline to after the intervention (P < .05), with significant differences sustained at 1-week and 1-month follow-ups. Our results showed differences in stigma, attitudes, and MHL between groups across time points. Intervention participants provided positive feedback, and the program was appraised as informative.

CONCLUSIONS

Remote online delivery of a novel MHL educational program can effectively decrease mental health stigma, improve attitudes toward help-seeking, and increase the recognition and knowledge of mental health issues. Gaelic footballers with improved MHL may be better equipped to manage their mental health and cope with stressors, leading to improved mental health outcomes and overall mental well-being.

Barriers to and Facilitators of Collegiate Athletes Seeking Mental Health Services

CONTEXT

Approximately 1 in 5 student-athletes experience some type of mental health concern. However, fewer than half of student-athletes who report mental health concerns seek mental health treatment (ie, psychotherapy or medication). Data concerning barriers to student-athletes seeking mental health care are limited but suggest that stigma is the primary reason. Further, whether having shared identities with their sport psychologists (eg, race and gender) encourages student-athletes to seek help has been minimally explored.

OBJECTIVES

To determine the frequency of internal and external barriers to athletes seeking mental health care and examine the importance of athletes and sport psychologists sharing identities as a facilitator of seeking help.

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

A total of 266 student-athletes (53.8% women, 42.5% White) from a National Collegiate Athletic Association Division I university.

MAIN OUTCOME MEASURES

Student-athletes responded to 9 binary (yes or no) prompts related to internal barriers (eg, beliefs and attitudes about mental health) and 7 reflecting external barriers (ie, different stakeholders, such as the head coach). Regarding facilitators of mental health help-seeking, student-athletes rated how important it was for them to share each of 10 identities with their sport psychologist from 1 (not at all important) to 5 (extremely important). All identified barriers and facilitators were derived from existing research.

RESULTS

Differences were found in athletes' ratings of internal and external barriers. For example, a belief in one's own reliance and not having enough time were significant barriers, as was their head coach having a negative attitude about the importance of mental health. Female student-athletes rated sharing a gender identity with their sport psychologist as more important than did male student-athletes.

CONCLUSIONS

Despite efforts by the National Collegiate Athletic Association to reduce the stigma surrounding mental health, persisting barriers within collegiate sports may keep athletes from seeking help.

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.

The effectiveness of anti-stigma interventions for reducing mental health stigma in young people: A systematic review and meta-analysis

Experiencing mental health stigma during adolescence can exacerbate mental health conditions, reduce quality of life and inhibit young people's help-seeking for their mental health needs. For young people, education and contact have most often been viewed as suitable approaches for stigma reduction. However, evidence on the effectiveness of these anti-stigma interventions has not been consistent. This systematic review evaluated the effectiveness of interventions to reduce mental health stigma among youth aged 10-19 years. The review followed Cochrane and PRISMA guidelines. Eight databases were searched: PubMed, PsycINFO, MEDLINE, Web of Science, Scopus, EMBASE, British Education Index and CNKI. Hand searching from included studies was also conducted. Randomised controlled trials and experimental designs that included randomised allocation to interventions and control groups were included in the review. Narrative synthesis was employed to analyse the results. A meta-analysis was conducted to determine the effectiveness of included interventions. Twenty-two studies were included in the review. Eight studies reported positive effects, 11 studies found mixed effects and 3 studies reported no effect on indicators of mental health stigma among youth. Seven of the effective studies were education-based. Eleven studies were suitable for meta-analysis, and the multivariate meta-analytic model indicated a small, significant effect at post-intervention (d = .21, p < .001), but not at follow-up (d = .069, p = .347). Interventions to reduce stigma associated with mental health conditions showed small, short-term effects in young people. Education-based interventions showed relatively more significant effects than other types of interventions.

Too Close for Comfort: Stigma by Association in Family Members Who Live with Relatives with Mental Illness

Stigma by association is described in qualitative research of family members who have relatives diagnosed with mental illness, depicting their sense of public shame for having these relationship ties. However, there have been relatively few empirical studies thus far, in part due to the isolation of family members affecting research recruitment. In order to address this gap, an online survey was administered to 124 family members, comparing those who live in the same home with their ill relative (n = 81) and those who do not (n = 43). A remarkable incidence of one in three family members reported experiencing stigma by association. Those living with an ill relative reported comparatively higher levels of stigma by association using an adapted questionnaire measure. Both groups experienced loneliness (moderate levels), but importantly, the cohabiting relatives perceived themselves as lacking support from friends and other family members. Correlational analyses revealed that those with heightened stigma by association reported heightened anti-mattering: that is, feeling that other people treat them as if they are insignificant and invisible. Anti-mattering was also associated with more loneliness and reduced social support. Our discussion focuses on the theme that family members who actually live with mentally ill relatives experience heightened social isolation that is under-recognized due to public stigma concerns, compounded by feeling their own lives do not matter to others. Public health implications are considered for the stigmatized family members who appear to be particularly marginalized.

Mental Health Awareness and Counseling Practice of Jamaican Clergy: An Exploratory Study

Clergy play a vital role in mental health care in Jamaica but little is known about their mental health awareness and practices. Thirty five Anglican and Baptist clergy were compared to 24 helping professionals and 67 community members using purposive sampling. Clergy's awareness exists with spiritualized beliefs about the etiology of mental illness as well as with effective and unethical counseling practices. Findings indicate the need for more training in mental health sensitization and practice.

Examining mental health knowledge, stigma, and service use intentions among Royal Canadian Mounted Police cadets

Background

Royal Canadian Mounted Police (RCMP) officers experience an elevated risk for mental health disorders due to inherent work-related exposures to potentially psychologically traumatic events and occupational stressors. RCMP officers also report high levels of stigma and low levels of intentions to seek mental health services. In contrast, very little is known about the levels of mental health knowledge and stigma of RCMP cadets starting the Cadet Training Program (CTP). The current study was designed to: (1) obtain baseline levels of mental health knowledge, stigma against peers in the workplace, and service use intentions in RCMP cadets; (2) determine the relationship among mental health knowledge, stigma against peers in the workplace, and service use intentions among RCMP cadets; (3) examine differences across sociodemographic characteristics; and (4) compare cadets to a sample of previously surveyed serving RCMP.

Methods

Participants were RCMP cadets (n = 772) starting the 26-week CTP. Cadets completed questionnaires assessing mental health knowledge, stigma against coworkers with mental health challenges, and mental health service use intentions.

Results

RCMP cadets reported statistically significantly lower levels of mental health knowledge (d = 0.233) and stigma (d = 0.127), and higher service use intentions (d = 0.148) than serving RCMP (all ps < 0.001). Female cadets reported statistically significantly higher scores on mental health knowledge and service use and lower scores on stigma compared to male cadets. Mental health knowledge and service use intentions were statistically significantly positively associated. For the total sample, stigma was inversely statistically significantly associated with mental health knowledge and service use intentions.

Conclusion

The current results indicate that higher levels of mental health knowledge were associated with lower stigma and higher intention to use professional mental health services. Differences between cadets and serving RCMP highlight the need for regular ongoing training starting from the CTP, designed to reduce stigma and increase mental health knowledge. Differences between male and female cadets suggest differential barriers to help-seeking behaviors. The current results provide a baseline to monitor cadet mental health knowledge and service use intentions and stigma as they progress throughout their careers.

Should I write about mental health on my med school app? Examining medical school admissions committee members' biases regarding mental health conditions

Mental health conditions can impact college students' academic achievements and experiences. As such, students may choose to disclose mental illnesses on medical school applications. Yet, no recent studies have investigated to what extent disclosure of a mental health condition may impact whether an applicant is accepted to medical school. We conducted an audit study to address this gap and surveyed 99 potential medical school admissions committee members from over 40 M.D.-granting schools in the United States. Participants rated a fictitious portion of a single medical school application on acceptability, competence, and likeability. They were randomly assigned to a condition: an application that explained a low semester grade-point average due to 1) a mental health condition, 2) a physical health condition, or 3) offered no explanation. After rating their respective application, all committee members were asked about when revealing a mental health condition would be beneficial and when it would be detrimental. Using ANOVAs, multinomial regression, and open coding, we found that medical school admissions committee members do not rate applications lower when a mental health condition is revealed. Committee members highlighted that revealing a mental health condition to demonstrate resiliency could be beneficial, but if the reference is vague or the condition is not being managed, it could be detrimental to a student's application. This work indicates that medical school admissions committee members do not exhibit a bias against mental health conditions and provides recommendations on how to discuss mental illness on medical school applications.

Associated factors of stigma toward people with mental illness among university and school students

PURPOSE

This study aimed to explore the associated factors of stigma towards people with mental illness among Omani school and university students.

DESIGN AND METHOD

A cross-sectional study among 371 school and university students with a multivariable linear regression model to identify the associated factors of personal and perceptions of stigma.

RESULTS

Male students, those with highly educated mothers, have high monthly income, higher mental health knowledge, employed fathers, and received focused education on mental illness showed fewer stigmatizing attitudes.

IMPLICATIONS FOR PRACTICE

Enhancing the knowledge about mental illness among school and university students and their families can play a significant role in reversing stigma.

The Influence of Stigma Perceptions on Employees' Claims Experiences for Psychological Injuries: Re-Examination of a Cross-Sectional Survey among Australian Police and Emergency Service Personnel

While a large body of research assessed the contribution of mental health stigma on disclosure, treatment seeking, and recovery, limited research exists seeking to identify the relative contribution of stigma beliefs on workers' compensation claims for psychological injury. Survey data of ambulance, fire and rescue, police, and state emergency service personnel (N = 1855, aged 45-54 years, 66.4% male) was re-examined to assesses the unique and combined associations of self-, personal, and workplace stigma with workers' compensation claims experiences and recovery. Participants responded to self-report stigma items (predictor variables), perceived stress, fairness, and support perceptions of going through the claims process and its impact on recovery (outcome variables). Multiple regression analyses revealed that the combined stigma dimensions predicted about one fifth of the variance of claims and recovery perceptions. Organisational commitment beliefs and the self-stigma dimension of experiences with others were the two most important, albeit weak, unique predictors across outcomes. Given the small but consistent influences of organisational commitment beliefs and the self-stigma dimension of experiences with others, it seems warranted to apply workplace interventions that are looking to establish positive workplace contact and a supportive organisational culture to alleviate negative effects attributable to mental health stigma.

A re-evaluation of Stuart's police officer stigma scale: Measuring mental health stigma in first responders

Stigma about mental illness is often identified as one of the most prominent obstacles to seeking mental health services. This seems to be particularly true among first responders. Unfortunately, the research regarding stigma in first responders is lacking. This may be due, in part, to the absence of appropriate measurement tools to allow such research. Police Officer Stigma Scale (POSS) has recently been developed to address this issue, but its psychometric properties have gone largely untested. Therefore, this study sought to identify the underlying factor structure and internal consistency of the POSS. This paper used a sample of 135 first responders. Using factor analysis with an orthogonal rotation on Stuart's 11-item POSS, the participant's results revealed two main components, accounting for a total of 72.79% of the overall variance. Factor one is "maltreatment of colleagues with a mental disorder," and is associated with six of the 11 items on the scale, such as "Most police officers believe that a colleague who has had a mental illness is not trustworthy." Factor two is "fear of disclosing a mental disorder." It includes items such as "Most police officers would not disclose to a supervisor/manager if they were experiencing a mental illness." Findings from this research are similar to the results of previous studies with components such as unwillingness to disclose a mental health condition, fear of how the public will treat an individual with a mental disorder, and anger toward those who decide to seek treatment or get diagnosed with a mental illness. These findings imply that Stuart's POSS is reliable but needs to include two components rather than one. With the two main components, further research can now be conducted to understand why and ultimately mitigate maltreatment or stigma against first responders with a mental health condition.

Prevalence and Determinants of Mental Health Problems and Mental Health Stigma Among Medical Students of Different Nationalities in Qatar

INTRODUCTION

Past studies have shown high prevalence of mental illness among medical students. This is often linked to the demands of the medical curriculum, and to mental health stigma that prevents students from seeking help. This study aimed to examine experiences of mental health problems among medical students of different nationalities in Qatar and to uncover sociodemographic factors related to their prevalence and associated stigma.

METHODS

A cross-sectional online survey was conducted with medical students in their second through fifth years at the College of Medicine at Qatar University. The survey began with a consent form, and those agreed to take the survey were directed to the questionnaire. The survey comprised 64 items across three sections. The first section collected sociodemographic data. The second section screened depressive symptoms using the PHQ-9; anxiety symptoms using GAD-7; and psychological distress symptoms using Kessler-6. The third section included 27 questions adopted from Schwenk et al, which evaluate students' perceptions of stigma and their attitudes toward seeking help with their mental health.

RESULTS

One hundred and eighty-two students participated in the study. The prevalence of self-reported symptoms of severe depression, anxiety, and psychological distress was 4.4% (95% CI 2-9), 10.4% (95% CI 7-16), and 39.6% (95% CI 33-47), respectively; the prevalence of high stigma was 31.9% (95% CI 25-39). Parental education, repetition of an academic year, progress in medical studies, gender, and nationality had statistically significant correlations with mental health problems and stigma.

CONCLUSION

In addition to the impact of the requirements of medical study, the high prevalence of reported mental illness among medical students is impacted by sociodemographic factors and the mental health stigma that constitutes a barrier to seeking help. Preventive wellbeing programs should be an essential component of medical curricula.

Mental health stigma among college students: Test of an interactive online intervention

Objective: Young adults have low rates of help-seeking despite high rates of mental health problems, which relate to stigmatizing attitudes. Education as well as contact with people with mental health problems may improve stigmatization. The present pilot study tested the efficacy of an online interactive educational intervention that utilizes avatars depicting distressed individuals on stigmatizing attitudes toward mental illness and help-seeking. Participants and Methods: Eighty-five college student participants were assessed on self- and public-stigma as well as attitudes toward help-seeking and were randomly assigned to one of three conditions (intervention, control, post-test only). Results: Pre-post comparisons indicate that interactive programs may be an accessible and efficient means to reduce stigmatizing attitudes toward help-seeking among college students. Future studies should include follow-up assessments and measures of behavior and should consider individual differences. including personal mental health history.

Stigma towards schizophrenia in Cyprus: Does studying a mental health related programme make a difference?

BACKGROUND AND AIMS

Students from mental health related programmes may display stigmatising attitudes towards people of schizophrenia, however there are no data available on this population in Cyprus. The purpose of the present study was (a) to examine the levels of contact and stigma towards schizophrenia in Cypriot students of programmes related to mental health and students of other programmes and (b) to examine whether the successful recognition of a person with schizophrenia through a vignette and the estimation of severity levels was related to stigmatising attitudes.

METHODS

The participants were undergraduate students purposively selected across Cypriot universities (N = 152). A vignette depicting a person with schizophrenia, followed by the OMI to examine stigma and the BAE to examine contact with mental illness were used to collect the data.

RESULTS

The results showed that studying a mental health related programme and being a man was associated with more positive views related to social integration. No further stigma dimensions were predicted by the included variables. Similarly, level of contact and being able to identify the mental condition and estimate its severity was not related to stigma.

CONCLUSION

The results emphasise the need to develop educational interventions to tackle stigma across students independently of their study programme and enhance mental health related programmes with opportunities for structured contact with patients with mental illness.

Mental Health Workers' Attitudes Towards Individuals With a Diagnosis of Borderline Personality Disorder: A Systematic Literature Review

The attitudes of mental health workers toward individuals with mental health conditions can impact the quality of care they provide. Negative attitudes among mental health workers seem particularly common in response to people diagnosed with borderline personality disorder (BPD). The current review aimed to identify and review the literature regarding mental health workers' attitudes toward individuals diagnosed with BPD, specifically focusing on studies comparing workers' attitudes toward BPD with attitudes toward other mental health diagnoses. The findings suggest that mental health workers have more negative attitudes toward individuals labeled as having BPD than toward individuals with other diagnoses, such as depression. This is likely due to factors associated with the label itself, in addition to workers' perceptions of BPD symptoms and previous experiences of delivering treatment. The implications of these findings are considered, with a particular focus on how mental health services can effectively address negative attitudes toward BPD.

Overcoming mental health stigma through student's awareness and project-based inclusive pedagogy in English teaching colleges: Moderating role of institutional support in China

Mental health stigma undermines collaborative work and creates communication breakdowns for students to face real-world challenges. Moreover, project-based English learning in East-Asian nations is a significant challenge for advancing students' effective learning, while students lack mental health self-awareness. Unawareness causes distractions and results in learning inefficiencies. Furthermore, without institutional support (IS) achieving effective learning could never be possible. Therefore, this study investigates the relationships between project-based learning (PBL) and mental health awareness (MHA) with effective English language teaching among university students in China. We also tested the moderation effect of IS in the relationships between PBL and MHA with effective English language learning (EEL). Using the purposive sampling technique, we collected valid responses from 713 students studying English as a foreign language in universities and colleges in Harbin, China. The findings interestingly supported the direct hypotheses between PBL and EEL, as well as MHA and EEL. Moreover, the moderating role of IS established a significant effect on both PBL and EEL, as well as MHA and EEL, respectively. Policymakers, practitioners, and academicians should understand that integrating PBL as an inclusive pedagogy method with proper IS may enhance effective learning; however, it will consume more time.

Exploring mental health stigma among chinese-english bilinguals: Dual-process model of emotional competence, flipped learning readiness, and academic performance in Mainland Chinese Universities

Due to severe global competition and performance-related academic challenges, Chinese students are compelled to learn English and become bilinguals despite their non-English majors. Consequently, these students frequently experience psychological issues, including mental health stigma. Hence, the present study aims to explore the psychological factors associated with the academic performance of Chinese-English bilinguals as an outcome of their emotional competence, flipped learning readiness, and mental health stigma. Drawing on data from 448 Chinese-English bilingual students in universities in mainland China, the results based on structural equation modeling (SEM) indicated that their academic performance, flipped learning readiness, and emotional competence are negatively influenced by their mental health stigma. Moreover, the findings also validate that both flipped learning readiness and emotional competence significantly mediate the indirect effects of mental health stigma on the academic performance of bilinguals. The study's implications offer new and compelling evidence on the primary issue of mental health stigma among Gen Z bilingual students to raise deterrence against this psychological menace through collaboration across policymakers, academics, and mental healthcare providers.

Operational challenges in the implementation of an anti-stigma campaign in rural Andhra Pradesh, India

BACKGROUND

Despite of literature available on mental health-related stigma interventions, little is reported about the operational challenges faced during the planning, implementation and evaluation phases.

METHODS

The Systematic Medical Appraisal, Referral and Treatment Mental Health Project was implemented in 42 villages of the West Godavari district in India. Andersen's Behavioural Model for Health Services Use was adopted to understand the factors influencing anti-stigma campaign delivery and the strategies identified to overcome these challenges.

RESULTS

The challenges faced during the planning and implementation phase included distance and time taken for travel by the field staff, inadequate mental health services and infrastructure within communities, engagement of community with the field staff and community's poor mental health literacy and knowledge. Strategies used to overcome these challenges were regular engagement with community stakeholders, understanding mental health literacy levels and seeking inputs from the community regarding campaign design, organizing live drama shows at community's preferred time and place and screening of recorded drama video clips where lives shows were difficult. The evaluation phase posed challenges such as non-availability of key stakeholders and inadequate time and funding to evaluate the entire study population.

CONCLUSION

The reported findings can help in planning and scaling up of the anti-stigma campaign in large trials in similar settings.

The Effects of Immersive Virtual Reality in Reducing Public Stigma of Mental Illness in the University Population of Hong Kong: Randomized Controlled Trial

Background

Public stigma in mental health often brings various adverse effects on people with mental illness. Researchers have been developing different interventions in combating public stigma.

Objective

This study investigates the effects of immersive virtual reality (IVR) in reducing the public stigma of mental illness using a single-blinded randomized control trial.

Methods

A pre-post experimental design with a 1-week follow-up was conducted. Participants (N=206) were recruited through the mass mail system of The Chinese University of Hong Kong and randomized into 3 conditions: immersive animation, text, and control. In the immersive animation condition (n=72), participants experienced the simulation of daily life and the stigma experienced as an animated story protagonist with mixed anxiety and depressive disorder with IVR. In the text condition (n=65), participants experienced an identical story to the immersive animation condition with first-person audio narration using the same virtual reality headset. In the control condition (n=69), participants watched a video about planets with IVR. All participants received interventions with a researcher-assisted Oculus Go virtual reality headset. Participants’ public stigma was measured through self-administered online questionnaires and compared across conditions and at different time points using repeated measures analysis of variance. Simple and sequential mediation analyses on the relationship of condition (immersive animation vs text) and follow-up public stigma with possible mediators, including sense of embodiment and story transportation, were conducted using PROCESS.

Results

Public stigma did not differ significantly across conditions at pre-experiment (P>.99). In the immersive animation and text conditions, public stigma was significantly reduced at postexperiment and at the 1-week follow-up compared to pre-experiment (all with P<.001). Public stigma in the control condition at postexperiment and follow-up remained unchanged compared with pre-experiment (P=.69). Immersive animation had significantly lower public stigma than the control at postexperiment (P=.003) and follow-up (P=.02). Text also had lower public stigma than the control at postexperiment (P=.007) and follow-up (P=.03). However, immersive animation did not significantly differ from text in public stigma at postexperiment and follow-up (both P>.99). In simple mediation models, both sense of embodiment (95% CI –0.22 to 0.46) and story transportation (95% CI –0.18 to 0.00) were not significant mediators. In the sequential mediation model, both sense of embodiment and story transportation were significant sequential mediators. Sense of embodiment was positively associated with story transportation (P<.001), while story transportation was negatively associated with public stigma (P<.001). The indirect effect of the sequential mediation model was significant (95% CI –0.38 to –0.11).

Conclusions

This study provides novel findings and a rigorous comparison in understanding the effects of IVR on public stigma. The findings showed that IVR and text with audio narration performed similarly and significantly in stigma reduction. Sense of embodiment and story transportation were found to be sequentially associated with public stigma reduction.

Trial Registration

Centre for Clinical Research and Biostatistics Clinical Trial Registry CUHK_Ccrb00638; https://www2.ccrb.cuhk.edu.hk/registry/public/632

Improving Attitudes Towards Personality Disorder: Is Training for Health and Social Care Professionals Effective?

Health and social care professionals are more likely to hold negative attitudes towards people with a diagnosis of personality disorder than toward people with other mental health diagnoses. Negative attitudes have also been found to adversely impact care and service provision. This review sought to systemically evaluate training aimed at improving professional attitudes towards people with a diagnosis of personality disorder. Electronic databases PsychINFO, PubMed, Embase, Web of Science, and ProQuest were searched, and 19 articles were identified. Results show that training is effective and that improvements tend to be maintained. The results suggest that (1) co-production with people with personal experience of a personality disorder diagnosis, (2) communicating a psychological model to participants, and (3) teaching participants clinical skills for use in their work improve effectiveness. Further research in the form of randomized controlled trials that use validated measures and follow-up participants for at least 6 months is needed.

Encouraging a Little Help from Our Friends: Resident Physician Burnout & Peer Communication Curriculum

INTRODUCTION

Resident physician burnout and depression rates are increasing faster than in the non-physician workforce. To foster a supportive community where such concerns may be addressed, residents can be educated in identification and first-line support of burnout in fellow residents. The literature has not described peer roleplaying applied toward aiding fellow residents with burnout.

METHOD

This pilot study evaluated an educational component aimed at fostering a strong emotional and informational social support system. The curriculum used peer roleplaying to develop self-awareness and social support, improve communication skills, and teach about existing mental health resources, thereby encouraging intervention. Residents listed behavioral manifestations of burnout and dysphoria that we developed into real-life scenarios. During experiential workshops, residents roleplayed "distressed" and "helper" residents and practiced communicating empathy. To tackle mental health stigma, all were required to practice expressing distress and seeking help. Residents completed a pre-roleplaying questionnaire, curriculum satisfaction questionnaire, and reflection essay.

RESULTS

All 42 Internal Medicine and Transitional Year residents (69% male, 93% international medical graduates) participated. Resident-reported comfort, competence, confidence, and knowledge increased, as did positive appraisals of the clinical teaching environment representing a safe atmosphere. Six themes were cited in >25% of essays: knowledge of communication techniques, knowledge of approach tactics or strategies, knowledge of hospital resources, commitment to helping colleagues, importance of burnout, and belief this training produced a better understanding of oneself.

CONCLUSION

As first-witnesses of resident physician distress, peers occupy an underutilized, yet crucial preventive and supportive role in burnout and mental health intervention, especially during times of shared crises such as the coronavirus pandemic. Creating roleplays from personal experiences facilitated meaningful discussion of burnout and dysphoric emotions. Roleplaying offered a low-cost, effective method to destigmatize and encourage discussion of burnout, educate on signs and symptoms, and learn available resources to offer an afflicted colleague in osteopathic and allopathic residency programs.

Depressive Symptoms, Help-Seeking, and Barriers to Mental Healthcare Among Healthcare Professionals in Lithuania

Summary. Background:

Previous research suggests that healthcare professionals (HCPs) experience high levels of work-related psychological distress, including depressive symptoms. Due to the stigma of mental health problems and other barriers, HCPs are likely to be hesitant to seek appropriate mental healthcare. We aimed to explore these phenomena among HCPs in Lithuania.

Methods:

A web survey inquiring about depressive symptoms, help-seeking, and barriers to mental health-care was conducted. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). 601 complete questionnaires were included in the analyses. The barriers to help-seeking were identified using the inductive content analysis approach. Descriptive, non-parametric, and robust statistical analysis was performed using SPSS software.

Results:

Most of the respondents have reported depression-like symptoms over the lifetime, although only about a third of them sought professional help. Of those, roughly half preferred a private specialist. The stigma and neglect of mental health problems were the most common barriers to help-seeking. Around half of the HCPs believed that seeking mental healthcare can imperil their occupational license. About a quarter of the HCPs screened positive for clinically relevant depressive symptoms. Statistically significant differences in the PHQ-9 score were found between categories of healthcare specialty, marital status, religious beliefs, workplace, and years of work as a HCP. Fewer years of work and younger age were associated with the higher PHQ-9 score.

Conclusions:

Our findings suggest that HCPs in Lithuania may be inclined not to seek appropriate mental healthcare and experience poor mental health, although stronger evidence is needed to verify these findings.

Public Attitudes Toward Psychiatric Hospitals: A Rural-Urban Comparative Public Survey in Odisha State, India

Background: Integration of psychiatric care with public health services and offering mental health care services to patients from lower socioeconomic status remains a global challenge. Scarcity of funds and professional workforce in psychiatric hospitals contribute to this situation. However, negative attitudes in the population are also a known impediment to patients seeking mental health services. This study aimed to assess the attitudes toward psychiatric hospitals among the urban and rural population in India. Subjects and Methods: The study was carried out amongst the general population in Odisha, India. The total sample (n = 988) includes 496 respondents from an urban-setting, and 492 respondents from rural parts of the district. Participants were selected by using simple random-sampling from the Asian Institute of Public Health (AIPH) data base. A standardized seven-item questionnaire was adopted, with responses indicated on a 5-point Likert-scale. Interviews were fully structured and conducted face-to-face. Results: Level of education (B = -0.192, ß = -0.320, p < 0.000) and urban-rural comparison (B = -0.272, ß = -0.189, p < 0.000) significantly influenced attitudes toward psychiatric hospitals. Gender, age, and religious beliefs did not show any significant effect on attitudes toward psychiatric hospitals. Individuals in rural areas and those with lower education levels showed more negative attitudes toward psychiatric hospitals. Conclusion: Negative attitudes toward psychiatric hospitals from those living in rural areas as well as those with lesser education may be reflective of the lack of availability, accessibility, affordability, and credibility of such mental health services. The Mental Health Care Act in India is a progressive legislation which might improve the situation of the provided services and, consequently, reduce negative attitudes in the years to come.

Is a Rose Really Just as Sweet? Editorial: On Becoming "Research on Child and Adolescent Psychopathology"

The current editorial outlines the reasoning that went into changing the name of the Journal of Abnormal Child Psychology to Research on Child and Adolescent Psychopathology. Connotations of the term "abnormal" have changed, since it was first used for the journal title in 1973. It is now frequently interpreted as describing the person, and not the condition that he or she has. It also does not currently promote the view that the person needs professional intervention but is often interpreted as indicating that the person is defective in some way. The new name of the journal was not intended to promote any single way of conceptualizing mental health problems but to provide a name that captures the significant distress and impairment experienced by persons with serious psychological difficulties, recognizes the need for professional intervention for these individuals, and attempts to minimize potential harmful effects of labelling. This name change is embedded in a broader appeal for mental health professionals to be sensitive to how labels can reinforce the stigma associated with mental health problems and to work to change the stigma that is associated with such problems in most modern societies.

Mental health stigma among Middle Eastern adolescents: A protocol for a systematic review

WHAT IS KNOWN ON THE SUBJECT?: Four out of every five people with mental health disorders face stigma. Mental health and, consequently, mental health stigma are very common among youth living in the Middle East countries. Several studies have investigated mental health among adolescents in the Middle East, but studies on stigma are very scattered. There is no systematic review on stigma among adolescents with mental disorders across all the Middle East countries despite the common historical roots, similar cultural backgrounds, and recent widespread problems in the area. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper will aim to review and analyse the studies on stigma among adolescents with mental disorders in the Middle East countries, from different aspects such as the age rang, kind of stigma and risk factors of stigma. The study will cover studies on all kinds of stigma among Middle Eastern adolescents up to 18 years old published between 2000 and 2019. The study terms are generally focused on four categories: (a) kinds of Stigma, (b) Mental health problems, (c) Age range and (d) Region of study population. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Increasing understanding and awareness of different angles of mental health stigma among adolescents may be helpful for better coping with this challenge. Understanding the nature of stigma may give adolescents the ability of ignoring it and avoid starting self-stigma and/or stopping to seek help. ABSTRACT: Introduction Although many epidemiological and interventional investigations regarding improving mental health among youth in the Middle East have been performed, there is no systematic review specifically analysing the studies on stigma among adolescents with mental disorders (A-MDs) across all Middle East countries despite their common historical roots, similar cultural backgrounds, and recent widespread problems in the area. Purpose We will aim to systematically review and analyse the English language studies on stigma among A-MDs in the Middle East published between 2000 and 2019. Method The Web of Knowledge, Science Direct, PsycINFO and MEDLINE are electronic databases that will be included in this study. Furthermore, the bibliography lists of eligible articles will be manually searched for additional included articles. Descriptive statistics will be represented by mean score and standard deviation for continuous data and number/percentage for categorical data. Discussion This study may act as a resource for future studies attempting to assess and/or reduce stigma among children and adolescents with mental health issues specifically in the Middle East. Implications It is important for healthcare providers, including nursing professional, to improve their knowledge and vision towards stigma in their community. The outcomes of this study can be a shortcut reaching this information.

Using Item Response Theory to Develop Revised (SSOSH-7) and Ultra-Brief (SSOSH-3) Self-Stigma of Seeking Help Scales

The current research developed ultra-brief (SSOSH-3) and revised (SSOSH-7) versions of the Self-Stigma of Seeking Help scale. Item response theory was used to examine the amount of information each item provided across the latent variable scale and test whether items functioned differently across women and men. In a sample of 857 community adults, results supported removal of three reverse-scored items to create the SSOSH-7. The three most informative items were retained to create the SSOSH-3. Differential item functioning testing supported the use of both versions across women and men. Results replicated in an undergraduate student sample (n = 661). In both samples, the SSOSH-3 (αs = .82-.87) and SSOSH-7 (αs = .87-.89) demonstrated evidence of internal consistency. The SSOSH-3 (rs ≥ .89) and SSOSH-7 (rs ≥ .97) were highly correlated with the original SSOSH across samples and demonstrated significant correlations with help-seeking constructs and in similar magnitude to the original SSOSH.

The Wicked Problem of Stigma for Youth Living With Anxiety

Anxiety disorders typically emerge in childhood and, if left untreated, can lead to poor health and social outcomes into adulthood. Stigma contributes to the burden of mental illness in youth. Mental health stigma has been conceptualized as a wicked problem and efforts to address this complexity require a greater understanding of how stigma operates in the lives of youth. Fifty-eight youth in Manitoba, Canada aged 10 to 22 years and living with anxiety took part in the study. Data collection involved in-depth interviews and arts-based methodologies. Youth living with anxiety faced stigma at three levels: (a) interpersonal, (b) intrapersonal, and (c) structural. Stigma held by others, internalized by youth and embedded in social institutions led to compromised relationships with family and peers, low self-esteem and self-efficacy, reduced help-seeking, and discrimination in school, workplace and health care settings. Implications and potential strategies for addressing these levels of stigma are discussed.

Stigma and discrimination as correlates of mental health treatment engagement among adults with serious mental illness

OBJECTIVE

The negative impacts of stigma on mental health treatment initiation are well established, but the relationship of stigma to proactive engagement in mental health treatment (e.g., actively working toward therapy goals) is largely unexamined. This study examined the relationship between mental health treatment engagement and stigma experiences, discrimination experiences, and internalized stigma among adults with serious mental illness. Age, race, gender, and education were tested as moderators of the relationships between stigma-related variables and treatment engagement.

METHOD

Data were collected from 167 adults with serious mental illnesses who were receiving services at 5 psychosocial rehabilitation programs. Treatment engagement was assessed by participants' primary mental health care providers, using the Service Engagement Scale. The relationship between treatment engagement, stigma, and discrimination as well as potential demographic moderators were tested with Pearson's correlations and multiple linear regressions.

RESULTS

Treatment engagement was not correlated with experiences of stigma, experiences of discrimination, or application of stigmatizing beliefs to self. Gender, race, and age were not significant moderators but education was. Experiences of stigma were associated with greater treatment engagement in those with a higher level of education (p = .007), whereas application of stigma to one's self was associated with poorer treatment engagement in those with a higher level of education (p = .005).

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Among individuals with higher levels of education, efforts to prevent internalization of public stigma may be crucial to promote proactive mental health treatment. Replication studies are needed to confirm these findings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Pharmacy and Medical Students' Mental Health Symptoms, Experiences, Attitudes and Help-Seeking Behaviors

Objective. To examine and compare the prevalence of mental health problems, help-seeking attitudes, and perceptions about mental health problems among US pharmacy and medical students. Methods. A cross-sectional analysis was conducted using existing, anonymous survey data collected in the Healthy Minds Study during the 2015-2016 academic year. The analysis included 482 students (159 pharmacy students and 323 medical students) from 23 institutions in the United States. Analyzed topics included demographic characteristics, mental health status and symptoms, substance abuse, stigma related to mental health, help-seeking behaviors and attitudes, and mental health treatment perceptions. Results. Pharmacy and medical students experienced similar rates of depression (18% met clinical cut-offs), but pharmacy students were more likely to meet clinical cutoffs for anxiety (21% vs 11%). Pharmacy students were less likely to seek help from student counseling services (only 11% vs 49%) and also less likely to know where to seek help on campus if needed. Pharmacy students also reported having higher levels of stigma regarding mental health treatment. Conclusion. There are differences between pharmacy and medical students with regards to their experience of mental health symptoms, willingness to seek help, and perception of stigma. Despite the small sample, this analysis of national data indicates that opportunities exist to improve campus-based mental health education and offerings for pharmacy and medical students.

Mental health and stigma on campus: Insights from students' lived experience

The JED Campus framework presents a multi-faceted approach to how colleges and universities can provide quality mental health services to their students and enhance the support of the campus community. However, research has suggested that a significant barrier to students seeking help and utilizing on-campus resources is the fear of stigma associated with mental illness. The current study was interested in learning more from students with mental health diagnoses about their experiences on campus. Focus groups were conducted and topics discussed included stigma, impact of university policies, and how resources could better address student needs. The findings suggest that students feel stigma is a significant barrier in how mental health is addressed on campus and that universities need to be more proactive in their approach to create a safe and inclusive campus for all members of the community.

Use of an Educational Video to Reduce Barriers to Military Mental Health Care

OBJECTIVE

Although there is significant need for mental health care among service members, stigma surrounding these services, along with myths associated with behavioral health treatment, discourages care seeking. This study evaluated the effect of a video designed to demystify mental health treatment on barriers to seeking care among military personnel.

METHODS

Participants were 294 active duty U.S. Marine Corps personnel who were randomly assigned to the intervention video only, the intervention video with discussion, or an attentional control video. Participants completed questionnaires that assessed social stigma regarding mental health treatment and willingness to seek help at pretest, posttest, and 6-week follow-up; personal desire for mental health care was assessed at pretest and 6-week follow-up.

RESULTS

Participants who viewed the intervention video in either condition showed significant and similar decreases in social stigma and increases in willingness to seek help at posttest (p<.001), whereas participants in the control group showed no change at posttest in either variable. Although social stigma did not differ by intervention group at the 6-week follow-up, participants in either intervention were 2.56 times more likely than participants in the control group to report a personal desire for mental health care at the 6-week follow-up (p=.05). There were no significant differences between the two interventions on the main outcomes.

CONCLUSIONS

A video in which mental health care providers explain the treatment process may be effective as an initial stand-alone social stigma reduction intervention. Additional efforts are likely needed to sustain effects and to realize increases in help-seeking behavior.

Mental health stigma among people of color: An examination of the impact of racial discrimination

OBJECTIVE

The primary goal of this study was to examine the relations between racial discrimination experiences and different dimensions of mental health stigma among a diverse sample of people of color.

METHOD

Participants were recruited through blast emails at a large public university and completed an online survey (N = 205). Four linear regressions were completed predicting from recent racial discrimination experiences to (1) negative beliefs about mental health problems, (2) treatments, (3) treatment seeking and (4) anticipated stigma.

RESULTS

Results indicated that recent racial discrimination experiences contributed unique variance in anticipated stigma from loved ones, as well as negative beliefs about mental health problems.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Racial discrimination contributes to increased anticipated stigma and negative beliefs about mental health problems. Addressing the impact of racial discrimination as it influences these dimensions of mental health stigma is important to promote recovery among people of color.

Increased Rates of Mental Health Service Utilization by U.S. College Students: 10-Year Population-Level Trends (2007-2017)

OBJECTIVE

This study aimed to document population-level trends in mental health service utilization by college students.

METHODS

The study drew on 10 years of data from the Healthy Minds Study, an annual Web-based survey, with a sample comprising 155,026 students from 196 campuses. Analyses focused on past-year mental health treatment and lifetime diagnoses of a mental health condition. Changes in symptoms of depression and suicidal ideation and levels of stigma were hypothesized as potential explanatory factors.

RESULTS

Rates of treatment and diagnosis increased significantly. The rate of treatment increased from 19% in 2007 to 34% by 2017, while the percentage of students with lifetime diagnoses increased from 22% to 36%. The prevalence of depression and suicidality also increased, while stigma decreased.

CONCLUSIONS

This study provides the most comprehensive evidence to date regarding upward trends in mental health service utilization on U.S. campuses over the past 10 years. Increasing prevalence of mental health problems and decreasing stigma help to explain this trend.

Altered States of Consciousness: Evaluation of a voice-hearing simulation during an immersive art exhibition

AIM

To improve public understanding of the subjective experience of auditory hallucinations and increase empathy towards individuals who hear voices and have other unusual sensory experiences.

METHODS

This pilot study developed a new immersive art exhibition, Altered States of Consciousness, which gave members of the public an individualized voice-hearing simulation experience in 2 real-world settings-an art gallery and the London Underground. A total of 150 visitors completed visual analogue scales immediately before and after their experience of the exhibition.

RESULTS

Post-exhibition, there were significant increases in understanding what it feels like to hear voices, compassion towards voice hearers, and comfort in talking about these experiences. Participants enjoyed the simulation, felt they learned from their involvement, and did not find it stressful.

CONCLUSIONS

The exhibition and voice-hearing simulation has further potential for public engagement and stigma reduction.

Integrated primary care: patient perceptions and the role of mental health stigma

Some patients are more willing to see a behavioral health provider within primary care. The purpose of this study was to evaluate the patients’ perspectives of having access to a psychologist within primary care and to investigate whether mental health stigma affected preferences. In total, 36 patients completed questionnaires after seeing a psychologist in primary care. Patients were satisfied with having a primary care psychologist involved in their care. Most patients were more likely to see the psychologist in primary care and those who preferred this indicated higher levels of mental health stigma. The overarching theme for why patients saw a psychologist in primary care was convenience. Mental health stigma may also have played a role. Results suggest that providing integrated services may reach patients who may not have otherwise sought services in a behavioral health clinic. Findings from this study encourage the continued integration of behavioral health services.

Accounting for differences in risk of HCV re-infection by mental health diagnoses

There is widespread concern regarding the potential for hepatitis C virus (HCV) reinfection among key populations, particularly among people who inject drugs (PWID) and those living with a mental health condition. Area Covered: In this editorial we discuss the potential for specific mental health diagnoses (e.g., bipolar vs. substance use associated mania, vs. schizophrenia related disorders) to impact reinfection risk. This is an important consideration given distinct variations in risk behaviors for blood-borne virus infections (e.g., needle sharing) and patterns of health service use between diagnoses. Consideration of psychotropic agents may also have an effect on HCV reinfection given the supplemental influence of certain agents (e.g., typical antipsychotic drugs) on risk behaviours. Expert Commentary: An improved understanding of these effects may foster the beginning of a new era in the response to the optimal delivery of harm reduction programs and HCV care among PWID and those living with a mental health condition.

Perceived and Personal Mental Health Stigma in Latino and African American College Students

Mental health stigma occurs when people have negative thoughts and beliefs of those with mental health illnesses or mental health treatment. Mental health stigma is related to an assortment of negative outcomes including discrimination in housing and employment, reduced usage of mental health services, and poor mental health outcomes. These implications may be particularly salient for ethnic minorities such as African Americans and Latinos who already suffer from other types of discrimination. This study examines perceived and personal mental health stigma in African American and Latino college students from a nontraditional university to help elucidate factors related to the development of mental health stigma. Students completed surveys concerning their stigma beliefs. African American students were found to have higher rates of mental health stigma than Latino students. Furthermore, anxiety about those with mental illness was related to greater mental health stigma for both groups. For African Americans, it was found that their perception of their ability to visibly identify those with mental illness was related to greater mental health stigma. These findings suggest that interventions to reduce mental health stigma in college students should target specific ethnic minority groups and focus on issues that are particularly salient to those communities.

Attitude toward psychiatrists and psychiatric medication: A survey from five metropolitan cities in India

BACKGROUND

Stigmatization and overall scarcity of psychiatrists and other mental health-care professionals remain a huge public health challenge in low- and middle-income countries, more specifically in India. Most patients seek help from faith healers, and awareness about psychiatrists and treatment methods is often lacking. Our study aims to explore public attitudes toward psychiatrists and psychiatric medication in five Indian metropolitan cities and to identify factors that could influence these attitudes.

MATERIALS AND METHODS

Explorative surveys in the context of public attitudes toward psychiatrists and psychiatric medication were conducted using five convenience samples from the general population in Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). We used a quota sample with respect to age, gender, and religion using the census data from India as a reference.

RESULTS

Mean scores indicate that attitudes toward psychiatrists and psychiatric medication are overall negative in urban India. Negative attitudes toward psychiatrists were associated with lower age, lower education, and strong religious beliefs. Negative attitudes toward psychotropic medication were associated with lower age, male gender, lower education, and religion.

CONCLUSION

In line with the National Mental Health Policy of India, our results support the perception that stigma is widespread. Innovative public health strategies are needed to improve the image of psychiatrists and psychiatric treatment in society and ultimately fill the treatment gap in mental health.

Exploring attitudes toward eating disorders among elite athlete support personnel

To date, little is known about the beliefs, attitudes, and experiences of athlete support personnel (ASP) working in elite sport toward disordered eating (DE) and eating disorders (EDs). This study seeks to explore this area of mental health, employing an attribution model of stigma as a conceptual lens. Interviews were undertaken with 14 service providers (seven males and seven females) working in high-performance sport in Ireland. In contrast to previous research in the general population, findings revealed that sport-based personnel, in the main, did not hold the individual responsible for the development of their eating disorder. The predominant emotional response of those who had worked with an athlete with a known or suspected eating disorder was anxiety and worry. In line with the findings of previous studies with other health professionals, negative views on the prognosis of those with EDs were expressed by the ASP. Furthermore, confidentiality was found to be a significant barrier to bringing athletes' disclosure of problematic eating or exercise behavior to the fore. The findings of this study add to the limited research exploring attitudes toward EDs in sport and highlights the importance of greater education and openness toward this particular mental health problem.