The effect of educational information about treatments for schizophrenia on stigmatizing perceptions

How does loneliness interact with positive, negative and depressive symptoms of psychosis? New insights from a longitudinal therapy process study

Cross-sectional research suggests an association between loneliness and psychotic symptoms, but the causal direction of this association is still unclear. Even though loneliness has been proposed as a potential treatment target to improve psychotherapy for psychosis, not much is known about its role in the treatment process. In this study, we re-analyzed data from a therapy process study to investigate the temporal dynamics between loneliness and psychotic symptoms throughout therapy and to explore whether state-of-the-art CBT for psychosis (CBTp) decreases loneliness. Over the course of up to 45 weekly sessions of CBTp, 57 patients reported their feelings of loneliness and current positive, negative and depressive symptom levels at each session. Multilevel regression revealed a reduction in all symptoms over time, but no reduction in loneliness. Time-lagged multilevel regression showed that loneliness predicted subsequent negative and depressive symptoms, whereas positive symptom levels predicted subsequent loneliness. Thus, changes in loneliness seem to be both cause and consequence of psychotic symptom changes. These findings highlight the importance of loneliness as a treatment target, particularly in patients with negative symptoms and depression. Future research should address loneliness-specific interventions as an augmentation of state-of-the-art CBTp.

Investigating AVHs narratives through text analysis: the proposal of Dialogic Science for tackling stigmatization

BACKGROUND

Auditory verbal hallucinations (AVHs) are a significant symptom of various psychological conditions, often stigmatized and misunderstood. Moving beyond traditional psychological, psychotherapeutic and psychiatric approaches, recent research shifts focus on understanding AVHs through community perspectives and the resulting stigmatization. This research approach is crucial for better support and understanding of AVHs, however it still suffers from the lack of a rigorous and shared methodology for studying and reducing stigma.

METHODS

Our study, part of the Italian "PsicoVoice" project, aims to investigate community discourses on AVHs, in order to observe whether and to what extent they are drivers of stigmatisation processes. Engaging 268 participants with direct (hearers) and indirect (such as relatives and professionals) experiences of AVHs, the research analyzes a corpus of 54,320 instances using MADIT: a text analysis methodology which is both qualitative and quantitative. MADIT allows for an innovative examination of the rhetorical-argumentative structures within narratives, producing an index for measuring the narratives' practical impact on people' interactions around AVHs.

RESULTS

The analysis revealed that the overall community discourses are predominantly shaped by absolute and personal belief-driven modalities. This way of conveying sense, even with non-necessarily-judgmental words, contributes to a stigmatizing environment for individuals with AVHs, cementing a static representation dominated by personal opinions and reducing the potential for more nuanced, diverse interactions about AVHs.

CONCLUSION

The study's findings underscore the importance of addressing the narrative structures within community discourses. By intervening in these narratives, there is potential to shift towards a less stigmatizing social construction of AVHs. Thus, the article concludes using the results to provide some insights on how to generate these interventions. This approach could significantly impact how communities understand and interact with individuals experiencing AVHs, promoting more inclusive and supportive environments and interventions.

Causal Explanations, Treatability, and Mental Illness Stigma: Experimental Study

OBJECTIVE

The purpose of this study was to test the effects of causal explanations, information about treatability, and type of psychiatric diagnosis on how the public reacts to an individual described as having a specific mental illness versus subclinical distress.

METHODS

A 5 (mental health condition) × 2 (treatability) × 4 (causal explanation) vignette experiment was embedded in an online survey, followed by assessments of prognostic optimism and desire to maintain social distance from the vignette character. Data were collected, in late 2022, from a probability sample (N=1,607) representative of the U.S. adult population. Ordinary least-squares regression was used to estimate the effects of the experimental conditions, covariates, and interactions on respondents' desire for social distance and their prognostic optimism.

RESULTS

Attribution of mental illness to a genetic predisposition (vs. no attribution) significantly (p<0.001) predicted unwillingness to socially interact with the vignette character, regardless of the character's psychiatric diagnosis. Describing the illness as treatable with medication or psychotherapy (vs. no treatability information) also reduced willingness to socially interact, yet it also increased optimism for recovery. Desire for social distance and prognostic pessimism were greater for alcohol use disorder, opioid use disorder, or schizophrenia compared with major depression or subclinical distress.

CONCLUSIONS

Attributing mental illness solely to genetics predicts social rejection of people diagnosed as having psychiatric disorders. Efforts to reduce stigma, increase social acceptance, and protect the mental health of individuals diagnosed as having a mental illness should include not framing mental illness exclusively in genetic terms.

Prevalence and risk for symptoms of PTSD among survivors of a COVID-19 infection

COVID-19 pandemic has profound psychological effects worldwide and the psychological sequelae will persist for a long time among COVID-19 survivors. This cross-sectional study aimed to explore the prevalence of PTSD and its associated risk factors in COVID-19 survivors of the first wave pandemic. Demographics questionnaire, the Impact of Events Scale-Revised, the Pittsburgh Sleep Quality Index, the Fatigue Scale-14, the Resilience Style Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. The propensity score-matching (PSM) method was employed to adjust covariate or confounding variables in order to derive more accurate conclusions. After PSM, adjusted odds ratios and 95% confidence intervals were determined by binary conditional logistic regression. A total of 1541 COVID-19 survivors were included firstly and 15.2% reported PTSD symptoms, 1108 participants left after PSM. Four risk factors were identified: higher severity of COVID-19 infection, fatigue, COVID-19 related stigma and poor sleep quality. When designing psychological interventions to alleviate PTSD symptoms of COVID-19 survivors, reducing stigma and fatigue, and improve their sleep quality are suggested.

Mediating role of resilience in the relationship between COVID-19 related stigma and mental health among COVID-19 survivors: a cross-sectional study

BACKGROUND

The global coronavirus disease 2019 (COVID-19) has caused many negative effects on physical and mental health of patients who have survived COVID-19. Apart from some long-lasting physical sequelae, those COVID-19 survivors are also suffering stigma and discrimination at different levels around the world. The current study aims to assess the role resilience played in stigma and mental disorders among COVID-19 survivors.

METHODS

The cross-sectional study was carried out among former COVID-19 patients in Jianghan District (Wuhan, China) from June 10 to July 25, 2021. The demographic questions, the Impact of Events Scale-Revised, the Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Resilience Style Questionnaire and the Short Version of COVID-19 Stigma Scale of 12 items were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis and Structural Equation Modeling were used to make data description and analysis.

RESULTS

A total of 1541 out of 1601 COVID-19 survivors (887 females and 654 males) were included in the analysis. Perceived stigma of those COVID-19 survivors correlates significantly with anxiety (r = 0.335, P < 0.001), depression (r = 0.325, P < 0.001) and post-traumatic stress disorder (PTSD) (r = 0.384, P < 0.001). It has a direct effect on COVID-19 survivors' anxiety (β = 0.326, P < 0.001), depression (β = 0.314, P < 0.001), PTSD (β = 0.385, P < 0.001) and their resilience (β = - 0.114, P < 0.01). Resilience partially mediated the association between perceived stigma and anxiety (β = 0.020, P < 0.01), depression (β = 0.020, P < 0.01), and PTSD (β = 0.014, P < 0.01) among COVID-19 survivors.

CONCLUSION

Stigma has a significant negative impact on mental health, while resilience plays a mediator role in the relationship between stigma and mental health among COVID-19 survivors. Based on our study, we suggested that when designing psychological interventions for COVID-19 survivors, consideration should be taken into account to reduce stigma and improve resilience.

The effect of cognitive behavioral therapy-based psychoeducation on internalized stigma and functional remission in individuals diagnosed with schizophrenia

PURPOSE

The aim of this study is to determine the effect of cognitive behavioral therapy-based psychoeducation provided to individuals diagnosed with schizophrenia on internalized stigma and functional remission.

DESIGN AND METHODS

The study was conducted based on the quasi-experimental design with pretest-posttest control group with 100 individuals, who were diagnosed with schizophrenia, in a Community Mental Health Center between September 2020 and June 2021.

FINDINGS

It was determined that after the cognitive behavioral therapy-based psychoeducation, the internalized stigma level decreased and the functional remission level increased in the experimental group compared with the control group.

PRACTICE IMPLICATIONS

In the study, it was determined that the experimental and control groups had low levels of functional remission and high levels of internalized stigma before the cognitive behavioral therapy-based psychoeducation, and the functional remission levels increased and the internalized stigma levels decreased in the experimental group compared with the control group after the cognitive behavioral therapy-based psychoeducation.

Psychological Interventions for Young People With Psychotic Disorders: A Systematic Review

BACKGROUND

Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12-30) with psychotic disorders.

METHODS

A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis.

RESULTS

Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies (i.e., integrative interventions combining psychoeducation and family/group interventions). All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders.

CONCLUSION

There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166756], identifier [CRD42020166756].

Changing Attitudes Towards Voice Hearers: A Literature Review

Auditory verbal hallucinations, or voice hearing, is increasingly understood as a common experience. Despite this, voice hearers still experience a great deal of stigma, which can have serious negative impacts on the person's experience of their voices, and their recovery. Research has demonstrated that healthcare professionals may be a major source of the stigma surrounding voice hearing, with service-level implications for the development and delivery of evidence-based interventions. Therefore, reducing this stigma is a critical intervention target. The purpose of this narrative review is to examine evidence for interventions aimed at reducing stigma towards people who hear voices, in populations of healthcare professionals, students, and the general public. The available evidence supports the use of anti-stigma interventions based around direct contact with voice hearers and education about voice hearing. However, further research is necessary in this area to confirm these findings.

Changing Healthcare Professionals' Attitudes Towards Voice Hearers: An Education Intervention

Despite being a relative common experience, hearing voices remains highly stigmatised, with serious consequences. Numerous interventions have been developed to reduce stigma towards mental illness in general, however most have failed to include implicit measures of stigma, and these have yet to be applied to hearing voices. The current study examined the efficacy of an education intervention in changing the explicit and implicit stigma held by healthcare professionals (N = 59) towards voice hearers. Results indicated that the education intervention led to significant decreases in explicit but not implicit measures of stigma, though participants demonstrated relatively positive baseline implicit attitudes towards voice hearers. These findings suggest that education interventions could be one way of reducing stigma towards voice hearers. Further research is necessary to explore the impact of education interventions in samples with more negative baseline attitudes, such as early career professionals, students, and the general population.

A Call to Action. A Critical Review of Mental Health Related Anti-stigma Campaigns

Using a knowledge-attitudes-behavior practice (KABP) paradigm, professionals have focused on educating the public in biomedical explanations of mental illness. Especially in high-income countries, it is now common for education-based campaigns to also include some form of social contact and to be tailored to key groups. However, and despite over 20 years of high-profile national campaigns (e.g., Time to Change in England; Beyond Blue in Australia), examinations suggest that the public continue to Other those with experiences of mental ill-health. Furthermore, evaluations of anti-stigma programs are found to have weak- to no significant long-term effects, and serious concerns have been raised over their possible unintended consequences. Accordingly, this article critically re-engages with the literature. We evidence that there have been systematic issues in problem conceptualization. Namely, the KABP paradigm does not respond to the multiple forms of knowledge embodied in every life, often outside conscious awareness. Furthermore, we highlight how a singular focus on addressing the public's perceived deficits in professionalized forms of knowledge has sustained public practices which divide between "us" and "them." In addition, we show that practitioners have not fully appreciated the social processes which Other individuals with experiences of mental illness, nor how these processes motivate the public to maintain distance from those perceived to embody this devalued form of social identity. Lastly, we suggest methodological tools which would allow public health professionals to fully explore these identity-related social processes. Whilst some readers may be frustrated by the lack of clear solutions provided in this paper, given the serious unintended consequences of anti-stigma campaigns, we caution against making simplified statements on how to correct public health campaigns. Instead, this review should be seen as a call to action. We hope that by fully exploring these processes, we can develop new interventions rooted in the ways the public make sense of mental health and illness.

‘Treatable and Changeable’: The Effect of Treatment and Malleability Information on Stigma Towards Children with Behavioural Problems and Their Parents

Improving knowledge about childhood mental health issues, reducing stigma, and encouraging appropriate treatment-seeking are important goals for public health. This study examined the effect of treatment and malleability information on stigmatisation towards children with Oppositional Defiant Disorder (ODD) and their parents, and on endorsements of causal beliefs. In an experimental study, university students (N = 234) were randomly allocated to receive/not receive treatment information (information on the existence and effectiveness of treatment for ODD) and to receive/not receive malleability information (information emphasising brain malleability and the potential to change). Participants then rated four measures of stigma towards a fictitious child with ODD and mother (blame, incompetence, dangerousness, and social distance), and rated their endorsements of causal explanations for ODD. Neither treatment nor malleability information had significant effects on stigmatisation towards either the child or mother. However, this information did impact upon causal beliefs about ODD as stemming from biological or mixed biological/environmental causes. Implications for the future development of public health initiatives and stigma research on childhood mental health are discussed.

[The effect of medical and psychotherapeutic treatment models for schizophrenia on stigma and recovery expectations]

BACKGROUND

It is common practice to inform patients about causes and treatment models when starting psychiatric treatment or psychotherapy for schizophrenia. However, previous research indicates that focusing on etiological models increases stigmatizing beliefs. This raises the question of whether contemporary, medical or cognitive behavioral therapy (CBT)-based treatment models share this negative side effect.

AIM

This experiment tested whether providing information about medical vs. CBT-based vs. combined treatment models affects stigmatizing attitudes towards schizophrenia and the expected efficacy of these treatments.

METHODS

Participants received a case vignette of a person with schizophrenia including either: (1) no treatment details, or a description of treatment with (2) medication, (3) CBT, or (4) medication and CBT. Next, stigmatizing attitudes (stereotypes, affective reactions, and desired social distance) were assessed and participants rated the perceived effectiveness of different treatment methods.

RESULTS

No treatment model showed an effect on stigmatizing attitudes. Medical and CBT treatment information (alone or in combination) had a positive effect on subjective efficacy ratings for the respective treatment.

CONCLUSION

There appear to be no negative side effects of (biogenetic) models when presented in a context emphasizing recovery. Moreover, medication and CBT treatment information showed additive positive effects on the rating of treatment strategies. A combined treatment model integrating various evidence-based methods appears to be most useful in clinical practice.

ATTITUDES TOWARDS PEOPLE WITH PROBLEMATIC DRUG USE IN THE CITY OF LOJA, ECUADOR

ABSTRACT Objective: analyze attitudes toward people with problematic drug use in the city of Loja, Ecuador. Method: a quantitative, cross-sectional, preliminary study using survey methodology aimed at collecting data on attitudes towards people with problematic drug use by residents in the city of Loja, Ecuador. The sample size is 121 individuals. This study is part of a multi-center investigation that involves 10 universities and a National Drug Council in Latin America. Results: the results revealed that attitudes toward people with problematic uses of alcohol are positive while attitudes toward people with problematic uses of other drugs such as marijuana and cocaine are ambivalent. It also shows that ambivalence prevails according to the majority of socio-demographic variables, differing in the masculine gender, people in the range of 18-29 years; those who lives with their partner; those who have a higher education than high school who have a positive attitude towards people with problematic uses of alcohol. And the scale that presents the greatest difficulties is the area of personal contact with negative attitudes towards the users of marijuana and cocaine. Conclusion: it is vital to continue researching about stigma, social distance and attitudes towards people who use drugs in the Ecuadorian context, its impact on treatment and social integration and the most appropriate information strategies to avoid stigma.

Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis

This review evaluates the evidence on what interventions are effective in reducing public stigma towards people with severe mental illness, defined as schizophrenia, psychosis or bipolar disorder. We included 62 randomised controlled trials of contact interventions, educational interventions, mixed contact and education, family psychoeducation programs, and hallucination simulations. Contact interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.39, 95% CI: 0.22 to 0.55) and desire for social distance (d = 0.59, 95% CI: 0.37 to 0.80) post-intervention, but these were reduced after adjusting for publication bias (d = 0.24 and d = 0.40, respectively). Effects did not vary by type or length of contact. Effects at follow-up were smaller and not significant. Education interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.30, 95% CI: 0.14 to 0.47) and desire for social distance (d = 0.27, 95% CI: 0.08 to 0.46) post-intervention. Small improvements in social distance persisted up to 6 months later (d = 0.27, 95% CI: 0.05 to 0.49), but not attitudes (d = 0.03, 95% CI: -0.12 to 0.18). The combination of contact and education showed similar effects to those that presented either intervention alone, and head-to-head comparisons did not show a clear advantage for either kind of intervention. Family psychoeducation programs showed reductions in stigma post-intervention (d = 0.41, 95% CI: 0.11 to 0.70). The effectiveness of hallucination simulations was mixed. In conclusion, contact interventions and educational interventions have small-to-medium immediate effects upon stigma, but further research is required to investigate how to sustain benefits in the longer-term, and to understand the active ingredients of interventions to maximise their effectiveness.