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Morris J, Tattan-Birch H, Albery IP, Heather N, Moss AC. Look away now! Defensive processing and unrealistic optimism by level of alcohol consumption. Psychol Health 2024:1-19. [PMID: 38379336 DOI: 10.1080/08870446.2024.2316681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Health risk information is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or 'defensive processing', may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption. DESIGN Online participants (n = 597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) and demographics. RESULTS AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson's correlation r from.16 to .36), threat and susceptibility (r = .16) and unrealistic optimism (r = .50). AUDIT-C scores were also negatively associated with efficacy for controlling alcohol use (r = -0.48). CONCLUSION People with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
| | | | - I P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - N Heather
- University of Northumbria, Newcastle upon Tyne, United Kingdom
| | - A C Moss
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
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2
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von Peter S, Stuetzle S, Brieger A, Ponew A, Lust C, Bermpohl F, Bechdolf A, Hardt O, Schomerus G, Speerforck S. Leaving the stigma to the patients? Frequency of crisis experiences among mental health professionals in Berlin and Brandenburg and how they cope with it. J Ment Health 2024; 33:66-74. [PMID: 36880330 DOI: 10.1080/09638237.2023.2182415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/16/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND Although mental health professionals' mental health problems are gaining increased attention, there is little systematic research on this topic. AIMS This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities. METHODS An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated. RESULTS Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues. CONCLUSION The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed.
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Affiliation(s)
| | - Stefan Stuetzle
- Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Anna Brieger
- Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Angel Ponew
- Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Christian Lust
- Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Center (FRITZ), Vivantes Klinikum Am Urban, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Olaf Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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3
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Ponew A, Brieger A, Lust C, Speerforck S, von Peter S, Stuetzle S. Lived experiences matter: The role of mental health professionals' psychological crises and vulnerability in shaping their health beliefs and concepts. Front Psychiatry 2023; 14:1114274. [PMID: 36761862 PMCID: PMC9905638 DOI: 10.3389/fpsyt.2023.1114274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Mental health professionals are often affected by mental health problems and disorders. Yet, the effects of these lived experiences on their causal beliefs and health concepts have not been investigated. The current study investigates how professionals' lived depressive experiences and their perceived vulnerability to mental illness affect their causal beliefs about mental disorders, their general concept of mental health and their specific concepts of depression and burnout. METHODS An online survey was conducted with 218 mental health professionals from 18 psychiatric clinic departments in the German federal states of Berlin and Brandenburg, investigating their experiences with depression, self-assessed vulnerability, their causal beliefs of mental illness, their general health concept and specific illness concepts of depression and burnout. A path model was calculated to examine the relationships between these variables. Participants with and without lived experience of depression were grouped. RESULTS Lived experience of depression was indicated by 126 participants. For participants with no experience of depression, perceived vulnerability negatively predicted beliefs in biological causation, which positively predicted higher differentiation between depression and burnout. For participants with previous depression experiences, perceived vulnerability positively predicted beliefs in psychological and social causation. Continuum belief was predicted only in this group by the three variables of causal beliefs. Psychological and social causation was positively associated, while biological causes were negatively associated with continuum beliefs. CONCLUSION Mental health professionals are not external to the clinical situation. Their lived experiences do matter, shaping their beliefs and concepts and, thus, possibly also their actions toward patients.
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Affiliation(s)
- Angel Ponew
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Anna Brieger
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Christian Lust
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Stefan Stuetzle
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany.,Evangelische Hochschule Dresden, University of Applied Sciences for Social Work, Education and Care, Dresden, Germany
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Osman N, Michel C, Schimmelmann BG, Schilbach L, Meisenzahl E, Schultze-Lutter F. Influence of mental health literacy on help-seeking behaviour for mental health problems in the Swiss young adult community: a cohort and longitudinal case-control study. Eur Arch Psychiatry Clin Neurosci 2022; 273:649-662. [PMID: 36088495 PMCID: PMC10085901 DOI: 10.1007/s00406-022-01483-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
Poor knowledge about mental health disorders and their treatment likely contributes to the large treatment gap reported for mental health problems. Therefore, we studied the association between mental health literacy (MHL) and active help-seeking in a community sample. Participants were recruited from an add-on questionnaire study to the 'Bern Epidemiological At-Risk' (BEAR) study on 16-40-year-old community subjects of the Swiss canton Bern. At baseline, data of N = 1504, and at 3-year follow-up, data of N = 535 were available. Based on an unlabelled case vignette (on depression or schizophrenia), MHL was assessed by the questionnaire of Angermeyer and colleagues. Cross-sectional and longitudinal baseline predictors of help-seeking were analysed using path analyses. Additionally, sensitivity analyses of the prospective model were computed for sex, vignette, and baseline mental health problems/disorders. Cross-sectionally, help-seeking was associated with non-endorsement of biogenetic causal explanations, presence of mental health problems/disorders, help-seeking before baseline, poorer functioning, and lower health satisfaction. The prospective model was similar; yet, help-seeking at follow-up was associated with endorsements of the causal explanation 'biogenetics' and, additionally, 'childhood trauma' but not the presence of baseline mental health problems/disorders. Sensitivity analyses revealed a significant impact on sex, vignette, and mental health problems/disorders. For example, actual functional problems were predictive in males, while health satisfaction was predictive in females. Our findings indicate that future studies on drivers of help-seeking should assess very large community samples with case vignettes on different mental disorders to examine appropriate subgroups and their likely interaction to address group-specific factors in awareness campaigns.
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Affiliation(s)
- N Osman
- Department of Psychiatry and Psychotherapy/LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany.
| | - C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - B G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - L Schilbach
- Department of Psychiatry and Psychotherapy/LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany.,Medical Faculty, Ludwig Maximilians Universität, Munich, Germany
| | - E Meisenzahl
- Department of Psychiatry and Psychotherapy/LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany
| | - F Schultze-Lutter
- Department of Psychiatry and Psychotherapy/LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
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Doll CM, Michel C, Betz LT, Schimmelmann BG, Schultze-Lutter F. The Important Role of Stereotypes in the relation between Mental Health Literacy and Stigmatization of Depression and Psychosis in the Community. Community Ment Health J 2022; 58:474-486. [PMID: 34037914 PMCID: PMC8860791 DOI: 10.1007/s10597-021-00842-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 05/14/2021] [Indexed: 12/23/2022]
Abstract
Increased mental health literacy (MHL) has not reduced stigmatization of people with mental disorder. Thus, we examined the role of stereotypes in the interplay of MHL (correct labelling, causal explanations) and the wish for social distance (WSD) from people with depressive and psychotic symptoms in a community sample of 1526 German-speaking participants in the Swiss 'Bern Epidemiological At-Risk' study (age 16-40 years; response rate: 60.1%). Following the presentation of an unlabelled case vignette of depression or psychosis, MHL, stereotypes and WSD were assessed in a questionnaire survey. Their interrelations were studied using structural equation modelling. MHL was not directly linked to WSD, only the psychosocial causal model was directly negatively associated with WSD. Perceived dangerousness particularly increased WSD, this was increased by a biogenetic causal model and decreased by a psychosocial causal model. Awareness-campaigns that, next to biological causes, emphasize psychosocial causes of mental disorders might better reduce stigmatization.
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Affiliation(s)
- Carolin M Doll
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Heinrich-Heine-University, Düsseldorf, Germany. .,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Heinrich-Heine-University, Düsseldorf, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
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6
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Serial indirect effects of psychosocial causal beliefs and stigma on help-seeking preferences for depression. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Barry DT, Oberleitner DE, Beitel M, Oberleitner LMS, Gazzola MG, Eller A, Madden LM, Zheng X, Bergman E, Tamberelli JF. A Student Walks into Class … Vignettes to Identify Substance Use Disorder Models of Illness among College Students. Subst Use Misuse 2022; 57:1523-1533. [PMID: 35787230 DOI: 10.1080/10826084.2022.2091787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Illness models, including illness recognition, perceived severity, and perceived nature can affect treatment-seeking behaviors. Vignettes are a leading approach to examine models of illness but are understudied for substance use disorders (SUDs). We created vignettes for multiple common DSM-5 SUDs and assessed SUD illness models among college students. METHODS Seven vignettes in which the protagonist meets DSM-5 diagnostic criteria for SUDs involving tobacco, alcohol, cannabis, Adderall, cocaine, Vicodin, and heroin were pilot tested and randomly assigned to 216 college students who completed measures related to illness recognition, perceived severity, and perceived nature. MANOVAs with Scheffe post-hoc tests were conducted to examine vignette group differences on models of illness. RESULTS Vignettes met acceptable levels of clarity and plausibility. Participants characterized the protagonist's substance use as a problem, a SUD, or an addiction most frequently with Vicodin, heroin, and cocaine and least frequently with tobacco and cannabis. Participants assigned to the Vicodin, heroin, and cocaine vignettes were the most likely to view the protagonist's situation as serious and life-threatening, whereas those assigned to the cannabis vignette were the least likely. Numerically more participants characterized the pattern of substance use as a problem (91%) or an addiction (90%) than a SUD (76%), while only 15% characterized it as a chronic medical condition. CONCLUSIONS Illness recognition and perceived severity varied across substances and were lowest for cannabis. Few participants conceptualized SUDs as chronic medical conditions. College students may benefit from psychoeducation regarding cannabis use disorder and the chronic medical condition model of SUDs.
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - David E Oberleitner
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Psychology, University of Bridgeport, Bridgeport, Connecticut, USA
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - Lindsay M S Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Marina Gaeta Gazzola
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - Anthony Eller
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lynn M Madden
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xiaoying Zheng
- APT Foundation, Inc, New Haven, Connecticut, USA.,Yale University, New Haven, Connecticut, USA
| | - Emma Bergman
- APT Foundation, Inc, New Haven, Connecticut, USA.,Quinnipiac School of Medicine, Hamden, Connecticut, USA
| | - Joseph F Tamberelli
- APT Foundation, Inc, New Haven, Connecticut, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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8
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Wittmann L, Dorner R, Heuer I, Bock T, Mahlke C. Effectiveness of a contact-based anti-stigma intervention for police officers. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 76:101697. [PMID: 33836436 DOI: 10.1016/j.ijlp.2021.101697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Police force interaction rates with individuals with mental health conditions are on the rise. International research reveals that the presence of a mental health condition increases the risk for detention and use of force by police officers. Stigmatization of individuals with mental health conditions as dangerous and unpredictable is assumed to have an impact on the likelihood of police use of force. The following study examines a trialogical intervention to reduce stigmatization of individuals with a diagnosis of schizophrenia in a police officer sample. METHOD 1318 police officers participated in a trialogical contact-based intervention with the aim to reduce stigmatizing attitudes and beliefs. Emotional reactions, stereotypes and social distance were assessed prior to and after the intervention in a one-group design. RESULTS Negative stereotypes were positively associated with social distance in individuals with a diagnosis of schizophrenia and were positively associated with anxiety. Dependent sample t-test revealed reduced anxiety towards individuals with a diagnosis of schizophrenia, less negative stereotypes, and less social distance post intervention. All results were significant, and all effect sizes showed a small to moderate effect. CONCLUSIONS Trialogical contact-based, short-term anti-stigma interventions appear to reduce stigmatizing attitudes towards individuals with mental health conditions in a large police force sample. A missing control group is a key study limitation. Further research is needed to examine the effectiveness of the intervention in a randomized-controlled trial. However, the results clearly suggest that anti-stigma interventions could be beneficially introduced into police training.
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Affiliation(s)
- Linus Wittmann
- Department of Health Psychology and Health Education, University of Flensburg, Germany.
| | - Robert Dorner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Imke Heuer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
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Speerforck S, Hertel J, Stolzenburg S, Grabe HJ, Carta MG, Angermeyer MC, Schomerus G. Attention Deficit Hyperactivity Disorder in Children and Adults: A Population Survey on Public Beliefs. J Atten Disord 2021; 25:783-793. [PMID: 31271090 PMCID: PMC7897776 DOI: 10.1177/1087054719855691] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To investigate beliefs and attitudes of the public toward attention deficit hyperactivity disorder (ADHD) in children and adults. Method: In a representative population survey in Germany (N = 1,008) using computer-assisted telephone interviews, we asked participants about causal beliefs, illness recognition, treatment recommendations, and beliefs about ADHD, presenting an unlabelled vignette of a child or an adult with ADHD. Results: The most frequently endorsed causal beliefs for the depicted child with ADHD were "TV or Internet," "lack of parental affection," and "broken home." In comparison with the child vignette, biological causal beliefs were endorsed more often after the adult vignette. In the child vignette, 66% advised against a treatment with stimulant medication. About 90% of respondents had heard of ADHD. Of those, 20% said they believed ADHD to be not a real disease. Conclusion: Beliefs of the German public partly contradict evidence and should be considered in therapeutical and public contexts.
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Affiliation(s)
- Sven Speerforck
- University Medicine Greifswald, Germany,Sven Speerforck, Department of Psychiatry, University of Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany.
| | | | | | | | - Mauro G. Carta
- Center for Public Mental Health, Gösing am Wagram, Austria
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10
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Morris J, Albery IP, Heather N, Moss AC. Continuum beliefs are associated with higher problem recognition than binary beliefs among harmful drinkers without addiction experience. Addict Behav 2020; 105:106292. [PMID: 32007833 DOI: 10.1016/j.addbeh.2020.106292] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 11/18/2022]
Abstract
Low problem recognition may be an important barrier to opportunities for self-change or help-seeking in harmful drinkers. Little is known about how the beliefs harmful drinkers hold about the nature and causes of alcohol problems affect problem recognition and subsequent behaviour change processes. Participants (n = 597) recruited online were randomised to one of two conditions designed to promote beliefs according to (a) a continuum model of alcohol problems or (b) a binary disease model, or (c) a control condition. Participants completed measures of alcohol problem beliefs, problem recognition and other indices including the Alcohol Use Disorder Identification Test (AUDIT), addiction beliefs, addiction experience and demographics. Results showed that harmful drinkers without addiction experience exposed to the continuum condition had significantly higher problem recognition than those in binary disease model or control conditions. Continuum beliefs appear to offer self-evaluative benefits for harmful drinkers with low alcohol problem recognition, thus potentially facilitating help-seeking or self-change regarding alcohol use. Further research to understand the mechanisms by which continuum beliefs may promote more accurate drinking self-evaluation and its potential for behaviour change is warranted. The role of continuum beliefs may have important consequences for alcohol-related messaging and interventions seeking to promote self-change or help-seeking.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom.
| | - I P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - N Heather
- Faculty of Health & Life Sciences, Northumbria University, United Kingdom
| | - A C Moss
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
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11
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Wechsler D, Schomerus G, Mahlke C, Bock T. Effects of contact-based, short-term anti-stigma training for medical students : Results from a randomized controlled trial. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2020; 34:66-73. [PMID: 32112263 DOI: 10.1007/s40211-020-00337-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/08/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mental health stigma (MHS) places a burden on those affected that far exceeds psychosocial harms. Contact-based anti-stigma work has been found effective for several target groups. For medical students however, its efficacy remains unclear. AIM The purpose of this study was to examine the efficacy of contact-based, trialogic anti-stigma training for medical students. METHODS A randomized controlled trial (RCT) was conducted, controlling for standard clinical placement in psychiatry. External validity was maximized by including all students (n = 204) who started their 6‑week obligatory psychiatry course during the study period between March and July 2018. Assessments were conducted at the beginning of each of the two covered terms and immediately postintervention. RESULTS Students who received the anti-stigma training displayed significantly less stigmatizing attitudes after the intervention, measured using the MICA (Mental Illness-Clinicians' Attitudes) scale as primary outcome. Analogous findings were noted for social distance and stereotypes, whereas these could not be observed for emotional reactions. All significant changes were independent of gender and age. CONCLUSION The positive results underpin the research in this field and point towards the inclusion of comparable interventions in regular student curricula. Given the limitation of a missing late follow-up, however, further research regarding the persistence of stigma reduction is needed.
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Affiliation(s)
- Dominik Wechsler
- Centre for Psychosocial Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany.
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Candelaria Mahlke
- Centre for Psychosocial Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Thomas Bock
- Centre for Psychosocial Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
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12
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Soziale Milieus: Ein relevantes Konzept für ein besseres Verständnis von Stigma und psychiatrischer Unterversorgung? DER NERVENARZT 2020; 91:785-791. [DOI: 10.1007/s00115-020-00927-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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von dem Knesebeck O, Lehmann M, Löwe B, Lüdecke D. Causal attributions for somatic symptom disorder. J Psychosom Res 2020; 129:109910. [PMID: 31887458 DOI: 10.1016/j.jpsychores.2019.109910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Two research questions will be addressed: (1) What does the German public think about possible causes of somatic symptom disorder (SSD) and are there differences in causal attributions according to symptom and course of SSD? (2) Are causal attributions associated with beliefs about treatment and stigmatizing attitudes? METHODS Two vignettes with symptoms of SSD were used in a national telephone survey in Germany (N = 1004). Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Respondents were asked about their agreement with five causal beliefs (broken home, heredity, lack of willpower, work stress, and misinterpretation of body signals). RESULTS About 90% of the respondents agreed that work stress is a possible cause of the SSD symptoms. Agreement was significantly more pronounced in case of a person with fatigue and an earlier severe somatic disease. A quarter endorsed lack of willpower as a possible cause. Lack of willpower was associated with a significant increase of desire for social distance in both vignettes. Work stress was associated with a significantly increased likelihood of positively evaluating the effectiveness of psychotherapy in both cases of SSD. CONCLUSIONS Public beliefs about causes of SSD are associated with stigma and treatment beliefs. Emphasising work stress as a cause may promote the belief that psychotherapy is effective for treatment of SSD.
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Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20146 Hamburg, Germany.
| | - Marco Lehmann
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, Martinistr. 52, 20146 Hamburg, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, Martinistr. 52, 20146 Hamburg, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20146 Hamburg, Germany
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Speerforck S, Stolzenburg S, Hertel J, Grabe HJ, Strauß M, Carta MG, Angermeyer MC, Schomerus G. ADHD, stigma and continuum beliefs: A population survey on public attitudes towards children and adults with attention deficit hyperactivity disorder. Psychiatry Res 2019; 282:112570. [PMID: 31558401 DOI: 10.1016/j.psychres.2019.112570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 12/20/2022]
Abstract
ADHD is a mental illness of high epidemiological and clinical importance, embedded in a complex socio-cultural context. We estimated the prevalence of attitudes related to ADHD in a representative population survey in Germany (n = 1008) after presenting an unlabelled vignette of a child or an adult with ADHD. Relations of personal experience, interpersonal contact and continuum beliefs with emotions and social distance were calculated using path models. About two-thirds of the German public indicated they believe in a continuum of ADHD symptoms, and half stated that they know somebody among family or close friends with a comparable problem. About one-quarter of respondents felt annoyed by the depicted person. While an adult with ADHD was most frequently accepted as a work colleague or neighbor, about one-quarter of the German general population rejected renting a room or giving a job recommendation. Personal Experience (both vignettes) and contact (adult vignette) were related to a higher belief in a continuum of symptoms, while explanation of variance was low. A belief in a continuum of symptoms was related to more pro-social reactions and less social distance. This study indicates that emphasizing aspects of a continuum of symptoms should be considered within the disorder model of ADHD.
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Affiliation(s)
- Sven Speerforck
- Department of Psychiatry, Medical Faculty, University of Leipzig, Germany; Department of Psychiatry, University Medicine Greifswald, Greifswald, Germany.
| | - Susanne Stolzenburg
- Department of Psychiatry, University Medicine Greifswald, Greifswald, Germany
| | - Johannes Hertel
- Department of Psychiatry, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry, University Medicine Greifswald, Greifswald, Germany
| | - Maria Strauß
- Department of Psychiatry, Medical Faculty, University of Leipzig, Germany
| | - Mauro G Carta
- Department of Public Health, Clinical and Molecular Psychiatry, University of Cagliari, Cagliari, Italy
| | | | - Georg Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Germany
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15
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Individuals with currently untreated mental illness: causal beliefs and readiness to seek help. Epidemiol Psychiatr Sci 2019; 28:446-457. [PMID: 29335036 PMCID: PMC6998972 DOI: 10.1017/s2045796017000828] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AIMS Many people with mental illness do not seek professional help. Beliefs about the causes of their current health problem seem relevant for initiating treatment. Our aim was to find out to what extent the perceived causes of current untreated mental health problems determine whether a person considers herself/himself as having a mental illness, perceives need for professional help and plans to seek help in the near future. METHODS In a cross-sectional study, we examined 207 untreated persons with a depressive syndrome, all fulfilling criteria for a current mental illness as confirmed with a structured diagnostic interview (Mini International Neuropsychiatric Interview). The sample was recruited in the community using adverts, flyers and social media. We elicited causal explanations for the present problem, depression literacy, self-identification as having a mental illness, perceived need for professional help, help-seeking intentions, severity of depressive symptoms (Patient Health Questionnaire - Depression), and whether respondents had previously sought mental healthcare. RESULTS Most participants fulfilled diagnostic criteria for a mood disorder (n = 181, 87.4%) and/or neurotic, stress-related and somatoform disorders (n = 120, 58.0%) according to the ICD-10. N = 94 (45.4%) participants had never received mental health treatment previously. Exploratory factor analysis of a list of 25 different causal explanations resulted in five factors: biomedical causes, person-related causes, childhood trauma, current stress and unhealthy behaviour. Attributing the present problem to biomedical causes, person-related causes, childhood trauma and stress were all associated with stronger self-identification as having a mental illness. In persons who had never received mental health treatment previously, attribution to biomedical causes was related to greater perceived need and stronger help-seeking intentions. In those with treatment experience, lower attribution to person-related causes and stress were related to greater perceived need for professional help. CONCLUSIONS While several causal explanations are associated with self-identification as having a mental illness, only biomedical attributions seem to be related to increase perceived need and help-seeking intentions, especially in individuals with no treatment experiences. Longitudinal studies investigating causal beliefs and help-seeking are needed to find out how causal attributions guide help-seeking behaviour. From this study it seems possible that portraying professional mental health treatment as not being restricted to biomedical problems would contribute to closing the treatment gap for mental disorders.
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Böge K, Hahn E, Cao TD, Fuchs LM, Martensen LK, Schomerus G, Dettling M, Angermeyer M, Nguyen VT, Ta TMT. Treatment recommendation differences for schizophrenia and major depression: a population-based study in a Vietnamese cohort. Int J Ment Health Syst 2018; 12:70. [PMID: 30473728 PMCID: PMC6234672 DOI: 10.1186/s13033-018-0247-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Vietnam, the mental health care infrastructure is on the verge of transformation with an increase in the demand for access to adequate and effective mental health care services. Public attitudes towards mental illness, as well as corresponding treatment options influence help-seeking behaviors of patients and caregivers, affecting the course of their treatment. This study assesses attitudes towards treatment options for depression and schizophrenia, as the two most common psychiatric disorders in Vietnam, accounting for at least 75% of all psychiatric inpatients. Methods A general population-based survey was conducted in Hanoi, Vietnam between April and August 2013. Participants received a description of a person with symptoms of either depression (n = 326) or schizophrenia (n = 403) and were asked to give recommendations for adequate sources of mental health support and treatment options. Multiple analyses on a single item level compared the likelihood of recommendation between schizophrenia and depression. Results Overall, respondents recommended health care services, ranging from seeking mental health care professionals, psychotherapists, and psychiatrists for both disorders. Psychotherapy was the most favored treatment method, whereas further treatment options, such as concentration and relaxation exercises, meditation or yoga and psychotropic medication were also endorsed as helpful. For the schizophrenia vignette condition, psychotherapy, visiting a psychiatrist or psychotherapist received stronger endorsement rates as compared to the depression vignette. Furthermore, ECT, Feng Shui-based practices, praying and visiting natural healers were recommended less by respondents for the depression vignette in comparison with the schizophrenia vignette. Conclusions The Vietnamese public endorsed evidence-based treatment recommendations from a variety of treatments options. Differences in the treatment recommendations between depression and schizophrenia reflected the perceived severity of each disorder. Further developments of the Vietnamese mental health care system concerning mental health care providers, as well as the legal regulations surrounding the provision of psychotherapy are needed.
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Affiliation(s)
- Kerem Böge
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Eric Hahn
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Tien Duc Cao
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Medical University, Hanoi, Vietnam
| | - Lukas Marian Fuchs
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lara Kim Martensen
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Georg Schomerus
- 3Center for Public Mental Health, Untere Zeile 13, 3482 Gösing am Wagram, Austria
| | - Michael Dettling
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Matthias Angermeyer
- 4Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Van Tuan Nguyen
- 5Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
| | - Thi Minh Tam Ta
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,6Berlin Institute of Health, Berlin, Germany
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