Prejudice, social distance, and familiarity with mental illness

Benevolence Toward Schizophrenia Scale: Construction and evidence of validation

Abstract The aim of this study was to construct and seek evidence for the validity of the Escala de Benevolência frente à Esquizofrenia (Benevolence Toward Schizophrenia Scale). Two studies were conducted in Joao Pessoa, Paraíba, Brazil. Study 1 describes the development and evidence of the factor validity of the Benevolence Toward Schizophrenia Scale with a sample composed of 200 university students aged 16 to 51 years old (M = 25.31; SD = 7.21). The data were subjected to exploratory factor analysis, which revealed one single seven-item factor that explained 37.74% of the variance and a satisfactory Cronbach’s alpha (0.77). The aim of Study 2 was to test the goodness-of-fit of the Benevolence Toward Schizophrenia Scale factor structure with a sample composed of 200 university students aged 16 to 52 years old (M = 24.82; SD = 6.97). The one-factor structure exhibited adequate goodness-of-fit; the composite reliability value was 0.83, which indicates scale stability and satisfactory psychometric parameters for assessing benevolent prejudice toward schizophrenia.

Stigma of Mental Illness in Germans and Turkish Immigrants in Germany: The Effect of Causal Beliefs

Background: Stigma poses an additional burden for people suffering from mental illness, one that often impairs their social participation and can prevent them from seeking adequate help. It is therefore crucial to understand how stigma develops in order to counteract it by setting up effective evidence-based anti-stigma interventions. The present study examines the effect of causal beliefs on stigmatizing behavioral intentions, namely people's desire to distance themselves from persons with mental illness. In addition, we draw cross-cultural comparisons between native Germans and Turkish immigrants to investigate the influence of culture on stigma and causal beliefs and to broaden knowledge on the biggest immigrant group in Germany and on immigrants in Western countries in general. Methods: n = 302 native Germans and n = 173 Turkish immigrants were presented either a depression or a schizophrenia vignette. Then, causal beliefs, emotional reaction and desire for social distance were assessed with questionnaires. Path analyses were carried out to investigate the influence of causal beliefs on the desire for social distance and their mediation by emotional reactions for Germans and Turkish immigrants, respectively. Results: We found an influence of causal beliefs on the desire for social distance. Emotional reactions partly mediated this relationship. Causal attribution patterns as well as the relationship between causal attributions and stigma varied across both subsamples and mental illnesses. In the German subsample, the ascription of unfavorable personal traits resulted in more stigma. In the Turkish immigrant subsample, supernatural causal beliefs increased stigma while attribution to current stress reduced stigma. Conclusion: Our study has implications for future anti-stigma interventions that intend to reduce stigmatization of mentally ill people. Targeting the ascription of unfavorable personal traits and supernatural causal attributions as well as promoting current stress as the cause for mental illness appears to be of particular importance. Also, the mediating influence of emotional responses to causal beliefs needs to be addressed. Furthermore, differential interventions across cultural groups and specific mental illnesses may be appropriate.

"It opened up a whole new world for me": Experiences of military commanders in employing individuals with intellectual disabilities

BACKGROUND

Research on supported employment for individuals with intellectual disabilities has focused mainly on its effect on employees. Scant research has assessed the influence on employers and on the work setting. This study focused on a unique program to foster the employment of individuals with intellectual disabilities in the Israeli military and examined the effect of the program on the employers (military commanders) and on the military units.

METHOD

Semi-structured interviews were conducted with 28 military commanders.

RESULTS

Four themes illustrate the influence of people with intellectual disabilities on the military units in which they work: (a) functioning of the military unit, (b) effect on other soldiers, (c) effect on commanders, and (d) effect on attitudes toward people with intellectual disabilities.

CONCLUSIONS

Results suggest that employing soldiers with intellectual disabilities has beneficial effects on both commanders and the military units, although some negative attitudes remain and merit interventions.

Dehumanization, prejudice, and social policy beliefs concerning people with developmental disabilities

We investigated the nature of prejudice toward people with developmental disabilities, its potential roots in dehumanization, its implications for social policy beliefs affecting this target group, and strategies for reducing prejudice toward people with developmental disabilities. Studies 1 ( N = 196, MTurk) and 2 ( N = 296, undergraduates) tested whether prejudice took a hostile or ambivalent (both hostile and benevolent components) form. Consistent support for a hostile prejudice model was found. This model was comprised of beliefs that people with developmental disabilities may harm others, should be kept separate from others, and are dependent on others. Also, greater dehumanization was associated with greater prejudice, and prejudice mediated the effect of dehumanization on participants’ social policy beliefs. Study 3 ( N = 151, MTurk) provided construct validity for the newly developed multidimensional measure of prejudice. Study 4 ( N = 156, undergraduates) showed that presenting a person with developmental disabilities in either humanizing or individuating ways reduced dehumanization and prejudice and, in turn, increased the favorability of social policy beliefs.

On continuum beliefs and psychiatric stigma: Similarity to a person with schizophrenia can feel too close for comfort

Continuum belief interventions that blur boundaries between "normal" individuals and individuals with psychiatric problems have shown promise in reducing psychiatric stigma. Interventions to date have afforded participants considerable psychological distance from individuals with mental illness. An intervention that compels psychological closeness to individuals with mental illness may lead to increased anxiety/threat and an attenuated intervention effect on stigma. In a randomized experiment, one hundred thirty-five participants listened to a bogus interview involving an ostensible person with schizophrenia who shared numerous characteristics in common with participants. In the interview, the target person (1) did not verbally broach issues of similarity to "normal" people, (2) endorsed a continuum view, or (3) endorsed a categorical view. Participants then read a bogus research article on schizophrenia that (1) was agnostic with respect to the continuum/categorical distinction, (2) attested to a continuum view, or (3) attested to a categorical view. Correlational analyses demonstrated that greater endorsement of continuum beliefs predicted less stigma. Experimental analyses demonstrated that the continuum intervention had no effect on stigma. The continuum intervention increased participants' feelings of anxiety/threat, measured via self-report and a lexical decision task. These findings might usefully inform the design of stigma reduction programming centered on continuum beliefs.

Stigma toward people with mental health problems in Indonesia

Introduction

Mental health problems are serious issues in Indonesia. The prevalence of severe mental disorder in Indonesian population is 1.7‰. In community, people with mental disorder are often stigmatized, while in fact this stigmatization could negatively impact them. One of the most common form of discrimination toward people with mental disorder is the practice of pasung.

Method

This research conducted a survey study on 1,269 respondents in East Java (in which the prevalence of severe mental disorder is 2.2‰). The instruments used were Community Attitudes towards Mental Illness (CAMI), Mental Health Knowledge Schedule (MAKS), and a sociodemographic questionnaire.

Result

The result shows that better knowledge about mental health was associated with lower public stigma toward people with mental disorder. Significance differences in stigma toward people with mental illness were also found across groups of age, sex, experience of contact, history of mental disorder, attitude toward pasung, marital status, and income level.

Conclusion

The finding implies that anti-stigma interventions in Indonesia should consider associated sociodemographic factors and use psychosocial approach to improve literacy and contact with mental health patients.

Investigation of attitudes toward mental illness among nursing students in Indonesia

Objective

People with mental illness (PMI) are often stigmatized or experience negative attitudes from society. In particular, nursing students’ attitudes toward PMI will influence the quality of care these patients receive. Some factors influencing attitudes toward PMI among nursing students have been identified. The present study aimed to examine factors influencing attitudes toward mental illness among nursing students in Indonesia.

Methods

Nursing students (n = 317) were assessed for attitudes toward mental illness using the Community Attitude toward the Mentally Ill questionnaire. Details regarding sociodemographic variables (age, gender, ethnicity, year of study, monthly family income, personal experience with mental illness, family history of mental illness, and knowing or having direct contact with PMI) and knowledge about mental illness by using Mental Health Knowledge Schedule questionnaire were also obtained.

Results

The mean Community Attitude toward the Mentally Ill questionnaire score was 103.75 ± 9.15, with the highest mean of the four subscales being that of authoritarianism 27.97 ± 2.87 followed by social restrictiveness, community mental health ideology, and benevolence 27.52 ± 3.68, 24.38 ± 3.80, and 23.89 ± 3.27, respectively. The factors significantly associated with nursing students’ attitudes toward mental illness were age (r = −0.18, P = 0.001), year of study (H = 16.65, P < 0.001), knowing or having direct contact with PMI (Z = −2.35, P = 0.019), and knowledge of mental illness (r = −0.22, P < 0.001).

Conclusions

Several demographic variables, direct contact with PMI, and level of knowledge about mental illness can contribute to variations in attitudes toward PMI among nursing students in Indonesia. Education and direct contact with PMI serve as intervention strategies to reduce negative attitudes and stigma associated with mental illness among nursing students.

Political attitudes as predictors of the multiple dimensions of mental health stigma

BACKGROUND

Mental health (MH) stigma is multidimensional and remains common in the United States and throughout the world. While sociopolitical attitudes such as right-wing authoritarianism (RWA) have emerged as strong predictors of some aspects of MH stigma, no study has assessed the relationship between RWA and multidimensional components of MH stigma, or linked this relationship to a theory of stigma.

AIMS

The association between RWA and multiple stigma outcomes, including stereotypes, attributions/negative affect, social distance, microaggressions and help-seeking self-stigma was assessed controlling for covariates, including education, age, social desirability, race/ethnicity, gender, geographic location and prior contact with mental illness.

METHOD

A total of 518 US residents (from all geographic regions; convenience sample) completed an online survey.

RESULTS

Findings indicated that RWA was significantly associated with all MH stigma dimensions analyzed, even after controlling for covariates. A hypothesized mediator for this relationship, dangerous world beliefs, was not supported as a theoretical explanation.

CONCLUSION

Right-wing authoritarianism predicts various dimensions of mental health stigma, but more research is needed to determine the theoretical underpinnings. These current findings may guide research in this area and be used to target a variety of conservative audiences for stigma reduction.

Burden of common mental disorders among pregnant women: A systematic review

INTRODUCTION

Common mental disorders (CMDs) including depressive and anxiety disorders during antenatal period is reported to affect both mother and child health outcomes. There is scarce evidence about burden of CMDs during pregnancy from Lower and Middle Income Countries.

OBJECTIVE

To review the evidence about the burden of common mental disorders among pregnant women METHODS: Major databases were searched systematically for English language studies on prevalence of CMDs. Quality assessment of studies was done with the modified version of Newcastle-Ottawa Scale for non-analytical studies.

RESULTS

Twenty three studies were included in the review. The prevalence of CMDs among pregnant women ranged from 1%-37%. Depression was more commonly studied (ranged from 1%-30%). Prevalence of GAD ranged from 1%-26%. Factors commonly associated with CMDs were lower SES, intimate partner violence, history of previous episode of CMDs, history of mental illness in family and unmarried status. Effect of CMDs on child health outcome was also detected.

CONCLUSION

CMDs are common during pregnancy with varying prevalence depending on various settings and scales used.

Student pharmacists' social distancing toward people with mental illness

Introduction

Findings from previous studies indicated patients with mental illness feel pharmacists do not provide appropriate care. In addition, many patients with mental illness report not having a strong relationship with their pharmacist. The objective of this study was to determine the level of social distance of student pharmacists toward patients with mental illness.

Methods

Student pharmacists completed an anonymous survey. Data were collected using the Bogardus Social Distance Scale (SDS). Level and correlates of social distancing were examined.

Results

Incomplete surveys were excluded, resulting in 334 completed surveys. A total of 276 students (83%) had an SDS score ≥14, indicating social distancing. There was no statistical difference noted in social distancing between students and year of training (P = .482). The greatest social distancing was in relation to trusting someone with mental illness to "care for their child," where less than 1 in 5 students (17%) were willing to do this. Most students (88%) were willing to work or be neighbors with someone with mental illness, indicating less social distancing in these domains. Regression analysis indicated a significant change in sum score with knowing someone or having a first-degree relative with mental illness.

Discussion

Results indicate social distancing is prominent among pharmacy students. Results may be used in the future to help identify solutions for improving social distancing and increasing pharmacy student interaction to patients with mental illness. Further training related to mental illness may assist with decreasing social distancing among pharmacy students.

Mental Health Related Stigma as a 'Wicked Problem': The Need to Address Stigma and Consider the Consequences

Recent reviews on the evidence base for mental health related stigma reduction show that under certain conditions interpersonal contact is effective in promoting more positive attitudes, reduced desire for social distance, and increased stigma related knowledge (knowledge which disconfirms beliefs based on stereotypes). Short-term interventions may have effects that are attenuated over time; longer term programmes may support sustained improvements, but research following up long-term interventions is scarce. However, the effectiveness of these interventions should not obscure the nature of stigma as a social problem. In this article we describe stigma as a 'wicked problem' to highlight some implications for intervening against stigma and evaluating these efforts. These include the risks of unintended consequences and the need to continually reformulate the concept of stigma, to ensure that tackling stigma at the structural, interpersonal, and intrapersonal levels become part of the core business of stakeholder organisations. We compare the main targets of anti-stigma programmes with what is known about the sources of stigma and discrimination and their impacts to identify targets for future intervention. In some cases, interventions have been directed at the interpersonal level when structural level intervention is also needed; in others, systematic reviews have not so far identified any interventions.

An examination of perceptions of individuals with an intellectual disability, with and without co-morbid schizophrenia: effects of labels on stigma

BACKGROUND

Research demonstrates negative perceptions of individuals with intellectual disabilities (ID) and individuals with schizophrenia, but no study has examined ID with a co-morbid psychiatric disorder. The present study examined the social distance desired from and perceptions of dangerousness of ID, schizophrenia and co-morbid schizophrenia and ID and examined the impact of providing a label for the behaviours presented in a vignette.

METHODS

A total of 160 participants, all university students, were randomly assigned to one of six vignettes detailing a person with schizophrenia, ID, or a person with both presenting problems. Half of the participants were randomly assigned to read vignettes that had a label provided for the behaviours of the target.

RESULTS

Participants desired more social distance from the unlabelled than labelled targets. Presence of schizophrenia resulted in increased social distance, but co-morbid ID and schizophrenia elicited less desire for social distance than schizophrenia alone. Schizophrenia resulted in more perceived danger, but labelled co-morbid schizophrenia and ID resulted in little perceived danger.

CONCLUSIONS

Labels resulted in positive outcomes, particularly, when ID was co-morbid with schizophrenia. Schizophrenia stigma appears to be impacted by an ID label, indicating educating the public about the spectrum of co-morbidity may be useful.

Addressing the public health concerns of Fetal Alcohol Spectrum Disorder: Impact of stigma and health literacy

BACKGROUND

Fetal alcohol spectrum disorders (FASD) are a group of developmental disabilities that may result from the mother's consumption of alcohol during pregnancy. The present study examined the effects of health literacy and stigma on the public health agenda for preventing FASD.

METHODS

Three hundred and forty-one participants were sampled to ascertain levels of endorsement of the public health priorities of FASD, and FASD health literacy. Stigma towards women who consume alcohol during pregnancy, and towards biological mothers of children with FASD were operationalized using ratings of difference and disdain.

RESULTS

Public stigma towards women who consume alcohol during pregnancy was greater than stigma towards biological mothers of children with FASD. Research participants with higher FASD literacy were more likely to endorse the prevention priorities of FASD, but also more likely to endorse greater stigma towards biological mothers of children with FASD. Interestingly, those who endorsed greater stigma supported the public health priorities of FASD more strongly. Female research participants more strongly supported the prevention priorities of FASD than male participants. Male participants were more likely to endorse stigma than female participants.

CONCLUSIONS

Stigma experienced by biological mothers of children with FASD generalizes to women who consume alcohol while pregnant. Some results were contrary to expectations: stigma was positively associated with health literacy and endorsement of prevention priorities of FASD. Reasons for these findings are speculated and should be tested in future research.

Social Distance and Community Attitudes Towards People with Psycho-Social Disabilities in Uttarakhand, India

Stigma is an important contributor to the large treatment gap for people with mental and psycho-social disabilities (PPSD) in India. Social distance as assessed by willingness to engage in relationships with PPSD is a proxy measure of stigma and potential discrimination. In North India, investigations of community attitudes towards PPSD have been limited. To describe attitudes towards people with depression and psychosis, a community sample of 960 adults in Dehradun district, India from 30 randomised clusters, was surveyed using a validated tool to assess social distance, beliefs and attitudes related to mental illness. Participants preferred greater social distance from a person with psychosis than a person with depression. Beliefs and attitudes around mental illness were diverse reflecting a wide spread of belief frameworks. After controlling for confounding, there was increased social distance among people who believed PPSD were dangerous. Factors that reduced social distance included familiarity with PPSD, and belief that PPSD can recover. Attitudes to PPSD, stigma and social distance are complex and likely to require complex responses that include promoting awareness of mental health and illness, direct contact with PPSD and increasing access to care for PPSD.

Systematic review of studies of mental health nurses' experience of anger and of its relationships with their attitudes and practice

WHAT IS KNOWN ON THE SUBJECT?: It is generally felt that it is helpful for mental health nurses to control their emotions during their work. There are different approaches, but there is growing acceptance that different emotions may need different coping strategies. There is lots of evidence that nurses sometimes feel anger in a number of situations, but the research about anger in mental health nurses has never been examined as a whole. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We have systematically identified all previous research where nurses completed measures that tried to measure their anger in certain situations, compared it to other people or investigated how it affected them or what its relationship was with their practice. Only a few studies have measured nurses' anger. However, it seems that while nurses are not generally angrier than any other group, they do often feel anger in relation to management of patient aggression and their job situation more generally. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Anger is the most commonly reported problematic emotion for mental health nurses. It may influence their practice and affect their well-being. This has implications for staff support and training.

ABSTRACT

Introduction Emotional regulation is important in mental health nursing practice, but individual emotions may require different regulation strategies. There is ample evidence that nurses experience anger specifically during their work, for example when experiencing patient aggression. It is, therefore, important to consolidate what is known about how anger manifests in mental health nursing practice.

AIM

We aimed to systematically identify, evaluate and synthesize results from studies about mental health nurses and anger, where anger was measured objectively.

METHODS

Systematic literature review based on PRISMA guidelines.

RESULTS

We identified 12 studies. A range of validated and nonvalidated instruments was used. Mental health nurses may have lower levels of anger than normative samples, but anger is commonly reported as an issue for them. Anger was studied in relation to its links with (1) clinical management of patients, notably violence containment; and (2) employment issues more generally, notably job motivation. Anger is related to nurses' attitudes about the acceptability of coercion, but there is no evidence that it results in more coercion.

IMPLICATIONS FOR PRACTICE

Nurses should be aware of the potential influence of anger on their practice. Anger, specifically, should be considered when supporting mental health nurses, for example in clinical supervision. Emotional regulation training should target anger.

Self-Stigma and Age-Related Hearing Loss: A Qualitative Study of Stigma Formation and Dimensions

PURPOSE

This study explored experiences of self-stigma among older persons with age-related hearing loss (ARHL) using Corrigan's conceptualization of self-stigma process formation and the attribution model as its theoretical framework.

METHOD

In-depth semistructured interviews were conducted with 11 older persons (mean age = 81 years) with ARHL.

RESULTS

Self-stigma was present in the lives of the participants. Analysis revealed the existence of 3 stages of self-stigma in which the 3 core dimensions of stigma (cognitive attributions: being old, stupid, and crippled; emotional reactions: shame, pity, and feeling ridiculed; and behavioral reactions: concealment, distancing, and adapting to hearing aids) were observed. Hearing devices emerged as having a significant influence on stigmatic experiences in all stages and dimensions of self-stigma.

CONCLUSION

The study contributes to the theoretical and practical understanding of self-stigma regarding ARHL as well as to the understanding of the role of hearing devices in the development of this stigma.

A Brief Survey of Public Knowledge and Stigma Towards Depression

BACKGROUND

The burden from depression is affected by the public's beliefs, stigma, and resulting behavior. Lack of knowledge, misunderstanding, and stigma about depressed people and their surroundings are barriers to improving their mental health. This study aimed to examine public beliefs regarding depression, especially how to recognize depression, treatment, and stigma.

METHODS

A self-administered questionnaire was distributed to participants receiving an annual health checkup. We asked whether they agreed with four short sentences: "it is not necessary to worry about depression in a person behaving brightly" (misunderstanding about the behavior of depressed people), "rest is important for treating depression" (belief about the necessity of rest), "medicine is effective for treating depression" (belief about the effectiveness of pharmacotherapy) and "a weak personality causes depression" (stigma about the cause of depression). We also analyzed the association between these beliefs and factors such as health literacy, regularly visiting an outpatient clinic, history of depression, and demographic variables.

RESULTS

Among 1,085 respondents (75.0% response rate), 54.5%, 75.6%, 58.9%, and 70.8% responded appropriately to the "misunderstanding about the behavior of depressed people", "necessity of rest", "effectiveness of pharmacotherapy", and "stigma about the cause of depression" items, respectively. Regarding stigma about the cause of depression, 30.7% of respondents agreed that a weak personality caused depression. Female sex and younger age group were associated with appropriate answers. Health literacy was only associated with appropriate beliefs about the effectiveness of pharmacotherapy.

CONCLUSIONS

Thirty percent of participants had the stigmatizing belief that a weak personality causes depression and only 58.9% believed in the effectiveness of pharmacotherapy for depression. Over 70% understood the necessity of rest and knew that depression is possible in those who act brighter. General health literacy alone might not improve knowledge and beliefs about depression. An educational intervention or campaign to reduce stigma toward depression and improve knowledge about the treatment of depression is needed.

Effect of direct and indirect contact with mental illness on dangerousness and social distance

BACKGROUND

This study is based on the contact hypothesis that contact with mental illness is the most effective anti-stigma strategy.

AIMS

This study aims to analyze which form of contact can most effectively decrease the dangerousness and social distance associated with schizophrenia, depression and alcoholism.

METHOD

In total, 573 Korean adults ( M_age = 43.71 years, standard deviation ( SD) = 13.41; 54.1% male, 45.9% female) were surveyed about randomly assigned vignettes of schizophrenia, depression and alcoholism. The participants were questioned on the dangerousness and social distance associated with the assigned vignette, as well as direct and indirect contact experience with the mental illness. Two-way analysis of variance (ANOVA) was used to determine the main effect and interaction effect that the type of mental illness and contact experience have on the two dependent variables (dangerousness and social distance).

RESULTS

The findings show that the type of mental illness has a significant main effect on dangerousness and social distance, but contact type only has a significant main effect on social distance. Moreover, the two independent variables (mental illness subtype and contact experience) have an interaction effect on two dependent variables (dangerousness and social distance). Therefore, the anti-stigma effect of contact varies according to the type of mental illness.

CONCLUSION

Our findings suggest that appropriate anti-stigma strategies are required for each type of mental illness. Considering that opportunities for direct contact with persons with mental illness are highly limited, it is necessary to actively utilize indirect contact.

Social distance toward people with schizophrenia is associated with favorable understanding and negative stereotype

Previous studies have suggested the consequence of mental health-related public stigma: the problem of knowledge may develop into problem of attitude and behaviour. However, this has not been directly explored in a longitudinal study. As the secondary analysis from our previous randomized controlled trial (RCT) for 219 participants who completed the survey at the 12-month follow-up, we aimed to investigate whether the knowledge and attitude components of stigma toward people with schizophrenia affect each other. At baseline and at 12 months, three types of stigma scales were measured: favorable understanding, negative stereotype, and social distance toward people with schizophrenia. A structured equation model was fitted to the trajectory of stigma scales taking into account the effect of the other stigma components and the interventions. The results showed that greater social distance toward people with schizophrenia at baseline was associated with less favorable understanding and more negative stereotype at the 12-month follow-up. This was not in line with the existing consequences from the previous studies; however, in line with the recent RCTs showing that social contact is the most effective intervention to reduce stigma. Future observational studies with a larger sample size are needed to clarify this relationship further.

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.

Educational intervention to decrease stigmatizing attitudes of undergraduate nurses towards people with mental illness

Health professionals can hold stigmatizing views about people with mental illness. In addition to being discriminatory, these beliefs cause anxiety that can affect learning in the clinical environment. A review of an undergraduate nursing curriculum introduced the Modern Apprenticeship curriculum model and provided an opportunity for an educational intervention designed to address stigmatizing beliefs about people with mental health and addiction problems. The aim of the present study was to measure the extent to which an educational intervention - guided clinical experience in an acute mental health unit during the first year of the curriculum - decreased stigmatizing beliefs of undergraduate nurses towards those with mental health and addiction issues. In a before-and-after design, Corrigan's Attribution Questionnaire was used to collect data pre- and post-guided clinical experience in an acute mental health unit. The intervention resulted in a significant positive change in stigmatizing attitudes for four of the nine factors tested. There was a non-significant positive change in three factors, while two factors showed a non-significant negative change. Using guided clinical experience as an educational intervention in the first year of an undergraduate nursing curriculum can contribute to positive change in undergraduate nurses' stigmatizing beliefs. The findings have implications for teaching of mental health content in undergraduate nursing programmes.

Changing BSN Students' Stigma Toward Patients Who Use Alcohol and Opioids Through Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training: A Pilot Study

BACKGROUND

Stigma associated with substance use is considered a barrier to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) and assisting patients to receive appropriate treatment.

OBJECTIVES

To test the efficacy of SBIRT education and training in changing undergraduate nursing students' attitudes about working with patients who have problems with alcohol and opioid use.

DESIGN

A sample of 49 undergraduate nursing students were surveyed, using five subscales, at three time points.

RESULTS

After a 15-week semester that included (a) SBIRT education and (b) weekly clinical experiences with patients who had alcohol use problems the undergraduate nursing students' stigma decreased as measured by three of the five subscales. The students' attitudes toward working with patients who had opioid use problems exhibited favorable change as measured by four of the five subscales.

CONCLUSION

SBIRT education and training for undergraduate nursing students might help mitigate some of their stigma toward working with patients who have mild to moderate alcohol and opioid use problems.

Stigma among Singaporean youth: a cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population

OBJECTIVES

Stigma against mental illnesses is one of the significant obstacles faced by mental health service users and providers. It can develop at a young age and is also influenced by culture. Youths in Southeast Asian countries are under-represented in mental health research, thus this study aims to explore the dimensions of stigma and social tolerance and examine its correlates in the younger, multiethnic population of Singapore.

DESIGN

An online survey collected data with sociodemographic questions, the Attitudes Towards Serious Mental Illness (Adolescent version) Scale, Social Tolerance Scale and an open-text question on words or phrases participants associated with the term 'mental illness'. Principal component analysis and multiple regression models were conducted to investigate the factor structure of the attitudes and social tolerance scales and their sociodemographic correlates.

PARTICIPANTS

Participants included 940 youths aged 14-18 years old who were residing in Singapore at the time of the survey and were recruited through local schools.

RESULTS

About a quarter of the students (22.6%) reported participating in mental health awareness campaigns while nearly half (44.5%) associated pejorative words and phrases with the term mental illness. The Attitudes Towards Serious Mental Illness (Adolescent version) Scale yielded five factors while the Social Tolerance Scale yielded two. Ethnicity, gender and nationality were significantly correlated with factors of both scales. Chinese youths showed higher sense of 'physical threat' and lower 'social tolerance' than those of other ethnicities. Females showed more 'wishful thinking', 'social concern' and 'social responsibility' towards the mentally ill than males.

CONCLUSIONS

The dimensions of stigma and social tolerance are different in Asian cultures compared with Western cultures. Sociodemographic differences in attitudes towards the mentally ill were found among youths living in Singapore. Misconceptions and negative attitudes towards mental illness are common, demonstrating a clear need for effective stigma reduction campaigns.

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.

Interprofessional education in mental health: An opportunity to reduce mental illness stigma

Mental illness stigma is a common problem in healthcare students and professionals in addition to the general public. Stigma is associated with numerous negative outcomes and hence there is an urgent need to address it. This article explores the potential for interprofessional education (IPE) to emerge as a strategy to reduce mental illness stigma amongst healthcare students and professionals. Most anti-stigma strategies use a combination of knowledge and contact (with a person with lived experience) to change attitudes towards mental illness. Not surprisingly interprofessional educators are well acquainted with theory and learning approaches for attitude change as they are already used in IPE to address learners' attitudes and perceptions of themselves, other professions, and/or teamwork. This article, through an analysis of IPE pedagogy and learning methods, identifies opportunities to address mental illness stigma with application of the conditions that facilitate stigma reduction. The goal of this article is to raise awareness of the issue of mental illness stigma amongst healthcare students and professionals and to highlight interprofessional education as an untapped opportunity for change.

Stigma: The Perspective of Workers on Community Mental Health Services-Brazil

In this study, we have surveyed how professionals from multidisciplinary teams at psychosocial care centers (CAPS), in the city of São Paulo, understand the concept of mental illness stigma. The aim of the survey was to characterize the actions developed by the team to overcome stigma and, thus, contribute to develop strategies that incorporate overcoming stigma in the territory. Our objective is to get acquainted to the concepts about stigma shared by the participants. This survey was based on the theory of stigma by Erving Goffman; data were collected through semi-structured interviews with mental health professionals belonging to the CAPS teams. Results indicate that social exclusion is understood as a synonym to stigma, and that proximity of CAPS to society in the territory facilitates social inclusion and the overcoming of the mental illness stigma.

Effect of a mental health training programme on Nigerian school pupils' perceptions of mental illness

BACKGROUND

Stigmatizing attitudes and discriminatory behaviour towards persons with mental illness are known to start in childhood. In Nigeria, it is not unusual to see children taunting persons with mental illness. This behaviour continues into adulthood as evidenced by the day-to-day occurrences in the community of negative attitudes and social distance from persons with mental illness. School-based interventions for pupils have been found to increase knowledge about mental illness. Children are recognised as potential agents of change bringing in new ways of thinking. This study determined the effect of a 3-day mental health training for school pupils in Southwest Nigeria, on the perceptions of and social distance towards persons with mental illness.

METHODS

A total of 205 school pupils drawn from two administrative wards were randomly assigned to control and experimental groups. The mean age of the pupils was 14.91 years (±1.3). The pupils in the intervention group received a 5-h mental health training session spaced out over 3-days. Apart from didactic lectures, case history presentations and discussions and role-play were part the training. Outcome measures were rated using a knowledge, attitude and social distance questionnaire at baseline, immediately following the training for both group and 3-week post intervention for the intervention group. A Student Evaluation Form was administered to evaluate the pupils' assessment of the training programme. Frequencies, Chi square statistics, paired t test were used to analyse the data received.

RESULTS

At immediate post-intervention, the intervention group had a significantly higher mean knowledge score compared to controls, 21.1 vs. 22.0; p = 0.097 to 26.1 vs 22.0; p < 0.01. Respondents in the intervention group had a higher mean attitude score of 5.8 compared to 5.6 in the control group although this was not statistically significant (p < 0.627). Comparisons within the intervention group from baseline to immediate post-intervention showed a significant increase in mean knowledge and attitude scores of respondents, 21.0-26.2: p < 0.001 and 4.8-5.8; p = 0.004 respectively. This change was sustained at 3 weeks post intervention. The majority (98.8%) noted that the training was useful to them.

CONCLUSIONS

Multiple contacts and mixed-method training sessions produced a positive and sustained change in knowledge of and attitude towards persons with mental illness in school pupils in Nigeria.

Stigma toward psychosis and its formulation process: prejudice and discrimination against early stages of schizophrenia

BACKGROUND

Stigma toward psychosis can prevent social attendance and help-seeking behavior. Early detection and intervention has been shown to improve patient outcome in schizophrenia. The aim of this study was to reveal the characteristics and formulation process of stigma toward each clinical stage of schizophrenia, taking people's backgrounds into consideration.

METHODS

The participants consisted of three groups: general public, patients with mental illness, and psychiatric professionals. We performed a survey examining stigmas toward people with psychotic-like-experiences (PLE), at-risk mental state for psychosis (ARMS), schizophrenia, or depression. Prejudice was measured using a 21-item questionnaire, and discrimination was measured using the Social Distance Scale.

RESULTS

The participants consisted of 149 people from the general public, 97 patients, and 119 psychiatric professionals. Generally, a similar pattern was observed among the groups in which prejudice and discrimination against PLE was mildest, followed by that against ARMS and depression, and finally schizophrenia. When the stigma of the general public was compared with that of psychiatric professionals, the prejudice and discrimination against PLE of the general public were both lower than those of the psychiatric professionals. However, the prejudice of the general public was stronger than that of the professionals for ARMS. Furthermore, the discrimination of the general public was stronger than that of the professionals for schizophrenia.

CONCLUSIONS

The stigmas of mental illness differed according to the clinical stage, although the pattern of severity was similar among the three groups. A formulation process is suggested in which stigma toward schizophrenia develops from an attitudinal property (prejudice) against ARMS and a behavioral property (discrimination) against schizophrenia.

Early intervention for stigma towards mental illness? Promoting positive attitudes towards severe mental illness in primary school children

Purpose

Stigma towards severe mental illness (SMI) is widespread, exacerbating mental health problems, and impacting on help-seeking and social inclusion. Anti-stigma campaigns are meeting with success, but results are mixed. Earlier intervention to promote positive mental health literacy rather than challenge stigma, may show promise, but little is known about stigma development or interventions in younger children. The purpose of this paper is to investigate children’s knowledge, attitudes and behaviour towards SMI and whether we can positively influence children’s attitudes before stigma develops.

Design/methodology/approach

A cross-sectional study investigated mental health schema in 7-11 year olds. An experimental intervention investigated whether an indirect contact story-based intervention in 7-8 year olds led to more positive mental health schema.

Findings

Young children’s schema were initially positive, and influenced by knowledge and contact with mental illness and intergroup anxiety, but were more stigmatising in older girls as intergroup anxiety increased. The indirect contact intervention was effective in promoting positive mental health schema, partially mediated by knowledge.

Social implications

Intervening early to shape concepts of mental illness more positively, as they develop in young children, may represent a more effective strategy than attempting to challenge and change mental health stigma once it has formed in adolescents and adults.

Originality/value

This study is the first to investigate an intervention targeted at the prevention of stigma towards SMI, in young children, at the point that stigma is emerging.

Interpersonal Contact and Attitudes Toward Adolescents Who Abuse Substances

Only 7.6% of adolescents in need of substance abuse treatment actually receive it. Many adolescents are hesitant to seek treatment due to public stigma (i.e., negative attitudes and beliefs of the general public toward individuals who abuse substances). However, decades of research indicate that interpersonal contact with stigmatized groups helps reduce stigma. This study used structural equations and data from 638 undergraduate students to test the relationships between students' total interpersonal contact with individuals who abuse substances and their attitudes toward those individuals. We found that total contact did not have significant effects on stigma and was associated with better helping attitudes toward adolescents who abuse alcohol but not marijuana. In addition, African Americans and females endorsed greater stigmatization of adolescents who abuse alcohol but better helping attitudes toward those who had received treatment. Increasing contact with individuals who abuse substances, irrespective of type and valence, may not be widely useful as a way of improving attitudes toward such people.

"I'm not being rude, I'd want somebody normal": Adolescents' Perception of their Peers with Tourette's Syndrome: an Exploratory Study

Tourette's syndrome (TS) is a highly stigmatised condition, and typically developing adolescents' motives and reasons for excluding individuals with TS have not been examined. The aim of the study was to understand how TS is conceptualised by adolescents and explore how individuals with TS are perceived by their typically developing peers. Free text writing and focus groups were used to elicit the views of twenty-two year ten students from a secondary school in South East England. Grounded theory was used to develop an analytical framework. Participants' understanding about the condition was construed from misconceptions, unfamiliarity and unanswered questions. Adolescents who conceived TS as a condition beyond the individual's control perceived their peers as being deprived of agency and strength and as straying from the boundaries of normalcy. People with TS were viewed as individuals deserving pity, and in need of support. Although participants maintained they had feelings of social politeness towards those with TS, they would avoid initiating meaningful social relationships with them due to fear of 'social contamination'. Intergroup anxiety would also inhibit a close degree of social contact. Participants that viewed those with TS as responsible for their condition expressed a plenary desire for social distance. However, these behavioural intentions were not limited to adolescents that elicited inferences of responsibility to people with TS, indicating that attributional models of stigmatisation may be of secondary importance in the case of TS. Implications for interventions to improve school belonging among youth with TS are discussed.

Challenging the Stigma of Mental Illness Among College Students

PURPOSE

This study investigated the impact of contact- and education-based antistigma interventions on mental illness stigma, affirming attitudes, discrimination, and treatment seeking among college students.

METHODS

Data were collected from 198 students of a Chicago University campus in spring of 2014. Participants were randomly assigned to one of three conditions: a contact-based antistigma presentation, education-based presentation, or control condition. Measures of stigma, discrimination, affirming attitudes, and treatment seeking were administered at preintervention and postintervention.

RESULTS

A 3 × 2 analysis of variance was completed for each measure to examine condition by trial interactions. Both contact- and education-based interventions demonstrated a significant impact on personal stigma, perceptions of empowerment, discrimination, attitudes towards treatment seeking, and intentions to seek treatment from formal sources. No difference in effect was demonstrated between the contact- and education-based conditions.

CONCLUSIONS

These findings suggest that these two approaches should be considered for challenging mental illness stigma among college students.

Eating disorder public service announcements

Purpose

– Previous studies have documented that exposure to stereotypical information about certain social groups leads to unfavorable perceptions and feelings toward that group. Integrating insights from the mental illness stigma and the social identity perspective literatures, the purpose of this paper is to explore the effects of eating disorder public service announcements (ED PSAs) that employ stigma formats through the lenses of the stereotype content model (SCM) and the Behaviors from Intergroup Affect and Stereotypes (BIAS) Map.

Design/methodology/approach

– The study followed an experimental control group design. Participants were exposed to either a stigmatizing or a non-stigmatizing PSA.

Findings

– Exposure to the stigmatizing PSA resulted in lower perceptions of warmth and competence being attributed to people who have an ED which further predicted greater feelings of contempt toward these individuals. The stigmatizing PSA also directly predicted greater feelings of contempt.

Practical implications

– The findings suggest that using stereotypes about EDs in PSAs aimed at preventing such diseases may elicit perceptions of low warmth and competence, further associated with increased feelings of contempt toward people who have an ED in healthy individuals.

Social implications

– The stereotyping effects of PSAs may reduce the social and emotional support that people with EDs receive and may exacerbate their emotional distress.

Originality/value

– From a theoretical point of view, these results extend the understanding of mental illness stereotypes from an intergroup, SCM and BIAS Map perspective as it applies to EDs. More importantly, this study draws attention to possible unintended consequences of PSAs, a matter that is rarely researched, but that can have severe implications.

The effects of pity on self- and other-perceptions of mental illness

Previous research has demonstrated that pity may have a positive influence on public perceptions of individuals with a mental illness but has not adequately addressed the potential negative impacts of pity perceptions. Seventy-five research participants with serious mental illness completed measures of pity, public stigma, shame, hopelessness, personal empowerment, self-esteem, depression, and quality of life at baseline. Measures of hopelessness, personal empowerment, self-esteem, and depression were repeated six months later. Bivariate correlations found significant associations between pity and "other" effects of stigma including dangerousness, fear, segregation, avoidance and perceived stigma. Baseline pity was significantly correlated with self-effects of stigma such as shame, hopelessness, lower empowerment, lower self-esteem, depression, and decreased quality of life. At six-month follow-up, baseline pity was still associated with increased hopelessness and depression along with decreased empowerment and self-esteem. Anger, avoidance, perceived stigma, shame, and self-esteem were significantly related to pity in multiple linear regressions. Outcomes of path analyses suggest that the significant positive relationship between pity at baseline and depression at six-month follow-up was mediated by self-esteem and hopelessness. Individuals who view mental illness with pity experience negative self- and other-effects of stigma. These effects persist 6-months later. These findings have important implications for stigma-reducing advertising programs.

Effectiveness of an intervention for reducing social stigma towards mental illness in adolescents

AIM: To evaluate the effectiveness of an intervention for reducing social stigma towards mental illness in adolescents. The effect of gender and knowledge of someone with mental illness was measured.

METHODS: Two hundred and eighty secondary school students were evaluated using the Community Attitudes towards Mental Illness (CAMI) questionnaire. The schools were randomized and some received the intervention and others acted as the control group. The programme consisted of providing information via a documentary film and of contact with healthcare staff in order to reduce the social stigma within the school environment.

RESULTS: The intervention was effective in reducing the CAMI authoritarianism and social restrictiveness subscales. The intervention showed significant changes in girls in terms of authoritarianism and social restrictiveness, while boys only showed significant changes in authoritarianism. Following the intervention, a significant reduction was found in authoritarianism and social restrictiveness in those who knew someone with mental illness, and only in authoritarianism in those who did not know anyone with mental illness.

CONCLUSION: The intervention was effective to reduce social stigma towards people with mental illness, especially in the area of authoritarianism. Some differences were found depending on gender and whether or not the subjects knew someone with mental illness.

Predictors of personal, perceived and self-stigma towards anxiety and depression

BACKGROUND

Stigma towards individuals experiencing a mental illness is associated with a range of negative psychological, social and financial outcomes. Factors associated with stigma remain unclear; the relationship between stigma and various personal factors may depend on both the type of disorder being stigmatised and what type of stigma is assessed. Different forms of stigma include personal stigma (negative attitudes towards others), perceived stigma (perceived attitudes of others) and self-stigma (self-attribution of others' negative attitudes).

METHOD

Three hundred and fifty university students and members of the general public completed an online survey assessing contact with and knowledge of both depression and anxiety, age, gender, current depression and anxiety symptoms, and personal, perceived and self-stigma for both depression and anxiety.

RESULTS

Greater contact with, and knowledge of that illness predicted lower personal stigma for both anxiety and depression. Participants with greater levels of current depression symptomatology and females, reported higher perceived stigma towards depression. Males reported higher personal stigma for anxiety. For both anxiety and depression, higher current symptomatology was associated with greater levels of self-stigma towards the illness.

CONCLUSIONS

Findings confirm the role of contact and knowledge in personal stigma for both disorders, consistent with previous findings. This finding also supports evidence that interventions addressing these factors are associated with a decline in personal stigma. However, lack of relationship between contact with, and knowledge of a mental illness and perceived and self-stigma for either depression or anxiety suggests that these factors may not play a major role in perceived or self-stigma. The identification of symptomatology as a key factor associated with self-stigma for both anxiety and depression is significant, and has implications for community-wide interventions aiming to increase help-seeking behaviour, as well as individual treatment strategies for clinicians. Further research should examine whether these relationships hold for groups with clinically diagnosed depression and anxiety disorders.

Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries

This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.

Managing the terror of a dangerous world: Political attitudes as predictors of mental health stigma

BACKGROUND

Previous research has associated self-reported political conservatism to mental health stigma. Although the limitations of self-reported political attitudes are well documented, no study has evaluated this relationship from a more nuanced perspective of sociopolitical identity.

AIMS

To assess the relationship between political attitudes and mental health stigma (i.e. negative stereotypes and intended social distance), particularly from a standpoint of Right-Wing Authoritarianism (RWA)--a more specific measure of political conservatism.

METHOD

A sample of 505 New York State residents completed an online survey.

RESULTS

The results of this study indicated significant relationships between endorsements of self-reported conservatism and RWA to negative stereotypes and social distance in relation to mental illness. Individuals with 'High RWA' were more likely to see individuals with mental illness as dangerous and unpredictable, and less willing to want to socially associate with individuals with mental illness. These results remained statistically significant even when controlling for other factors that consistently predict mental health stigma. Negative stereotypes also partially mediated individuals with RWA's significant relationship to social distance.

CONCLUSION

Characteristics of political conservatives and right-wing authoritarians (e.g. threat-aversion, personal responsibility) are predictive of mental health stigma. Terror Management Theory may also help to explain this phenomenon.

Lessons learned from unintended consequences about erasing the stigma of mental illness

Advocates and scientists have partnered to develop and evaluate programs meant to erase the egregious effects of the different forms of stigma. Enough evidence has been collected to yield lessons about approaches to stigma change. Some of the most insightful of these lessons emerge from unintended consequences of good intentioned approaches, and are the focus of this paper. They include the limited benefits of education especially when compared to contact, beating stigma is more than changing words, beware pity as a message, understand the competing agendas of stigma change, replace ideas of normalcy with solidarity, and avoid framing self-stigma as the problem of people with mental illness and not of society. The paper ends with consideration of the back seat role that psychiatrists and other mental health providers should have in stigma change.

Stigmatisation of mental illness among employees of a Northern Nigerian University

Background:

Prejudices against people with mental illness are widespread in many societies leading to a number of detrimental consequences. In order to adequately develop programmes and services that will help protect the rights and privileges of people with mental illness, it is imperative to study the nature of stigma and factors associated with it. Our objective in this study was to observe the level of stigmatisation of the mentally ill among employees of a Nigerian University and the factors associated with it.

Materials and Methods:

The study was carried out at the Ahmadu Bello University Teaching Hospital and the Ahmadu Bello University main campus. Employing a two-staged random sampling technique, 15 departments were chosen from both institutions, after which 10 participants were further sampled from each department to obtain a total of 150 participants. All the participants were administered the socio-demographic questionnaire and Mental Illness Clinicians’ Attitude 4^th version (MICA 4).

Results:

The findings indicate that 53.4% of respondents’ classified as high stigmatisation while 46.6% was classified as low stigmatisation. Low scores on stigmatisation were observed among departments of psychiatry, nursing and ophthalmology, while high scores were observed among respondents from administration and engineering. Relationship between variables and predictors of stigmatisation were also established.

Conclusion:

There is a high tendency to stigmatise persons with mental illness except where there has been some contact with mental health practice or among the clinical departments in the hospital. We recommend community psychiatry care for the mentally ill and psycho-education for staff periodically to reduce this level of stigmatisation.

Exploring the Relationships Among Level of Contact, Nature of Contact, and Mental Illness Stigma in Adolescent Girls

This study explored the relationship of individuals' level of contact with someone with mental illness, and the nature of that contact, to mental illness stigma in adolescent females (N = 156). There were no significant associations among stigma and level of contact. The nature of the contact was significantly associated with stigma, such that those who knew someone who received treatment in a psychiatric facility had lower stigma, and those who attributed a deterioration of a past personal relationship to mental illness reported greater stigma.

Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis

OBJECTIVE

Cross-sectional studies frequently find higher age associated with negative attitudes towards persons with mental illness. We explore whether attitudes worsen over the life span, or follow a cohort pattern.

METHOD

Using data from three identical population surveys in Germany from 1990, 2001 and 2011 (combined sample n = 7835), we performed age-period-cohort analyses determining the association of age, time period and birth-cohort with social distance from a person with either depression (n = 3910) or schizophrenia (n = 3925), using linear and nonlinear partial least squares regression models.

RESULTS

Social distance increases with age, independent from cohort and period effects, cumulating to an increase of 2.4 (schizophrenia) and 2.3 (depression) on the 28 point social distance scale over the life span (youngest to oldest participant). We found a cohort effect in depression, but not schizophrenia, with decreasing social distance until 1970 and a slight increase in younger cohorts. Period effects were visible particularly in schizophrenia, with growing social distance over time.

CONCLUSION

Considering demographic change and the vulnerability of older persons to severe outcomes of mental illness such as suicide, the observed increase of negative attitudes over the life span seems highly relevant. We discuss the role of conservatism and preferences for agreeable social contacts in older age.