Prejudice, social distance, and familiarity with mental illness

Perceptions of the Previously Convicted: The Influence of Conviction Type and Therapy Participation

The present study explores individuals' desires for social distance from violent versus non-violent offenders and investigates whether disclosure of the offender's therapy completion influences this desire for distance. The study also investigates relationships between participants' desires for social distance and their perceptions of therapy effectiveness with offenders. Using a 2 × 2 factorial design, 150 undergraduate participants completed measures of social distance and perceived offender therapy effectiveness. Overall, respondents indicated higher desires for social distance from offenders convicted of violent versus non-violent crimes. Respondents also reported lower desire for social distance when the offenders reported completing therapy, even when their perception of therapy effectiveness was low. The results of this study have implications for treatment development. Results attest to the value of preparing incarcerated offenders with an accurate expectation of levels and patterns of stigma to be faced upon release and also speak to the value of disclosing treatment completion, especially in the context of healthy interpersonal relationship development and maintenance.

Validation of a brief implicit association test of stigma: schizophrenia and dangerousness

Abstract Background: Public perception of the link between schizophrenia and violence is exaggerated, and interventions are emerging that attempt to educate the public about the actual relationship between violence and schizophrenia. The effectiveness of programs targeting this dangerousness stereotype is unknown, however, as existing instruments do not capture a complete, unbiased picture of stigma.

AIMS

To report on the properties of the Brief Implicit Association Test-Schizophrenia Danger (BIAT-SD), which we developed to capture the implicit perception that people with schizophrenia are dangerous.

METHODS

We used a multi-trait, multi-method protocol to validate the BIAT-SD based on convergent and discriminant data from undergraduates (n = 97) at baseline and 4-weeks.

RESULTS

Preliminary evidence was found for construct validity, internal consistency, and 30-min retest stability.

CONCLUSIONS

Potential benefits and implications of the measure to improving the accuracy of stigma measurement are discussed.

The impact of caregiver familiarity with mental disorders on timing of intervention in first-episode psychosis

AIM

Based on prior research, we hypothesized that personal or family familiarity with psychosis would have a different effect on pathways to care as compared to personal or family familiarity with mental disorders.

METHODS

Caregivers of 32 patients receiving treatment for a first episode of psychosis at a specialized early intervention centre provided information regarding their familiarity with psychosis and mental disorders. Information on the duration of untreated psychosis (DUP) and on the duration of untreated illness (DUI) was collected from patients and their caregivers.

RESULTS

Although we found a trend in the direction of lowered DUP and longer DUI for those with personal or family familiarity with psychosis, these effects were not statistically significant. A trend was found for a higher DUI for those with personal or family familiarity with mental disorders in general, but this effect was not significant.

CONCLUSION

We did not find that differential familiarity with mental disorders and by extension, personal or family familiarity, affected measures of delay in treatment of a first episode of psychosis. Trends in our findings in the hypothesized directions suggest that a larger sample size may reveal significant differential effects of previous experience with mental disorders in general and psychosis in particular on delay in help seeking during different phases of the illness.

Stigma in the Area of Intellectual Disabilities: Examining a Conceptual Model of Public Stigma

Studies in the area of intellectual disability (ID) stigma are few and atheoretical. This study examined the adequacy of the conceptual framework of stigma from the mental illness field regarding ID. Telephone interviews were conducted with a nationally representative sample of 304 adults in Israel. Participants were read a vignette describing a man with ID and answered items related to cognitive, emotional, and behavioral reactions. Behavioral dimensions included: Withdrawal, Social distance, and Helping behaviors. The stigma process leading to Withdrawal was drawn through Negative affect, whereas the process to Social distance was drawn through Calm affect. One unique aspect of the stigma process in ID is the importance of Calm affect, which helped reduce Social distance.

Comparing stigmatising attitudes towards people with substance use disorders between the general public, GPs, mental health and addiction specialists and clients

BACKGROUND

Substance use disorders (SUDs) are among the most severely stigmatised conditions; however, little is known about the nature of these stigmatising attitudes.

AIMS

To assess and compare stigmatising attitudes towards persons with SUDs among different stakeholders: general public, general practitioners (GPs), mental health and addiction specialists, and clients in treatment for substance abuse.

METHODS

Cross-sectional study (N = 3,326) in which stereotypical beliefs, attribution beliefs (e.g. perceptions about controllability and responsibility for having an addiction), social distance and expectations about rehabilitation opportunities for individuals with substance use disorders were assessed and compared between stakeholders.

RESULTS

Individuals with substance use disorders elicited great social distance across all stakeholders. Stereotypical beliefs were not different between stakeholders, whereas attribution beliefs were more diverse. Considering social distance and expectations about rehabilitation opportunities, the general public was most pessimistic, followed by GPs, mental health and addiction specialists, and clients. Stereotypical and attribution beliefs, as well as age, gender and socially desirable answering, were not associated with social distance across all stakeholders.

CONCLUSION

The general public and GPs expressed more social distance and were more negative in their expectations about rehabilitation opportunities, compared to mental health and addiction specialists and clients. Although stigmatising attitudes were prevalent across all groups, no striking differences were found between stakeholders.

The Effects of Group Psychoeducational Programme on Attitude toward Mental Illness in Families of Patients with Schizophrenia, 2014

INTRODUCTION

Family members often play a vital role as caregivers in the lives of individuals with schizophrenia. RESULTS of the studies showed that family invironment is the most important determinint of patients outcomes like as quality of life, relapse, adherence. This study aimed to determine the effect of group psychoeducational programme on attitude towards mental illness in families of patients with schizophrenia.

METHODS

In this quasi-experimental study, 74 families who have schizophrenic patients hospitalized in psychiatric wards during sampling were selected by convenience sampling method. Then the sample was randomly assigned to experimental and control groups. The families of experimental group received 8 continuous 90-minute 3 times a week psychoeducational sessions. Family attitude towards mental illness was measured using the questionnaire of Opinion about Mental Illnesses (OMI) before and after intervention. Data analysis was conducted using χ(2) test, independent t-test, and paired t-test on SPSS software version 13.

RESULTS

The results showed that majority of the families had negative attitude towards mental illness (88.90%). In addition, the results showed that there was significant difference between different dimensions of attitude towards mental illness before and after psychoeducation in the experimental group. The mean score of families' post-test in the experimental group increased compared to control group 108.86 (14.9), vs. 88.86 (7.5).

CONCLUSION

The results of this study indicate that psychoeducation improves family attitude towards mental illness. Training methods like group psych education for the families of mental patients can be effective on their attitudes towards mental illness.

Perception of stigma toward mental illness in South India

BACKGROUND

Stigma associated with mental illnesses is one of the principal causes for mentally ill people not receiving adequate mental health care and treatment. The study was conducted to assess the extent of stigma associated with mental illness and knowledge of mental illness among the community.

MATERIALS AND METHODS

Community-based, cross-sectional study was conducted among 445 respondents from Udupi district; the community attitude toward the mentally ill (CAMI) scale was used to assess stigma. The probability proportional to sampling size technique was adopted to select the wards/blocks. Household from blocks/wards were selected using convenience sampling. Self- administered semi-structured questionnaire was used to collect the information. Data was analyzed using the software SPSS version 15.

RESULTS

Of the total 445 respondents, the prevalence of stigma toward mentally ill people was 74.61% (95% confidence interval, 0.7057, 0.7866). The prevalence of stigma was high under all the four domains of CAMI scale. High prevalence of stigma was seen among females and people with higher income.

CONCLUSIONS

The overall prevalence of stigma toward PWMI was found to be high. The stigma toward PWMI was associated with gender with respect to AU, BE and CMHI. Hence, the study suggests that there is a strong need to eliminate stigma associated with mental illness to improve the mental health status of the region.

Reported and Intended Behaviour Towards Those With Mental Health Problems in the Czech Republic and England

This is one of the first studies, which compares the level of stigmatizing behaviour in countries that used to be on the opposite sides of the Iron Curtain. The aim was to identify the prevalence of reported and intended stigmatizing behaviour towards those with mental health problems in the Czech Republic and to compare these findings with the findings from England. The 8-item Reported and Intended Behaviour Scale (RIBS) was used to assess stigmatising behaviour among a representative sample of the Czech population (n = 1797). Results were compared with the findings of an analogous survey from England (n = 1720), which also used the RIBS. The extent of reported behaviour (i.e., past and present experiences with those with mental health problems) was lower in the Czech Republic than in England. While 12.7% of Czechs reported that they lived, 12.9% that they worked, and 15.3% that they were acquainted with someone who had mental health problems, the respective numbers for England were 18.5%, 26.3% and 32.5% (P < 0.001 in each of these items). On the other hand, the extent of intended stigmatizing behaviour towards those with mental health problems is considerably higher in the Czech Republic. Out of maximum 20 points attached to possible responses to the RIBS items 5–8, Czechs had a lower total score (x = 11.0, SD = 4.0) compared to English respondents (x = 16.1, SD = 3.6), indicating lower willingness to accept a person with mental health problems (P < 0.001). The prevalence of stigmatizing behaviour in the Czech Republic is worrying. Both, further research and evidence based anti-stigma interventions, should be pursued in order to better understand and decrease stigmatizing behaviour in the Czech Republic and possibly across the post-communist countries in Central and Eastern Europe.

Stigma experienced by people using mental health services in San Diego County

OBJECTIVE

This paper describes how individuals struggling with severe mental illness experience stigma along multiple dimensions including their experiences of discrimination by others, their unwillingness to disclose information about their mental health, and their internalization or rejection of the negative and positive aspects of having mental health problems.

METHODS

This cross-sectional study employs descriptive analyses and linear regression to assess the relationship between demographics, mental health diagnoses and self-reported stigma among people receiving mental health services in a large and ethnically diverse county public mental health system (n = 1,237) in 2009. We used the King Stigma Scale to measure three factors related to stigma: discrimination, disclosure, and positive aspects of mental illness.

RESULTS

Most people (89.7 %) reported experiencing some discrimination from having mental health problems. Regression analyses revealed that younger people in treatment experienced more stigma related to mental health problems. Women reported experiencing more stigma than men, but men were less likely to endorse the potentially positive aspects of facing mental health challenges than women. Although people with mood disorders reported more discomfort with disclosing mental illness than people with schizophrenia, they did not report experiencing more discrimination than people with schizophrenia.

CONCLUSIONS

Study findings suggest that the multidimensional experiences of stigma differ as a function of age, gender, and diagnosis. Importantly, these findings should inform anti-stigma efforts by describing different potential treatment barriers due to experiences of stigma among people using mental health services, especially among younger people and women who may be more susceptible to stigma.

The public stigma of mental illness means a difference between you and me

Social desirability can influence reports of stigma change in that subscribing to stigmatizing attitudes might pose a threat to personal beliefs of open-mindedness, while endorsing difference might not be as troubling. A measure is needed that assesses stigma change but is less susceptible to desirability effects. This study examined the psychometrics of various assessments of perceived difference from a person with mental illness. A total of 460 participants were recruited online using Amazon's Mechanical Turk. Four measures of difference, the Likert Scale of Difference, Semantic Differential: Similar-Different Scale, Semantic Differential: Mental Illness versus Other Illness scale, and Cause of Perceived Difference Scale were compared to measures of stereotypes, affirming attitudes, and care seeking. A vignette describing a person with mental illness anchored the Difference Scale and a measure of stereotype. Results showed that measures of difference yielded significantly higher endorsements than measures of stereotypes; the Semantic Differential Scale: Similar-Different was endorsed at a higher rate than other difference scales. Difference scores were positively related to stereotypes and inversely related to affirming attitudes. Difference was also found to influence empowerment separate from, and in addition to stereotype. These results suggest a new domain as an efficient and sensitive measure of stigma change.

Suggested avenues to reduce the stigma of mental illness in the Middle East

BACKGROUND

Stigma toward mentally ill individuals acts as a barrier to accessing care and receiving treatment.

AIM

To review current evidence pertaining to stigma toward mental illness in the Middle East in order to inform effective and sustainable interventions in this region.

METHODS

We conducted a systematic literature search using the PubMed database and evaluated all identified studies according to specific inclusion criteria.

RESULTS

Stigma toward individuals with mental illness does exist in the Middle East. Stigmatizing attitudes are particularly high toward culturally proscribed mental illnesses like alcohol abuse and lower for other disorders such as depression and psychosis.

CONCLUSIONS

We propose the following initiatives to reduce stigma toward mental illness in the Middle East: (a) educate families to enable them to support their affected relatives, (b) increase cooperation between psychiatrists and faith healers and (c) educate young people in schools to increase their awareness and understanding of mental illnesses and to combat negative stereotypes.

Stigmatizing attitudes towards people with pedophilia and their malleability among psychotherapists in training

Offering counseling and psychotherapy to patients with pedophilia is considered an essential part of sexual abuse prevention by many experts in the field. Yet, professionals' willingness to offer treatment might be compromised by stigmatizing attitudes towards these patients. In the present study, we developed and tested a 10-min online intervention (including educational material and a video about a person with pedophilia) to reduce stigma and increase motivation to work with this particular patient group. Psychotherapists in training were either assigned to the anti-stigma intervention group (n=68) or the control group (n=69) that received information about violence-free parenting. In the anti-stigma condition, agreement with the stereotypes controllability and dangerousness, anger, reduced pity and social distance were significantly reduced after the intervention, compared to the control group, while motivation to work with this group remained unchanged. The effects persisted, though slightly reduced in size, for perceived controllability, anger and social distance at follow-up. Our results suggest that stigmatizing attitudes, negative affective responses and social distance regarding people with pedophilia among psychotherapists in training can be positively influenced by a low-cost intervention. Practical implications of these findings for high quality health care and child sexual abuse prevention are discussed.

Relationship between the public's belief in recovery, level of mental illness stigma, and previous contact

Disbelief exits that individuals who have a mental health condition are able to recover and fully function in life. This study analyzed 1,437 adults from the 2006 General Social Survey. Structural equation modeling (1) examined the relationship between respondents' level of prejudicial attitudes and social distance (i.e., stigma) toward individuals who have a mental health condition and their belief in the potential of recovery (2) tested whether previous contact with an individual who received treatment was a mediator. Findings indicated that the belief in recovery led to lower levels of social distance. Prejudicial attitudes were found to be a predictor of one's level of social distance. Previous contact was not a mediator however; males, minorities and those with less education were less likely to have had previous contact. Results indicated a need to emphasize the probability of recovering from a mental health condition when developing target-specific stigma reducing strategies.

Stigmatization of people with pedophilia: two comparative surveys

Despite productive research on stigma and its impact on people's lives in the past 20 years, stigmatization of people with pedophilia has received little attention. We conducted two surveys estimating public stigma and determining predictors of social distance from this group. In both studies, pedophilia was defined as a "dominant sexual interest in children." The survey was comprised of items measuring agreement with stereotypes, emotions, and social distance (among others). Responses were compared with identical items referring to either people who abuse alcohol (Study 1), sexual sadists or people with antisocial tendencies (Study 2). Study 1 was conducted in two German cities (N = 854) and Study 2 sampled 201 English-speaking online participants. Both studies revealed that nearly all reactions to people with pedophilia were more negative than those to the other groups, including social distance. Fourteen percent (Study 1) and 28 % (Study 2) of the participants agreed that people with pedophilia should better be dead, even if they never had committed criminal acts. The strongest predictors of social distance towards people with pedophilia were affective reactions to this group (anger and, inversely, associated, pity) and the political attitude of right-wing authoritarianism (Study 1). Results strongly indicate that people with pedophilia are a stigmatized group who risk being the target of fierce discrimination. We discuss this particular form of stigmatization with respect to social isolation of persons with pedophilia and indirect negative consequences for child abuse prevention.

Public stigma towards mental illness in the Greek culture

Mental illness stigma negatively affects the lives of individuals with mental health disorders. Studies have indicated that the type and degree of stigma significantly varies across cultures. This study aimed to add to this body of knowledge by examining the prevalence and the type of mental illness stigma among individuals who identified themselves as Greek. It also examined the influence of a range of potential within-culture stigma moderating factors, including levels of previous experience with mental illness and mental illness knowledge. A cross-sectional quantitative design was employed, and 111 participants living in England and Greece were sampled through the snowball sampling technique. Stigma prevalence was measured using the 'Community Attitudes to Mental Illness' questionnaire. The findings revealed that participants showed a high degree of sympathy for people with mental illness but also considered them to be inferior and of a lower social class, and needing strict societal control. Higher stigma was significantly associated with being educated in England (instead of Greece), higher religiosity, lower knowledge levels and lower levels personal experience of mental illness. Targeted antistigma campaigns specifically tailored for the Greek culture are required in order to help reduce stigmatizing attitudes.

Students' benefits and barriers to mental health help-seeking

Stigma is recognized as a potential barrier to seeking help for a mental health disorder. The present study assessed college students' perceived benefits and barriers to obtaining mental health treatment and stigma-related attitudes via a four-page survey. A total of 682 students at one Midwestern university participated in the study. Findings indicated that females perceived a greater number of benefits to having participated in mental health services and held significantly lower stigma-related attitudes than did males. Students who had ever received mental health services reported significantly more barriers to treatment than did students who had never received services. Health professionals should target students with educational programs about positive outcomes related to receiving mental health services and work with treatment centers to reduce barriers for receiving services.

How does direct to consumer advertising affect the stigma of mental illness?

Stigma interferes with life goals of people with mental illness. Direct-to-consumer advertising (DTCA) may impact stigmatizing attitudes. The purpose of this study is to examine the effects of psychiatric medication DTCA on the stigmatizing and affirming attitudes of the general population versus individuals self-identified with mental illness. Participants (n = 272) were randomly assigned to watch a DTCA about Cymbalta, an antidepressant, embedded in two other advertisements for non-pharmaceutical products. Participants completed measures of stigmatizing and affirming attitudes before and after viewing this DTCA. Results indicate that the Cymbalta DTCA worsened the attitudes of the general public. These participants were less likely to offer help, endorse recovery, and agree with self-determination attitudes towards people with mental illness following viewing the DTCA. The self-identified group reported less blame, less dangerousness, less social avoidance, more pity, and greater willingness to help after viewing the DTCA. Moreover, there was significant improvement in their endorsement of recovery. Results suggest that DTCAs about psychiatric medication may increase the public's stigma towards people with mental illness but reduce stigma among individuals who identify as having a mental illness. Findings are somewhat limited by selection biases and self-report. Implications for further development of DTCAs are considered.

Reducing the stigma of depression through neurobiology-based psychoeducation: a randomized controlled trial

AIMS

Attribution theory claims that people who are stigmatized experience more negative emotional and behavioral reactions from others when they are thought to be responsible for their problems. Accordingly, this study proposed a neurobiology-based psychoeducational intervention, which attempted to reduce people's blameworthy attitudes toward and social distance from depressed individuals.

METHODS

One hundred and thirty-two college students were randomly assigned to an experimental and control group. Participants in the experimental group received a 30-min lecture on neurobiology-based psychoeducation for depressive disorders, and were asked to fill out questionnaires before and 2 weeks after the intervention. The control group, with no intervention, also filled out the same questionnaires before and 2 weeks after the experiment. The main contents of the neurobiology-based psychoeducation concerned the neurotransmission processes and biological mechanisms of depression, in order to emphasize the biological attribution of depression.

RESULTS

An ancova indicated that the neurobiology-based psychoeducational intervention significantly elevated the biological attribution of depression and reduced the social distance from depressed individuals. Psychological blameworthy attitudes toward depression, however, did not significantly change.

CONCLUSIONS

Through a brief psychoeducation program about depression, knowledge of neuroscience could lead to positive benefits. Public awareness that depression can be effectively prevented and treated may be a way in which people can accept depressed individuals. Further studies are needed to certify the mechanisms of the effect of neurobiology-based psychoeducation.

Attitudes toward hiring applicants with mental illness and criminal justice involvement: the impact of education and experience

Individuals with mental health diagnoses, as well as those involved in the criminal justice system, experience a number of barriers in the recovery and reintegration progress, including access to stable, prosocial employment opportunities. Employment for these populations is important for establishing financial security, reducing unstructured leisure time, increasing self-worth, and improving interpersonal skills. However, research has demonstrated that individuals with psychiatric and/or criminal backgrounds may experience stigmatizing attitudes from employers that impede their ability to find adequate work. This study aimed to evaluate stigmatizing beliefs toward hypothetical applicants who indicated a mental health history, a criminal history, or both, as well as the effectiveness of psychoeducation in reducing stigma. Participants consisted of 465 individuals recruited from a large university who completed a series of online questions about a given applicant. Results of this study varied somewhat across measures of employability, but were largely consistent with extant research suggesting that mental illness and criminal justice involvement serve as deterrents when making hiring decisions. Overall, psychoeducation appeared to reduce stigma for hiring decisions when the applicant presented with a criminal history. Unfortunately, similar findings were not revealed when applicants presented with a psychiatric or a psychiatric and criminal history. Implications and limitations of these findings are presented, along with suggestions for future research.

Stigma and discrimination as a barrier to mental health service utilization in India

Stigma towards, and discrimination against, people with mental disorders is an important barrier to mental health service utilization in India. It contributes to delays in seeking care, impedes timely diagnosis and treatment for mental disorders, serves as an impediment to recovery and rehabilitation, and ultimately reduces the opportunity for fuller participation in life. In India there is a need to generate evidence base for context specific interventions that will address negative attitudes towards people with mental disorders and ensure implementation of these interventions by involving users, care-givers, community health workers and mental health service providers.

Mental health stigma and primary health care decisions

People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.

Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials

The stigma associated with mental disorders is a global public health problem. Programs to combat it must be informed by the best available evidence. To this end, a meta-analysis was undertaken to investigate the effectiveness of existing programs. A systematic search of PubMed, PsycINFO and Cochrane databases yielded 34 relevant papers, comprising 33 randomized controlled trials. Twenty-seven papers (26 trials) contained data that could be incorporated into a quantitative analysis. Of these trials, 19 targeted personal stigma or social distance (6,318 participants), six addressed perceived stigma (3,042 participants) and three self-stigma (238 participants). Interventions targeting personal stigma or social distance yielded small but significant reductions in stigma across all mental disorders combined (d=0.28, 95% CI: 0.17-0.39, p<0.001) as well as for depression (d=0.36, 95% CI: 0.10-0.60, p<0.01), psychosis (d=0.20, 95% CI: 0.06-0.34, p<0.01) and generic mental illness (d=0.30, 95% CI: 0.10-0.50, p<0.01). Educational interventions were effective in reducing personal stigma (d=0.33, 95% CI: 0.19-0.42, p<0.001) as were interventions incorporating consumer contact (d=0.47, 95% CI: 0.17-0.78, p<0.001), although there were insufficient studies to demonstrate an effect for consumer contact alone. Internet programs were at least as effective in reducing personal stigma as face-to-face delivery. There was no evidence that stigma interventions were effective in reducing perceived or self-stigma. In conclusion, there is an evidence base to inform the roll out of programs for improving personal stigma among members of the community. However, there is a need to investigate methods for improving the effectiveness of these programs and to develop interventions that are effective in reducing perceived and internalized stigma.

Changing stigma through a consumer-based stigma reduction program

This study assessed the Anti-Stigma Project workshop, a contact/education intervention developed by On Our Own of Maryland, Inc. and the Maryland Mental Hygiene Administration. Two separate randomized controlled trials administered pre- and post-test questionnaire assessments. One included people with mental illness (N = 127) and a second included mental health providers (N = 131). Post-intervention, people with mental illness were more aware of stigma, had lower levels of prejudice, and increased belief in recovery. Providers were more aware of stigma, had lower levels of prejudice, and increased concurrence in self-determination of people with mental illness. Increasing providers' stigma awareness and recognition can promote higher quality service delivery. Increasing stigma awareness and recognition for people with mental illness can foster confidence in overcoming psychiatric disabilities. Using a participatory action research team, our protocol included extant and newly developed stigma change tools. Organizations seeking to conduct effective evaluation studies should consider collaborative processes including the expertise of affected constituents.

Public stigma towards patients with schizophrenia of ethnic Malay: a comparison between the general public and patients' relatives

BACKGROUND

The stigma attached to mental disorders has been recognized as a major concern in healthcare services across societies.

AIMS

To compare the stigmatizing attitude towards patients with schizophrenia between the general public, relatives of patient with schizophrenia and relatives of patient with neurotic illnesses.

METHOD

The study sample of 600 subjects of Malay families was equally divided into three groups. The sample was selected using convenience sampling. Each subject completed a seven-item Social Distance Scale (SDS) and a six-item stereotypical beliefs (SB) scale of people with schizophrenia. Appropriate statistical analysis was then conducted to compare the differences in SDS and SB scores between the groups.

RESULTS

The scores of both SD and SB were consistent with each other, which reflected that far social distance and more negative attitudes were strongly adopted by the general public. There were significant differences in the total and most of the individual item scores of the SDS and the SB between the general public and the two relatives groups. However, the difference in the SDS scores between the relatives of patient with schizophrenia and neurotic illnesses was not significant. Among the socio-demographic factors, educational status had a stronger influenced on stigma than age and sex.

CONCLUSIONS

The stigma towards patients with schizophrenia among the Malay community was strong. Individuals who had been exposed to patient with schizophrenia or neurotic illnesses tended to have better perceptions towards schizophrenia than the general public. The contact that promotes familiarity with mental illness, which may diminish prejudicial attitudes, attributed to the improvement.

Opening Minds Stigma Scale for Health Care Providers (OMS-HC): examination of psychometric properties and responsiveness

BACKGROUND

Diminishing stigmatization for those with mental illnesses by health care providers (HCPs) is becoming a priority for programming and policy, as well as research. In order to be successful, we must accurately measure stigmatizing attitudes and behaviours among HCPs. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) was developed to measure stigma in HCP populations. In this study we revisit the factor structure and the responsiveness of the OMS-HC in a larger, more representative sample of HCPs that are more likely to be targets for anti-stigma interventions.

METHODS

Baseline data were collected from HCPs (n = 1,523) during 12 different anti-stigma interventions across Canada. The majority of HCPs were women (77.4%) and were either physicians (MDs) (41.5%), nurses (17.0%), medical students (13.4%), or students in allied health programs (14.0%). Exploratory factor analysis (EFA) was conducted using complete pre-test (n = 1,305) survey data and responsiveness to change analyses was examined with pre and post matched data (n = 803). The internal consistency of the OMS-HC scale and subscales was evaluated using the Cronbach's alpha coefficient. The scale's sensitivity to change was examined using paired t-tests, effect sizes (Cohen's d), and standardized response means (SRM).

RESULTS

The EFA favored a 3-factor structure which accounted for 45.3% of the variance using 15 of 20 items. The overall internal consistency for the 15-item scale (α = 0.79) and three subscales (α = 0.67 to 0.68) was acceptable. Subgroup analysis showed the internal consistency was satisfactory across HCP groups including physicians and nurses (α = 0.66 to 0.78). Evidence for the scale's responsiveness to change occurred across multiple samples, including student-targeted interventions and workshops for practicing HCPs. The Social Distance subscale had the weakest level of responsiveness (SRM ≤ 0.50) whereas the more attitudinal-based items comprising the Attitude (SRM ≤ 0.91) and Disclosure and Help-seeking (SRM ≤ 0.68) subscales had stronger responsiveness.

CONCLUSIONS

The OMS-HC has shown to have acceptable internal consistency and has been successful in detecting positive changes in various anti-stigma interventions. Our results support the use of a 15-item scale, with the calculation of three sub scores for Attitude, Disclosure and Help-seeking, and Social Distance.

Callanan M, Greenwood K. Parents' communication to primary school-aged children about mental health and ill-health: a grounded theory study

Purpose

– Stigma around mental health problems is known to emerge in middle childhood and persist into adulthood, yet almost nothing is known about the role of parents in this process. This paper aims to develop a model of parental communication to primary school-aged children around mental health and ill-health, to increase understanding about how stigma develops.

Design/methodology/approach

– Semi-structured interviews were performed with ten UK-based parents of children aged 7-11 years. Analysis followed an exploratory grounded theory approach, incorporating quality assurance checks.

Findings

– Parents’ communications are governed by the extent to which they view a particular issue as related to “Them” (mental ill-health) or to “Us” (mental health). In contrast to communication about “Us”, parental communication about mental “illness” is characterized by avoidance and contradiction, and driven by largely unconscious processes of taboo and stigma.

Originality/value

– This study was the first to explore parents’ communications to their 7-11 year old children about mental health and mental illness, and proposes a preliminary theoretical model that may offer insight into the development of stigma in childhood and the intergenerational transmission of stigmatized attitudes.

The impact of mental and substance-use disorders on employment transitions

The cyclic nature of serious mental illness (SMI) and substance-use disorders (SUD) suggests that persons with these conditions may experience high rates of transitions among employment states (full-time, part-time, and no employment). This study uses longitudinal data from two waves of the National Epidemiologic Survey of Alcoholism and Related Conditions to examine employment transitions for persons with SMI/SUD relative to a no-disorder control group. Conditional on employment status in Wave I, we estimate conditional odds ratios and marginal effects of each diagnosis on the probabilities of part-time or full-time employment in Wave II, holding constant other characteristics that influence employment decisions. The results show transitions across employment states are common for all groups but more frequent for persons with SMI/SUD than the controls. Persons with SMI are less likely, and persons with SUDs more likely, to transition out of no employment than the controls. Part-time employment is a relatively transitory state, particularly for persons with SMI/SUD, but full-time employment brings a measure of job stability to all groups. After controlling for differences in observable characteristics, the marginal effects of SMI and alcohol disorders on employment transitions are largely significant, but the effects of drug disorders are not.

Schools-based interventions for reducing stigmatization of acquired brain injury: the role of interpersonal contact and visible impairment

The purpose of this study was to determine the effectiveness of contact versus education interventions for adolescents in reducing stigmatizing attitudes toward people with acquired brain injury (ABI), and whether visibility of ABI affects the intervention outcome. 408 students (age range = 14-17 years) from 13 schools in the Mid-West of Ireland were randomly allocated to one of the three interventions: Education only, Contact (Visible Disability), or Contact ("Invisible" Disability). Stigmatizing attitudes were measured before and after intervention. Results suggest that a Contact intervention was more effective in reducing stigmatizing attitudes in terms of social restrictiveness, benevolence, and community mental health beliefs than education alone. Visibility of ABI impacted the effectiveness of the contact intervention on Community Mental Health beliefs only. Contact with a person with ABI is thus more effective in promoting positive attitudes than ABI education alone, while the presence of visible impairment was not found to increase this intervention effect.

Public stigma against people with mental illness in the Gilgel Gibe Field Research Center (GGFRC) in Southwest Ethiopia

BACKGROUND

Public understanding about mental illnesses and attitudes towards people with mental illness (PWMI) play a paramount role in the prevention and treatment of mental illness and the rehabilitation of PWMI. The aim of this study was to measure public stigma against PWMI and the factors associated with stigma in the Gilgel Gibe Field Research Center (GGFRC) in Southwest Ethiopia.

METHODS

This community-based, cross-sectional study was conducted from June to August 2012 among 845 randomly selected respondents by using the Community Attitudes towards the Mentally Ill (CAMI) scale, an interviewer-administered questionnaire. Data was entered with EPI-DATA and then exported to STATA for analysis. Simple descriptive and linear regression analyses were performed to identify predictors of stigma against PWMI.

RESULTS

Of the total of 845 respondents, 68.17% were from rural districts. The mean stigma score was 2.62 on a 5-point score. The majority of the respondents (75.27%) believed that mental illness can be cured. Stress, poverty, and rumination were the most often perceived causes of mental illness. Rural residents had significantly higher stigma scores (std. β = 0.61, P<0.001). A statistically significant inverse relationship was found between the level of education and degree of stigma (std. β = -0.14, P<0.01), while higher income was significantly associated with more stigma (std. β = 0.07, P<0.05). Respondents with higher scores for perceived supernatural causes (std. β = -0.09, P<0.01) and perceived psychosocial and biological causes (std. β = -0.14, P<0.001) had significantly lower stigma levels.

CONCLUSIONS

The study found a more undermining but less avoidant attitude towards PWMI. Rural residents showed higher levels of stigma. Stigma against PWMI was lower in people with an explanatory concept about the causes of mental illness and a higher level of education. Information, education, and communication about the causes, signs, and nature of mental illnesses would help to reduce stigma.

The etiology of mental disorders: public endorsement of traditional Chinese beliefs in Macau

BACKGROUND

Public beliefs concerning the causes of mental disorders are important in their effective treatment. The relative importance of public beliefs related to the etiology of mental disorders among Chinese populations and their relationship to other attitudes to mental disorders are poorly understood.

AIMS

To investigate the endorsement of beliefs related to the etiology of mental disorders in Macau, in particular, traditional Chinese beliefs, and to explore their relationship to general attitudes towards mental disorders.

METHODS

A survey of 361 members of the public measured attitudes towards 32 possible causes of mental disorders as well as contact with and social distance from individuals with a mental disorder.

RESULTS

The results indicated that traditional Chinese beliefs were ranked with relatively low importance compared with psychosocial causes. Traditional beliefs related to two underlying factors and were significantly higher in participants with lower education levels. There was a significant negative correlation between endorsement of traditional beliefs and contact with individuals with a mental disorder and a significant positive correlation between endorsement of traditional beliefs and desired social distance from individuals with a mental disorder.

CONCLUSION

Factors underlying traditional Chinese beliefs concerning the causes of mental disorders are associated with more negative attitudes towards individuals with a mental disorder, with such beliefs more strongly endorsed by those with relatively lower education levels.

Public opinion on imposing restrictions to people with an alcohol- or drug addiction: a cross-sectional survey

PURPOSE

Alcohol- and drug addiction tends to evoke disapproval and rejection among people. This study provides insight into the origin of people's negative attitudes towards these people. Corrigan's attribution model is used to examine intentions of the Dutch public to impose restrictions to people who are addicted to alcohol or illicit drugs.

METHODS

Data were derived from a cross-sectional survey among a representative panel of the Dutch population (N = 2,793). Path analyses were conducted to test the influence of attribution beliefs, emotional responses and familiarity with addictions on people's intentions to impose restrictions to these people.

RESULTS

More than half of the respondents agreed with imposing restrictions to someone with an addiction such as excluding from taking public office or forbid to care for children. Corrigan's attribution model was partially applicable to explain people's intentions to impose restrictions, since only a rather small percentage of the variance in people's intentions was explained by the model. The perception of personal responsibility for an addiction and high expectancy of aggressiveness have a positive influence on intentions to impose restrictions. Feelings of anger and fear were also predictors of intentions to impose restrictions.

CONCLUSIONS

The Dutch public showed high intentions to restrict people with an alcohol- or drug addiction which has an extensive impact on their life opportunities. Perceived aggressiveness, feeling of anger and fear, and perceived responsibility were associated with higher intentions to impose restrictions.

Dimensions of Attitudes towards the Mentally Ill in the General Population Stability and Change over Time at Urban and Rural Sites

Items measuring attitudes toward the mentally ill can be limited in relevance to a particular period or place. The main objective of the study was to provide evidence toward a questionnaire that was short and psychometrically stable over time and geography, and that could be used within comprehensive mental health surveys of general populations. Four rural samples, Lofoten 1983 (n = 470), 1990 (n = 947), 2000 (n = 864), and Valdres 2010 (n = 772), and two urban samples, Oslo 1990 (n = 948) and 2000 (n = 467), were used to test this. The questionnaire was self-administered with fixed questions and response alternatives. Using the three Lofoten and the two Oslo samples, the stability of the factor analytic structure of 19 attitude items was established. In all analyses, there was a clear leveling off after three factors. The 13 highest loading items on these three factors were used in a new rural region, Valdres, in 2010. The three established factors/dimensions, named Distance, Demands, and Positive, seemed to be reasonably stable within a variety of Norwegian samples. On the other hand, the analyses were different enough to recommend researchers and politicians to be careful when comparing absolute levels of the suggested indexes across different locations and at different points in time.

Differences in views of schizophrenia during medical education: a comparative study of 1st versus 5th-6th year Italian medical students

PURPOSE

This study explored medical students' causal explanations and views of schizophrenia, and whether they changed during medical education.

METHOD

The survey was carried out on medical students of the Second University of Naples, Italy, who attended their first-year and their fifth- or sixth-year of lessons. The 381 who accepted were asked to read a case-vignette describing a person who met the ICD-10 criteria for schizophrenia and then fill in the Opinions on mental illness Questionnaire.

RESULTS

The most frequently cited causes were psychological traumas (60%) and stress (56%), followed by misuse of street drugs (47%), and heredity (42%). 28% of students stated that persons with the disorder could be well again, and 28% that they were unpredictable. Labeling the case as "schizophrenia" and naming heredity among the causes were associated with pessimism about recovery and higher perception of social distance. First-year students more frequently reported psychological traumas among the causes (76 vs. 45%), and less frequently heredity (35 vs. 81%) and stress (42 vs. 69%), and they perceived less social distance from the "schizophrenics" than fifth/sixth-year students. In particular, 18% percent of first-year versus 38% of fifth/sixth-year students believed that these persons were kept at a distance by the other, and 45 versus 57% felt frightened by persons with the condition.

CONCLUSIONS

These results indicate a need to include education on stigma and recovery in schizophrenia in the training of medical students.

Shame-Focused Attitudes Toward Mental Health Problems

The purpose of this study was to examine the effects of gender and culture on shame-focused attitudes toward mental health problems. Two hundred and ninety-three university students from Asian, Latino, and Caucasian American cultural backgrounds participated in the study. The Attitudes Toward Mental Health Problems Scale was used to measure shame-focused attitudes. A 2 (gender) × 3 (culture) multivariate analyses of variance was performed. Results indicated that there was no significant gender difference in shame-focused attitudes toward mental health problems. Of the three ethnic cultural groups, Latino American students had the highest mean score on how shameful they would feel if they had mental health problems. Asian American students had the lowest mean score on how negative their families would view themselves if they had mental health problems. Implications of the results for rehabilitation research and practice are discussed.

A depression training session with consumer educators to reduce stigmatizing views and improve pharmacists' depression care attitudes and practices

OBJECTIVE

To measure the impact of a depression training day for pharmacists that included a 75-minute session with a consumer educator.

DESIGN

The training day included interactive lectures on depression; the effects and side effects of and indications for the use of antidepressants; adherence issues; non-drug treatment options for depression; and basic skills in communication. Pharmacists also participated in a session with a consumer educator and in counseling exercises that included role playing.

ASSESSMENT

The study used a randomized, clustered, comparative design to measure pharmacists' stigma, attitudes, and current practice related to the provision of pharmaceutical care to people with depression. Mean scores for depression-care practice after the training session were significantly higher in the intervention group than in the control group. Analysis of the changes between baseline and postintervention measures in both the control and intervention groups confirmed a significant difference in the change in both social distance and practice but no significant difference in the change in attitude between the 2 groups of pharmacists.

CONCLUSION

A continuing-education depression training day for pharmacists that involve consumer educators may improve the care delivered in the community pharmacy to people with depression.

Awareness of schizophrenia and intellectual disability and stigma across ethnic groups in the UK

Research has examined the public's understanding of mental illness and stigma, but there is scant evidence on intellectual disabilities. This study investigated whether the public from different ethnic groups can recognise symptoms of schizophrenia and intellectual disability depicted in a vignette, and what factors predict recognition and social distance. A survey of lay people of working age was completed in the UK (N=1002). The sample was ethnically mixed, with the largest groups consisting of white UK residents, and people from Asian and black African/Caribbean backgrounds. Regression analyses were performed to identify predictors of recognition and social distance. Across the whole sample, 25.7% recognised schizophrenia and 28.0% intellectual disability. Ethnicity, gender, education and prior contact predicted recognition of both vignettes. Social distance was higher for schizophrenia than intellectual disability, but overall participants were ambivalent to mildly negative about social contact with individuals with either symptomatology. Familiarity was associated with lower social distance for both conditions. Symptom recognition predicted reduced social distance for intellectual disability, but not for schizophrenia. The low levels of awareness of symptoms and high levels of stigma among some ethnic groups indicate a need for targeted public education efforts and further research.

Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review

BACKGROUND

Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance use disorders. Our objective was to assess health professionals' attitudes towards patients with substance use disorders and examine the consequences of these attitudes on healthcare delivery for these patients in Western countries.

METHODS

Pubmed, PsycINFO and Embase were systematically searched for articles published between 2000 and 2011. Studies evaluating health professionals' attitudes towards patients with substance use disorders and consequences of negative attitudes were included. An inclusion criterion was that studies addressed alcohol or illicit drug abuse. Reviews, commentaries and letters were excluded, as were studies originating from non-Western countries.

RESULTS

The search process yielded 1562 citations. After selection and quality assessment, 28 studies were included. Health professionals generally had a negative attitude towards patients with substance use disorders. They perceived violence, manipulation, and poor motivation as impeding factors in the healthcare delivery for these patients. Health professionals also lacked adequate education, training and support structures in working with this patient group. Negative attitudes of health professionals diminished patients' feelings of empowerment and subsequent treatment outcomes. Health professionals are less involved and have a more task-oriented approach in the delivery of healthcare, resulting in less personal engagement and diminished empathy.

CONCLUSIONS

This review indicates that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients. However, few studies have evaluated the consequences of health professionals' negative attitudes towards patients with substance use disorders.

Culture, threat, and mental illness stigma: identifying culture-specific threat among Chinese-American groups

We incorporate anthropological insights into a stigma framework to elucidate the role of culture in threat perception and stigma among Chinese groups. Prior work suggests that genetic contamination that jeopardizes the extension of one's family lineage may comprise a culture-specific threat among Chinese groups. In Study 1, a national survey conducted from 2002 to 2003 assessed cultural differences in mental illness stigma and perceptions of threat in 56 Chinese-Americans and 589 European-Americans. Study 2 sought to empirically test this culture-specific threat of genetic contamination to lineage via a memory paradigm. Conducted from June to August 2010, 48 Chinese-American and 37 European-American university students in New York City read vignettes containing content referring to lineage or non-lineage concerns. Half the participants in each ethnic group were assigned to a condition in which the illness was likely to be inherited (genetic condition) and the rest read that the illness was unlikely to be inherited (non-genetic condition). Findings from Study 1 and 2 were convergent. In Study 1, culture-specific threat to lineage predicted cultural variation in stigma independently and after accounting for other forms of threat. In Study 2, Chinese-Americans in the genetic condition were more likely to accurately recall and recognize lineage content than the Chinese-Americans in the non-genetic condition, but that memorial pattern was not found for non-lineage content. The identification of this culture-specific threat among Chinese groups has direct implications for culturally-tailored anti-stigma interventions. Further, this framework might be implemented across other conditions and cultural groups to reduce stigma across cultures.

Intervention for reducing stigma: Assessing the influence of gender and knowledge

AIM

To evaluate the effectiveness in reducing social stigma of an intervention and to assess the influence of gender and knowledge.

METHODS

The program consisted in providing information and contact with users of mental health in order to reduce social stigma in the school environment. A total of 62 secondary school students (age 14-16 years) were evaluated with the Opinions on Mental Illness (OMI) questionnaire before and after the intervention. The subscales of the OMI were: authoritarianism, interpersonal etiology, benevolence, restrictiveness and negativism. The analysis was performed over the total sample, separating by gender and knowledge of someone with a mental disorder. t-test for repeated measures was used in the statistical analysis.

RESULTS

All the OMI subscales showed a significant change after the intervention (P < 0.001), except for benevolence. Women presented significant changes in the subscales of authoritarianism and restrictiveness, while men presented changes in negativism and interpersonal etiology rather than restrictiveness (P < 0.001-0.003). Students that knew someone with a mental disorder presented significant changes in authoritarianism, interpersonal etiology, and negativism (P < 0.001-0.003) and students that do not know anyone with a mental disorder improved in restrictiveness and authoritarianism (P < 0.001-0.001). In all the subscales of the instrument the students improved their perception of mental disorders, reducing their levels of stigma.

CONCLUSION

The intervention designed to reduce social stigma was effective, especially in the area of authoritarianism. The whole sample showed improved attitudes towards mental illness, although the areas were different depending on gender and knowledge.

Attitudes toward community mental health care: the contact paradox revisited

Contact with people with mental illness is considered to be a promising strategy to change stigmatizing attitudes. This study examines the underlying mechanisms of the association between contact and attitudes toward community mental health care. Data are derived from the 2009 survey "Stigma in a Global Context-Belgian Mental Health Study", using the Community Mental Health Ideology-scale. Results show that people who received mental health treatment themselves or have a family member who has been treated for mental health problems report more tolerant attitudes toward community mental health care than people with public contact with people with mental illness. Besides, the perception of the effectiveness of the treatment seems to matter too. Furthermore, emotions arising from public contact are associated with attitudes toward community mental health care. The degree of intimacy and the characteristics of the contact relationship clarify the association between contact and attitudes toward community mental health care.

A hard pill to swallow: medication, empathy, and the value of collaborative recovery

Recovery from mental illness is a complex journey that is greatly facilitated when client and professional helper collaborate in the decision making process. It is further aided when the latter has an empathetic awareness of the client's experience, especially with regard to the impact of pharmacological treatment. The following article describes one psychologist's experience of being prescribed medication during a period of acute illness. Analysis of this experience is via a narrative, phenomenological approach. Results suggest that even when taken as directed, a medication can augment one's subjective feeling of illness. It further shows how challenging it can be for the ailing individual to assert his or her needs for something other than hospitalization. Although only one case is analyzed, it points to the impact that medication may have on the life of a person with mental illness, reinforcing the importance of collaboration and empathetic understanding of the other's experience.