Attitudes toward mental illness: recognition, desired social distance, expected burden and negative influence on mental health among Turkish freshmen

A Review on Mental Illness and Stigma

The concept of stigma is a universal problem that has been the subject of many studies. The phenomenon of stigmatization in psychiatric disorders is also an issue that should be particularly emphasized. Studies have reported that the diagnostic groups most exposed to stigmatization are psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, and substance use disorders. The stigma process is shaped especially by the clinical features of psychiatric disorders and the society’s attributions to the causes of psychiatric disorders. IIn order for interventions to be developed to prevent stigmatization to be effective, the causes of stigmatization must first be understood.. Therefore, in this study, it is aimed to review the stigmatization processes separately according to the types of psychiatric disorders.

General Medical Clinicians' Attitudes Toward People with Serious Mental Illness: A Scoping Review

Individuals with serious mental illness (SMI) experience significant premature mortality due to somatic conditions but often receive sub-optimal somatic care, but little research has been done to understand how general medical clinicians' attitudes may affect care provision or health outcomes. This review describes general medical clinicians' attitudes toward people with SMI, compares these attitudes to attitudes among mental health clinicians or toward individuals without SMI, and examines the relationship between attitudes and clinical decision making. Seventeen studies were reviewed. General medical clinicians reported negative attitudes toward individuals with SMI. These attitudes were generally more negative than attitudes among mental health clinicians and were consistently more negative when compared to attitudes toward individuals without SMI. Four studies suggest that these negative attitudes have an adverse effect on clinician decision making.

Physician referral to a psychologist: Testing alternative behavioral healthcare seeking models

OBJECTIVE

Primary care physicians (PCPs) often refer patients to psychological services, but help-seeking factors in the context of behavioral healthcare referral are understudied. This study examined perceptions of seeking psychological help for depression by comparing alternative structural equation models derived from the Theory of Reasoned Action (TRA).

METHOD

Internet survey participants (N = 685 US adults, 77% female, M _age  = 45) imagined themselves in a vignette scenario in which they are experiencing depression symptoms and encouraged by a PCP to see a psychologist.

RESULTS

Results supported the indirect model, in which the links between distal help-seeking factors (i.e., self-stigma, symptom recognition, perceived effectiveness of treatment) and intention to follow through on the referral to the psychologist were fully mediated by the more proximal TRA factors (i.e., attitudes, subjective norms, etc).

CONCLUSIONS

Our findings supported the use of TRA in understanding peoples' intention to seek psychological help for depression when referred by their PCP.

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.

Attitudes of Medical and Pharmacy Students Towards Patients Suffering from Schizophrenia

Research over the past twenty years has shown that the attitudes of health care workers and students towards people who are suffering from schizophrenia have become more negative. The aim of our study was to investigate the attitudes of medical and pharmacy students towards patients with schizophrenia and explore the differences in attitudes between study groups and students in different years. Materials and methods: Second- and fifth-year medical and pharmacy students from the Faculty of Medical Sciences at the University of Kragujevac were included in an observational, prospective, cross-sectional study. The sample consisted of 113 students from the pharmacy and medical schools who were chosen via random sampling. The students completed a two-part questionnaire. Th e first part contained questions about sociodemographic characteristics, whereas the second part was a translated version of the Mental Illness: Clinician’s Attitudes (MICA) v4 scale. Results: There is a statistically significant difference (р<0.05) in the attitudes towards people with schizophrenia between second- and fifth-year medical and pharmacy students (with lower scores in both groups in fifth-year students). Of the total number of students who had lower summed scores on the Likert scale, 51.3% had previously finished medical high school, whereas 28.3% had previously finished regular high school. Conclusion: Our results showed a statistically significant difference in attitudes towards people with schizophrenia between second- and fifth-year students as well as a difference related to previous high school education. This stresses the importance of levels of knowledge about schizophrenia to reducing the stigmatization of patients who suffer from this disorder.

Desire for social distance from people with mental disorders

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to make sense of this confusion, the present review focuses on research on the most commonly measured component: social distance. The review examines measurement of social distance; characteristics of people who desire greater social distance; experiences that affect social distance; characteristics of people that elicit social distance; the effects of psychiatric labelling; the effects of causal explanations for mental disorders; and interventions to reduce social distance. It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.

A cross-cultural comparison of British and Chinese beliefs about the causes, behaviour manifestations and treatment of schizophrenia

This study is set to examine the British (in England) and Chinese (in China and Hong Kong) beliefs about the causes, behaviour manifestations and treatments of schizophrenia. It was hypothesised that first the Chinese would hold more religious and superstitious beliefs towards the causation and treatment of schizophrenia and would prefer the use of alternative medicine; second, the British would emphasise more on internal (biological and psychological) and external (sociological) beliefs for the causes and treatments. It was also predicted that the Chinese would possess more negative attitudes and beliefs about the behaviour manifestations of schizophrenia than the British. All three hypotheses were confirmed after factor analysing the internal structure of the questionnaire. The relevance between investigating beliefs of schizophrenia and treatment of psychiatric disorders for clinical practice is also highlighted.

Stigma towards people with mental illness in developing countries in Asia

BACKGROUND

There is a wide range of literature on stigmatization and discrimination of people with mental illness. Most studies, however, derive from Western countries. This review aims at summarizing results from developing countries in Asia published between 1996-2006.

METHOD

Medline search focusing on English-speaking literature.

RESULTS

Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by scepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.

CONCLUSION

This review revealed that the stigmatization of people with mental illness is widespread in Asia. The features of stigmatization-beliefs about causes of and attitudes towards mental illness, consequences for help-seeking-have more commonalities than differences to Western countries.

Attitudes of mental health professionals toward people with schizophrenia and major depression

Several studies reveal poor knowledge about mental illness in the general population and stigmatizing attitudes toward people with mental illness. However, it is unknown whether mental health professionals hold fewer stigmatizing attitudes than the general population. A survey was conducted of the attitudes of mental health professionals (n = 1073) and members of the public (n = 1737) toward mental illness and their specific reaction toward a person with and without psychiatric symptoms ("non-case" as a reference category). Psychiatrists had more negative stereotypes than the general population. Mental health professionals accepted restrictions toward people with mental illness 3 times less often than the public. Most professionals were able to recognize cases of schizophrenia and depression, but 1 in 4 psychiatrists and psychologists also considered the non-case as mentally ill. The social distance toward both major depression and the non-case was lower than toward schizophrenia. However, in this regard, there was no difference between professionals and the public. The study concludes that the better knowledge of mental health professionals and their support of individual rights neither entail fewer stereotypes nor enhance the willingness to closely interact with mentally ill people.

Comparing the stigma of mental illness in a general hospital with a state mental hospital: a Singapore study

The stigma faced by psychiatric patients associated with the type of psychiatric facilities is controversial. This study was conducted to compare the stigma faced by patients with schizophrenia and non-schizophrenia psychiatric disorders in the outpatient departments of a state mental hospital with those in a general hospital in Singapore. A cross-sectional study involving two groups of outpatients in a state mental hospital (n=300) and in a university general hospital (n=300) were assessed with a 12-item stigma scale. Components of the scale assessed included social rejection, negative media perception, shame and social discrimination. Among schizophrenia patients, state mental hospital patients had significantly lower stigma scores compared to their counterparts in the general hospital. For other mental illnesses, the reverse was true: state mental hospital patients had significantly higher stigma scores compared to their counterparts in the general hospital. Stigma was also associated with a younger age and being employed though not by gender. The stigma faced by psychiatric patients is complex and may have institutional and disorder-specific elements. Possible reasons for this are discussed.

Nursing students' attitude change towards mental illness and psychiatric case recognition after a clerkship in psychiatry

Attitudes towards mental illness were measured in all 92 students of the seventh semester in the School of Nursing of Athens University before (time 1) and after (time 2) the completion of 40 and 90 hours of lectures on clinical psychiatry and clerkship, respectively. The instrument used to measure attitudinal dimensions was the Cohen and Struening's Opinions about Mental Illness (OMI) scale, which yieldsfive factors and was proven to be reliable and valid in previous studies. Hypothetical case vignettes were used to assess psychiatric case recognition. In factors A, B, and D statistically significant differences in attitudes towards mental illness between time I and 2 were observed. It seems that the completion of training in psychiatry influenced the students' opinions about mental illness; they expressed less authoritarianism and discriminatory beliefs as well as positive views about social integration of mentally ill persons. The group of students who failed to recognize the case vignettes satisfactorily also expressed negative views in four out of five OMI scale factors.

Attitudes of hospital staff toward mentally ill patients in a teaching hospital, Turkey

The aim of this study was to examine the attitudes of hospital staff toward major mental diseases: schizophrenia and depression. Negative attitudes were common among all of the hospital staff, and were more common among academicians, resident physicians and nurses. Causes of attitude variations were discussed.

BACKGROUND

Attitudes of hospital staff are important for admission, early diagnosis and treatment, and the rehabilitation process of mentally ill patients.

AIMS

The main objective of this study was to investigate and compare hospital workers' attitudes toward and knowledge of schizophrenia and depression.

METHODS

In 2001, a total of 160 hospital staff (40 academicians, 40 resident physicians, 40 nurses and 40 hospital employees) in a teaching hospital were interviewed with a questionnaire. The questionnaire included items about background information, a one-paragraph vignette, questions on social distance and expected burden, recognition of mental illness, hospitalization, prognostic outcome, and to whom and where the patient should be admitted.

RESULTS

Although academicians, resident physicians, and nurses have sufficient knowledge about schizophrenia and depression, the frequency of their negative attitudes towards mentally ill subjects was more than that for uneducated hospital employees.

CONCLUSIONS

It was commented that this difference might be as a result of negative effects of the medical education system.

LAY THEORIES OF CAUSES OF AND CURES FOR DEPRESSION IN A TURKISH UNIVERSITY SAMPLE

This paper reports a study on university students' attributions for the causes of and cures for depression conducted in a Turkish sample. Results revealed six components for causes, which were trauma, job-related problems, loss, disposition, intimacy, and isolation. Seven components were found for cures, which were hobby, sensation seeking, avoidance, professional help, religious practices, esteem, and spiritual activities. Men rated religious practices as more useful than women did. No other differences pertaining to gender or previous contact were found. Results are discussed together with the limitations of the study.

Response of Japanese patients to the change of department name for the psychiatric outpatient clinic in a university hospital

There has long been controversy over the stigma associated with mental illness and psychiatric facilities. In Japan, the department name "Department of Psychiatry" (in Japanese, Seishin-ka) itself evokes the lay public's and psychiatric patients' feelings of stigma. This phenomenon may hamper psychiatric treatment of adequate duration and quality. On July 1st, 1999, the Juntendo University Hospital changed the department name from "Department of Psychiatry and Neurology" (in Japanese, Seishin-Shinkei-ka) to Mental Clinic, accompanied by an increased number of new outpatients, as reported previously. In the present study, we turn our attention to the opinions of those patients who have received treatment in the department under both names. Questionnaires asking for their opinions about the department names revealed that the majority have feelings of stigma associated with the name "Department of Psychiatry and Neurology." This result did not correlate with demographic factors or the length of psychiatric treatment. However, those who experienced psychiatric admission were significantly less uncomfortable with the name than those who did not. It was also revealed that the change in the name lessened their feelings of stigma and negative self-image as patients of a general hospital. These results suggest the importance of the name of the psychiatric department in general hospitals, in Japan, from therapeutic, psychosocial and ethical viewpoints.

Influence of a 3-week psychiatric training programme on attitudes toward mental illness in medical students

The present study was carried out to assess the influence of psychiatric training, including direct patient contact, on attitudes toward mental illness. An experimental group consisting of medical students going through their 3-week training in psychiatry was compared with a control group going through training in ophthalmology. The psychiatric training involved direct patient contact and course work. Attitudes toward three different vignettes were assessed before and after training. Analyses showed that there were no significant changes in the attitudes of the psychiatry group when compared to the ophthalmology group. Inconsistent findings in the literature were pointed out and a more analytical approach, focusing on the specific features of exposure, was suggested.

Effect of psychiatric labels on attitudes toward mental illness in a Turkish sample

The influence of specific psychiatric labels and types of psychopathology on various attitudes were investigated in a sample (N = 84) of visitors of patients in a Turkish hospital. Vignettes representing two types of psychopathology with and without labels were used as the stimulus material and the attitudes toward those descriptions were assessed with the use of a questionnaire. Statistical analyses showed that labels had significant influence on recognition of mental illness, social distance, expected physical burden, and perception of treatment necessity. Type of psychopathology significantly influenced recognition of mental illness, social distance, expected physical burden, prognosis, and treatment choice. The results were discussed within the context of previous findings and the need for research pointed out.

Influence of having a hospitalized mentally ill member in the family on attitudes toward mental patients in Turkey

The influence of having a mentally ill member in the family on various attitudes was assessed. An exposed group (those having a mentally ill member) was compared with a no-exposure group. The attitudes assessed toward two vignettes included recognition of mental illness, social distance, expected burden, expected influence on one's health, treatment choice, and prognosis. The total sample consisted of 84 subjects selected from the family members of patients from psychiatric (exposed) and other (no-exposure) clinics. Direct experience with a mentally ill family member did not make a significant difference in the attitudes toward the vignettes, but the type of psychopathology did. The results were discussed within the context of findings from Western cultures.

Experienced Turkish nurses' attitudes towards mental illness and the predictor variables of their attitudes

General attitudes towards mental illness, attitudes towards two vignettes, and possible predictor variables of these attitudes were investigated among experienced Turkish nurses. The analyses showed that the nurses accepted both organic and psychological causation and had rather positive views on drug treatment, psychotherapy, and prognosis. However, they were more favourably disposed towards psychological causation and psychotherapy; the paranoid schizophrenia description was more readily perceived as mental illness and more 'negative' ratings were recorded for this than was the case in the description of neurosis. In terms of predictors, university education was related to lower acceptance of psychotherapy and chances of recovery; older respondents showed higher social distance to the neurosis vignette. The findings were discussed within the context of previous findings from Turkey and other countries.