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Zhang X, Wu M, Zeng T, Cai C. "I am not a good enough parent": The experience of self-stigma in parents of children with mental illness in China. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12466. [PMID: 38649333 DOI: 10.1111/jcap.12466] [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: 12/17/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
PROBLEM Self-stigma in parents of children with mental illness is an area easily overlooked by mental health providers. Many studies have shown that self-stigma in parents may result in social interaction avoidance, lower self-esteem, increased psychological pressure, and so on. However, a comprehensive picture of how parents of children with mental illness in China experience self-stigma is lacking. METHODS Individual semistructured face-to-face interviews were conducted with 20 parents from China during their child's psychiatric hospitalization. We followed the consolidated criteria for reporting qualitative research (COREQ) checklist. FINDINGS Four main themes were identified that captured the experience of self-stigma in parents of children with mental illness: (1) losing face and fear, (2) internalizing affiliate stigma, (3) feeling of self-blame and self-doubt, and (4) keeping oneself away from society. CONCLUSIONS These findings explain how Chinese parents of children with mental illness experience self-stigma. To better effect the treatment and rehabilitation of children with mental illness, it is necessary to recognize this self-stigma in parents and take action to improve their mental health.
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Affiliation(s)
- Xi Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meiliyang Wu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tieying Zeng
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunfeng Cai
- School of Nursing, Wuhan University, Wuhan, China
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2
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Li Y, Qiu D, Wu Q, Ni A, Tang Z, Xiao S. Affiliate stigma and its association with family burden among family members of people living with schizophrenia in China. Schizophr Res 2024; 267:193-200. [PMID: 38569392 DOI: 10.1016/j.schres.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Understanding affiliate stigma and its impact on family of people living with schizophrenia (PLS) in China is important for culturally informed intervention. This study aims to describe the pattern of affiliate stigma of family members of PLS in China and investigated the association between affiliate stigma and family burden. METHODS PLS and their family members dwelling in community were randomly recruited from four cities across China and completed measures of affiliate stigma and family burden. Linear regression analyses were used to determine the association between affiliate stigma and family burden. RESULTS A total of 493 dyads of family member and PLS were include in this study. The mean affiliate stigma in family members was 2.21 (SD = 0.61). The vast majority of family members reported the feeling of inferiority, helpless and sad because of their family members' schizophrenia, but few family members refusing to communicate or contact with the PLS. The mean score of overall family burden was 22.25 (SD = 14.90), with 98 % of participants reported moderate or severe burden. A higher level of affiliate stigma was associated with more family burden (b = 7.837, 95CI: 5.240 to 8.747). Affiliate stigma was significantly associated with family daily activities, entertainment activities, family relationship, physical health and mental health of family members, but not family economic burden. CONCLUSION A higher level of affiliate stigma was associated with more family burden among family with PLS. Anti-stigma intervention of mental illness should be consider not only PLS but also their family members.
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Affiliation(s)
- Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiuyan Wu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Anyan Ni
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zixuan Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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3
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Wong ELY, Yau JHY, Sze LCY, Kanagawa HS, Leung DKY, Liu T, Wong GHY, Lum TYS. A core competency framework for mental health peer supporters of older adults in a Chinese community: cross-culturally informed Delphi study. BJPsych Bull 2024; 48:92-99. [PMID: 37309186 PMCID: PMC10985733 DOI: 10.1192/bjb.2023.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/23/2023] [Indexed: 06/14/2023] Open
Abstract
AIMS AND METHOD Non-Western literature on the core competencies of mental health peer supporters remains limited. Therefore, we used a three-round Delphi study with peer supporters, service users (i.e. someone using peer support services) and mental health professionals to develop a core competency framework for peer supporters in the Chinese context. RESULTS The final framework included 35 core competencies, the conceptual origins of which were local (14.3%), Western (20%) and both local and Western (65.7%). They were grouped into five categories in ascending peer supporter role specificity: (1) self-care and self-development, (2) general work ethics, (3) work with others, (4) work with service users and (5) peer support knowledge. CLINICAL IMPLICATIONS A culturally valid mental health peer support competency framework can minimise role confusion and refine training and practice guidelines. In a Chinese context, peer supporters were valued as generic support companions, whereas functions highlighted in the West, such as role modelling, were perceived as less critical.
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Affiliation(s)
- Edwin Lok Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Jessie Ho-Yin Yau
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Lesley Cai Yin Sze
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Hotinpo Sky Kanagawa
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Dara Kiu Yi Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Tianyin Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Gloria Hoi Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Terry Yat Sang Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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4
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Sun KS, Lam TP, Wu D, Chan TH, Browne G, Chan SWC. A Chinese help-seeking model for psychological distress in primary care: An adaptation of Andersen's Behavioral Model of Health Services Use. Transcult Psychiatry 2024; 61:182-193. [PMID: 38233734 DOI: 10.1177/13634615231225130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Help-seeking for depression and anxiety disorders from primary care physicians in Western countries is at three times the rate of China. Western help-seeking models for common mental disorders have limitations in the Chinese settings. This article argues that an adapted model based on Andersen's Behavioral Model of Health Services Use could be an appropriate tool to better understand patients' help-seeking behaviors and improve outcomes. We applied a narrative review approach to integrate research findings from China into Andersen's model to generate a model that fits the Chinese context. We found 39 relevant articles in PubMed, MEDLINE, and Chinese journal databases from 1999 to 2022. Findings were mapped onto predisposing, enabling, and need factors of the model. This model emphasizes that predisposing factors including demographics, social norms, and health beliefs influence help-seeking preferences. Mental health service users in China tend to be older and female. Chinese generally have high concern about psychotropic medications, and social norms that consider psychological distress a personal weakness may discourage help-seeking. However, help-seeking can be enhanced by enabling factors in the health system, including training of primary care physicians, longer consultation time, and continuity of care. Need factors for treatment increase with the severity of distress symptoms, and doctor's skills and attitudes in recognizing psychosomatic symptoms. While predisposing factors are relatively hard to change, enabling factors in the health system and need factors for treatment can be targeted by enhancing the role of family doctors and training in mental health.
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Affiliation(s)
- Kai Sing Sun
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Tak Hon Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Graeme Browne
- Faculty of Health, Southern Cross University, Sydney, Australia
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5
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Chen JY, Wang YC, Xi HJ, Tao H, Zhao Q, Yu MT, Xin L, Hu LH, He Q, Zou WB, Peng YQ. Translation and validation of a Chinese version of the pancreatitis quality of life instrument (PANQOLI) in patients with chronic pancreatitis. Qual Life Res 2023; 32:3417-3426. [PMID: 37481482 DOI: 10.1007/s11136-023-03479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Chronic pancreatitis (CP) is a chronic fibroinflammatory pancreatic disease that severely impacts patients' quality of life (QoL). The Pancreatitis Quality of Life Instrument (PANQOLI) is an 18-item measure specifically designed to assess QoL amongst patients with CP. This study aimed to develop a Chinese version of PANQOLI and assess its reliability and validity in the Chinese CP cohort. METHODS Translation was performed according to forward-backwards translation steps and transcultural adaptation. Five hundred Mandarin Chinese-speaking patients with CP were enrolled, 250 for the exploratory factor analysis (EFA) and 250 for the confirmatory factor analysis (CFA). Item analysis, reliability analysis (internal consistency, split-half reliability, test-retest reliability), and validity analysis (content validity, construct validity, and convergent validity) were performed. RESULTS Item analysis of the Chinese version of PANQOLI revealed that the absolute t values of all items were > 3. Reliability analysis showed that Cronbach's α coefficient was 0.868, split-half coefficient was 0.934, and intraclass correlation coefficient was 0.859, demonstrating excellent reliability. For content validity, item level content validity index (I-CVI) ranged from 0.8 to 1.0, and average of I-CVI scores across all items (S-CVI/Ave) was 0.91. In construct validity analysis, EFA produced four dimensions after rotation, and results of CFA showed χ2/df = 2.346, comparative fit index (CFI) = 0.929, Tucker-Lewis index (TLI) = 0.915, and root-mean-square error of approximation (RMSEA) = 0.074. The analysis of convergent validity indicated that the Chinese version of PANQOLI was moderately correlated with the physical (r = 0.436, P < 0.001) and mental component summary (r = 0.518, P < 0.001) of the 36-Item Short Form Health Survey. CONCLUSION The Chinese version of PANQOLI appears to be culturally appropriate, reliable, and valid for assessing the QoL amongst Chinese patients with CP.
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Affiliation(s)
- Jia-Yun Chen
- Department of Gastroenterology, Digestive Endoscopy Center, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Yuan-Chen Wang
- Department of Gastroenterology, Digestive Endoscopy Center, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Hui-Jun Xi
- Medical Security Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hong Tao
- Department of Gastroenterology, Digestive Endoscopy Center, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Qi Zhao
- Department of Gastroenterology, Digestive Endoscopy Center, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Meng-Ting Yu
- Department of Gastroenterology, Digestive Endoscopy Center, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Lei Xin
- Department of Gastroenterology, Digestive Endoscopy Center, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Digestive Endoscopy Center, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Qian He
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Wen-Bin Zou
- Department of Gastroenterology, Digestive Endoscopy Center, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
- Shanghai Institute of Pancreatic Diseases, Shanghai, China.
| | - You-Qing Peng
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China.
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6
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Poku OB, Eschliman EL, Entaile P, Rampa S, Mehta H, Tal D, Silvert L, Li T, Becker TD, Govindasamy D, Stockton MA, Adedimeji A, Ho-Foster A, Blank MB, Dangerfield DT, Yang LH, Murray SM. "It's Better If I Die Because Even in the Hospital, There is a Stigma, People Still Gossip": Gossip as a Culturally Shaped Labeling Process and Its Implications for HIV-Related Stigma in Botswana. AIDS Behav 2023; 27:2535-2547. [PMID: 36646928 PMCID: PMC10350478 DOI: 10.1007/s10461-023-03980-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
This study qualitatively explores HIV-related gossip as both a manifestation and driver of HIV-related stigma, which is a known barrier to HIV testing and treatment in Botswana. Data were elicited from 5 focus group discussions and 46 semi-structured in-depth interviews with individuals living with HIV and community members with undisclosed serostatus in Gaborone, Botswana in 2017 (n = 84). Directed content analysis using the 'What Matters Most' theoretical framework identified culturally salient manifestations of HIV-related stigma; simultaneous use of Modified Labeling Theory allowed interpretation and stepwise organization of how the social phenomenon of gossip leads to adverse HIV outcomes. Results indicated that HIV-related gossip can diminish community standing through culturally influenced mechanisms, in turn precipitating poor psychosocial well-being and worsened HIV-related outcomes. These harms may be offset by protective factors, such as appearing healthy, accepting one's HIV status, and community education about the harms of gossip.
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Affiliation(s)
- Ohemaa B Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Evan L Eschliman
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Shathani Rampa
- Department of Psychology, Queens College, City University of New York, New York, NY, USA
| | - Haitisha Mehta
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Danielle Tal
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Lea Silvert
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Tingyu Li
- Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Melissa A Stockton
- Department of Psychiatry, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Lawrence H Yang
- School of Global Public Health, New York University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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7
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Slewa-Younan S, Krstanoska-Blazeska K, Blignault I, Li B, Reavley NJ, Renzaho AMN. Conceptualisations of mental illness and stigma in Congolese, Arabic-speaking and Mandarin-speaking communities: a qualitative study. BMC Public Health 2022; 22:2353. [PMID: 36522660 PMCID: PMC9753024 DOI: 10.1186/s12889-022-14849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Australia is an ethnically diverse nation. Research has demonstrated an elevated risk of developing a mental illness in culturally and linguistically diverse (CaLD) communities yet uptake of mental health services is low. To improve mental health treatment seeking and outcomes for CaLD individuals in Australia there is an urgent need to deeply understand barriers to treatment such as stigma. Using an exploratory qualitative approach, the aim of the study was to explore how CaLD communities' conceptualise and interpret mental illness and associated beliefs and experiences of stigma. METHODS The study focused on three key CaLD groups: the Congolese, Arabic-speaking and Mandarin-speaking communities residing in Sydney, Australia. A series of eight focus group discussions (n = 51) and 26 key informant interviews were undertaken online using Zoom during the period of November to December 2021. Focus group discussions and key informant interviews were digitally recorded, transcribed, and analysed using NVivo software. RESULTS Three major themes were identified. The first theme related to mental illness terminology used in the three communities. Despite variation in the terms used to refer to 'mental illness' all three communities generally distinguished between 'mental illness', a more severe condition and 'mental health problems', considered to arise due to stressors. The second theme centred on beliefs about mental illness; with all three communities identifying migration-related stressors as contributing to mental illness. Culturally related beliefs were noted for the Congolese participants with the perception of a link between mental illness and supernatural factors, whereas Mandarin-speaking participants highlighted lack of inter and intrapersonal harmony and failure to adhere to values such as filial piety as contributing to mental illness. The final theme related to mental illness related stigma and the various ways it manifested in the three communities including presence of collectivist public stigma felt across all three groups and affiliate (family) stigma reported by the Arabic and Mandarin-speaking groups. CONCLUSIONS We found rich diversity in how these communities view and respond to mental illness. Our findings provide some possible insights on both service provision and the mental health system with a view to building effective engagement and pathways to care.
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Affiliation(s)
- Shameran Slewa-Younan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia.
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | | | - Ilse Blignault
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Bingqin Li
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Andre M N Renzaho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
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8
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Li XH, Deng SY, Zhang TM, Wang YZ, Wei DN, Wong IYL, Chan CLW, Ran MS. Affiliate stigma of mental illness in family caregivers of persons with mental illness in Hong Kong. Int J Soc Psychiatry 2022; 68:1698-1707. [PMID: 34791960 DOI: 10.1177/00207640211057723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Affiliate stigma of family caregivers may severely influence family caregiving, early treatment, and recovery of people with mental illness (PMI), and it may be impacted by the knowledge of mental illness and contact with PMI. However, little is known about the correlation between affiliate stigma of family caregivers of PMI and contact in Hong Kong. AIMS This study aimed to investigate affiliate stigma and its influencing factors among family caregivers of PMI in Hong Kong. METHODS A total of 106 family caregivers in Hong Kong participated in the study. The measurements included affiliate stigma, contacts (quantity, quality, and level), knowledge, prejudice, and discriminatory behaviors. Multiple regression analyses were employed. RESULTS The mean score of affiliate stigma scale (ASS) in family caregivers was 2.17 (SD = 0.65). In regression analyses, the results showed that contact quantity and contact level were significantly associated with higher affiliate stigma and its cognitive domain, while contact quality (e.g. positive contact) were significantly associated with lower affiliate stigma and its all domains among family caregivers. The positive relationship between prejudicial attitudes and affiliate stigma was also found. CONCLUSIONS Affiliate stigma is severe among family caregivers of PMI in Hong Kong. The results of this study indicate that contact, especially positive contact, contributes to reducing affiliate stigma among family caregivers of PMI. The results of this study are important for development of health policy on reducing stigma in family caregivers of PMI. The effectiveness of Enhancing Contact Model (ECM) should be examined in future anti-stigma interventions.
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Affiliation(s)
- Xu-Hong Li
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Shu-Yu Deng
- Department of Social Work and Social Administration, University of Hong Kong, China
| | | | - Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Dan-Nuo Wei
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Irene Yin Ling Wong
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, China
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9
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Shu JL, Alleva JM, Stutterheim SE. Perspectives on mental health difficulties amongst
second‐generation
Chinese individuals in Germany: Stigma, acculturation, and
help seeking. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2022. [DOI: 10.1002/casp.2620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jin Li Shu
- Department of Work and Social Psychology Maastricht University Maastricht the Netherlands
| | - Jessica M. Alleva
- Department of Clinical Psychological Science Maastricht University Maastricht the Netherlands
| | - Sarah E. Stutterheim
- Department of Health Promotion & Care and Public Health Research Institute Maastricht University Maastricht the Netherlands
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10
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Misra S, Jackson VW, Chong J, Choe K, Tay C, Wong J, Yang LH. Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:486-512. [PMID: 33811676 DOI: 10.1002/ajcp.12516] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Stigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self-stigma than White American groups. In within-group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family's sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self-stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.
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Affiliation(s)
- Supriya Misra
- San Francisco State University, San Francisco, CA, USA
| | | | - Jeanette Chong
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karen Choe
- Teachers College, Columbia University, New York, NY, USA
| | - Charisse Tay
- Teachers College, Columbia University, New York, NY, USA
| | - Jazmine Wong
- New York University Langone Health, New York, NY, USA
| | - Lawrence H Yang
- New York University School of Global Public Health, New York, NY, USA
- Columbia Mailman School of Public Health, New York, NY, USA
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11
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Kormendi NM, Brown AD. Asian American mental health during COVID-19: A call for task-sharing interventions. SSM - MENTAL HEALTH 2021; 1:100006. [PMID: 34494013 PMCID: PMC8413682 DOI: 10.1016/j.ssmmh.2021.100006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/12/2021] [Accepted: 06/12/2021] [Indexed: 12/05/2022] Open
Abstract
In the age of COVID-19, the Asian American community is facing a number of unique risks and barriers to mental health care. Mounting challenges—including language barriers, unemployment, racialized trauma, and anti-Asian violence—threaten the health and wellness of these communities. Yet, structural obstacles prevent Asian Americans from accessing care within the professionalized behavioral health workforce. Leveraging the resources of Asian American peer networks, collectives, and community-based organizations through a task-sharing program presents an attractive alternative for mental health care provision. Investing in task-sharing approaches to care would both address access barriers and build capacity within the Asian American community.
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Affiliation(s)
- Nicole Misun Kormendi
- Apicha Community Health Center, 400 Broadway, New York, NY, USA, 10013.,Vassar College, 124 Raymond Ave, Poughkeepsie, NY, USA, 12604
| | - Adam D Brown
- Department of Psychology, New School for Social Research, 80 5th Avenue, 601, New York, NY, USA, 10011.,Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY, USA, 10016
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12
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Monnapula-Mazabane P, Petersen I. Mental health stigma experiences among caregivers and service users in South Africa: a qualitative investigation. CURRENT PSYCHOLOGY 2021; 42:9427-9439. [PMID: 34465971 PMCID: PMC8396139 DOI: 10.1007/s12144-021-02236-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/06/2022]
Abstract
The study aimed to understand the nature and context of mental health stigma among people living with a mental health condition and the subsequent effect on their caregivers. Semi-structured qualitative face to face interviews were conducted by trained mental healthcare professionals with mental health service users (n = 26) and caregivers (n = 24) in private rooms at a tertiary health facility, where service users were admitted. Following transcription and translation, data was analysed using framework analysis. There was limited knowledge about their mental health diagnosis by service users and generally low mental health literacy among service users and caregivers. Mental health service users reported experiences of stigma from their own families and communities. Caregivers reported withholding the patient’s diagnosis from the community for fear of being stigmatised, and this fear of stigma carries the risk of negatively affecting care treatment-seeking. Limited mental health knowledge, coupled with a high prevalence of perceived family and community stigma among caregivers and service users, impedes the capacity of caregivers to effectively cope in supporting their family members living with mental illness. There is a need for interventions to provide psychoeducation, reduce community stigma, and support coping strategies for caregivers and people with mental health conditions.
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Affiliation(s)
- Portia Monnapula-Mazabane
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
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Interdependence and reflected failure: Cultural differences in stigma by association. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2021. [DOI: 10.1016/j.jesp.2021.104130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Misra S, Mehta HT, Eschliman EL, Rampa S, Poku OB, Wang WQ, Ho-Foster AR, Mosepele M, Becker TD, Entaile P, Arscott-Mills T, Opondo PR, Blank MB, Yang LH. Identifying "What Matters Most" to Men in Botswana to Promote Resistance to HIV-Related Stigma. QUALITATIVE HEALTH RESEARCH 2021; 31:1680-1696. [PMID: 33764233 PMCID: PMC9287436 DOI: 10.1177/10497323211001361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups (n = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the "what matters most" (WMM) and "structural vulnerability" frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.
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Affiliation(s)
- Supriya Misra
- Department of Public Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, United States
| | - Haitisha T. Mehta
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Evan L. Eschliman
- Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, United States
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Private Bag UB 00705, Gaborone, Botswana
| | - Ohemaa B. Poku
- Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, United States
| | - Wei-Qian Wang
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Ari R. Ho-Foster
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Mosepele Mosepele
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Timothy D. Becker
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States
| | - Patlo Entaile
- Botswana-UPenn Partnership, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Phillip R. Opondo
- Department of Psychiatry, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Michael B. Blank
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 715 Broadway 12 Floor, New York, NY 10003, United States; Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, United States
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15
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Blind spots in stigma research? Broadening our perspective on mental illness stigma by exploring 'what matters most' in modern Western societies. Epidemiol Psychiatr Sci 2021; 30:e26. [PMID: 33729113 PMCID: PMC8061255 DOI: 10.1017/s2045796021000111] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS The theory of 'what matters most' (WMM) has been developed to understand differences in mental illness stigma between cultures, postulating that stigma becomes most pervasive in situations that matter most in a specific cultural context. The rise of populism in Western societies demonstrates that also within one cultural context, different values 'matter most' to different groups. We expand the WMM framework to explore the spectrum of stigma manifestations within Western societies, relating it to both conservative/authoritarian and liberal/modern values. From our findings, we will develop hypotheses on how further research into value orientations and stigma might address potential blind spots in stigma research. METHODS Based on a narrative review of the literature on mental illness stigma and value orientations, we apply the WMM framework to cultural mechanisms of stigma within modern Western societies. RESULTS There are several studies showing an association between traditional, authoritarian, conservative values with stronger mental illness stigma, while studies examining the stigma within liberal, modern value orientations are scarce. We hypothesise on situations where encountering a person with mental illness could threaten liberal values and thus might provoke stigma among persons with such value orientations. For example, living with a person with mental illness could be seen as consuming energy and time, thereby jeopardising 'self-actualisation', the modern value of realising one's own full potential. As a result, a person highly valuing self-actualisation might try to avoid contact with persons with mental illness. Instances of potential 'liberal stigma' also include structural stigma or self-stigma, when, e.g. changing assumptions of what is considered 'normal' increase perceptions of being fundamentally different when experiencing mental illness. CONCLUSIONS 'WMM' appears to be a useful framework to direct research to potential blind spots within the field of stigma research. Looking at instances where liberal values conflict with dealing with a person with mental illness could provide a more comprehensive understanding of stigma experiences among persons with mental illness. However, for measuring stigma, tapping into liberal variations of mental illness stigma is methodologically challenging. Qualitative work could be the first step to elicit potential stigma experiences based on conflicts with liberal values.
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Li J, Wang W, Hu W, Yuan Z, Zhou R, Zhang W, Qu Z. Validation of posttraumatic stress disorder (PTSD) and complex PTSD in Chinese children as per the ICD-11 proposals using the International trauma questionnaire. Eur J Psychotraumatol 2021; 12:1888525. [PMID: 33796232 PMCID: PMC7968872 DOI: 10.1080/20008198.2021.1888525] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Given that the validity of applying complex posttraumatic stress disorder (CPTSD) in nonclinical children remains unclear. Objectives: The current study aimed to explore the factor structure, discriminant validity, and risk factors of ICD-11 posttraumatic stress disorder (PTSD) and CPTSD using the International Trauma Questionnaire. Methods: A total of 3478 trauma-exposed Chinese children aged 9-12 years were included in this study. All participants were assessed for PTSD and CPTSD using the International Trauma Questionnaire (ITQ). Confirmatory factor analysis (CFA) was conducted to explore the factor structure of CPTSD in a sample of Chinese children. Latent class analysis (LCA) was employed to evaluate the discriminant validity of CPTSD symptoms. Multinomial logistic regression analyses determined associations between the different classes and traumatic events. Results: The CFA results showed that the first-order six-factor model was identified as the best-fitting model in Chinese children aged 9-12 years. Four different classes, CPTSD symptoms, PTSD symptoms, disturbances in self-organization (DSO) symptoms, and a low symptom class were found by LCA. Both prolonged interpersonal trauma and other types of trauma were risk factors for the CPTSD class and the PTSD class. Conclusions: The results of this study partially support the factorial validity and strongly support the discriminant validity of the ICD-11 proposals for PTSD and CPTSD in Chinese children, supporting the conceptualization of PTSD and CPTSD as sibling diagnoses based on the ICD-11. However, findings suggest the need for careful consideration of identified trauma types in the ICD-11 proposals.
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Affiliation(s)
- Jina Li
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Weiwei Wang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Wei Hu
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Ziyue Yuan
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Ruifu Zhou
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Weijun Zhang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Zhiyong Qu
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
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Yang LH, Ho-Foster AR, Becker TD, Misra S, Rampa S, Poku OB, Entaile P, Goodman M, Blank MB. Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging "What Matters Most" to Resist Stigma. AIDS Behav 2021; 25:459-474. [PMID: 32839870 PMCID: PMC8530255 DOI: 10.1007/s10461-020-03012-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Perceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify "full personhood" could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to "what matters most" (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both [Formula: see text]). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r = .39, p = .005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r = .32, p = .026) and social support number (r = .29, p = .047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.
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Affiliation(s)
- Lawrence H Yang
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Ari R Ho-Foster
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Supriya Misra
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Gaborone, Botswana
| | - Ohemaa B Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Melody Goodman
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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DeLuca JS, Hwang J, Stepinski L, Yanos PT. Understanding explanatory mechanisms for racial and ethnic differences in mental health stigma: the role of vertical individualism and right-wing authoritarianism. J Ment Health 2020; 31:39-49. [DOI: 10.1080/09638237.2020.1836556] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Joseph S. DeLuca
- Department of Psychology, John Jay College of Criminal Justice, City University of New York (CUNY), New York, NY, USA
- Department of Psychology, CUNY Graduate Center, New York, NY, USA
| | - Junseon Hwang
- Department of Psychology, John Jay College of Criminal Justice, City University of New York (CUNY), New York, NY, USA
| | - Lauren Stepinski
- Department of Psychology, John Jay College of Criminal Justice, City University of New York (CUNY), New York, NY, USA
| | - Philip T. Yanos
- Department of Psychology, John Jay College of Criminal Justice, City University of New York (CUNY), New York, NY, USA
- Department of Psychology, CUNY Graduate Center, New York, NY, USA
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Poku OB, Ho-Foster AR, Entaile P, Misra S, Mehta H, Rampa S, Goodman M, Arscott-Mills T, Eschliman E, Jackson V, Melese T, Becker TD, Eisenberg M, Link B, Go V, Opondo PR, Blank MB, Yang LH. 'Mothers moving towards empowerment' intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial. Trials 2020; 21:832. [PMID: 33028387 PMCID: PMC7542742 DOI: 10.1186/s13063-020-04676-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children's lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the "What Matters Most" stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the "Mothers Moving towards Empowerment" (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period. METHODS This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status). DISCUSSION Our trial will evaluate MME, a culturally based HIV stigma reduction intervention using the "What Matters Most" framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana. TRIAL REGISTRATION ClinicalTrials.gov NCT03698981 . Registered on October 8, 2018.
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Affiliation(s)
- Ohemaa B Poku
- Johns Hopkins University, Baltimore, MD, United States.
| | - Ari R Ho-Foster
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Botswana, Gaborone, Botswana
| | | | | | | | | | | | - Tonya Arscott-Mills
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Botswana, Gaborone, Botswana
| | | | - Valerie Jackson
- University of California San Francisco, San Francisco, CA, United States
| | | | - Timothy D Becker
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Bruce Link
- University of California Riverside, Riverside, CA, USA
| | - Vivian Go
- University of North Carolina at Chapel Hill, Chapel Hil, NC, USA
| | | | | | - Lawrence H Yang
- New York University, New York, NY, United States
- Columbia University Mailman School of Public Health, New York, NY, USA
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Tsai CH, Kao YC, Lien YJ. The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197109. [PMID: 32998328 PMCID: PMC7579483 DOI: 10.3390/ijerph17197109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022]
Abstract
Background: Research on social distancing from patients with depression has primarily focused on individual-level factors rather than context-level factors. This study aimed to investigate the relationship between individual-level and context-level factors and social distancing from depressive patients. Methods: Sample data were collected via computer-assisted telephone interviews with 800 Taiwanese adults aged 20 to 65 years in 2016. All effects were tested using multilevel analysis. Results: With regard to individual-level variables, male sex, older age, people with more perceived dangerousness and those with more emotional reaction of fear were associated with greater social distancing from depressive patients. After controlling for individual-level variables, a positive association was found between the degree of urbanization and social distancing. We also found the interaction between the density of psychiatric rehabilitation services and perceived dangerousness to be associated with social distance. This finding revealed that persons with more perceived dangerousness and living in a region with higher density of psychiatric rehabilitation services were associated with greater social distance. Conclusions: We found that social distancing from depressive patients is not only determined by individual-level factors but influenced by the surroundings. This study provides useful directions for the implementation of optimal anti-stigma interventions for patients with depression.
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Affiliation(s)
- Chi-Hsuan Tsai
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Heping East Road Section 1, Taipei 106, Taiwan;
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Chenggong Rd., Neihu District, Taipei 114, Taiwan;
| | - Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Heping East Road Section 1, Taipei 106, Taiwan;
- Correspondence:
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Prentice L, Klackl J, Agroskin D, Grossmann I, Alexandrov Y, Apanovich V, Bezdenezhnykh B, Jonas E. Reaction to norm transgressions and Islamization threat in culturally tight and loose contexts: a cross-cultural comparison of Germany versus Russia. ACTA ACUST UNITED AC 2020; 8:46-69. [PMID: 32626646 PMCID: PMC7319407 DOI: 10.1007/s40167-018-0073-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 11/19/2022]
Abstract
Prior research shows that North Americans and Western Europeans react to threats with defensive strategies based on behavioral approach vs. inhibition systems (BAS/BIS)—i.e., a desire to approach a goal or to avoid a threat. In the present research, we explored whether this phenomenon is more pronounced in tight cultures (e.g., Germany) as compared to loose cultures (e.g., Russia), testing how Germans and Russians respond to societal threats. We expected that due to the higher levels of cultural tightness, Germans would show stronger defensive reactions to threats than Russians. Additionally, we investigated the role of need for tightness (i.e., need for strict regulation of social order) in threat management processes. In Study 1, Germans recalling violations of societal norms produced stronger rightward bias on the line bisection task than Russians, indicative of greater BAS activation in Germans than in Russians. In Study 2, we used frontal alpha asymmetry, providing the first cross-cultural test of BIS-BAS reactions utilizing neuronal markers. In this study, presentation of societal threat in a video portraying Islamic immigration as a large-scale violation of social norms led to higher BIS activation among Germans than among Russians, if their need for tightness was high. We discuss the role of tightness, need for tightness, and type of threat for cross-cultural particularities of threat-induced motivational shifts.
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Affiliation(s)
- Liza Prentice
- Department of Psychology, Social Psychology, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria
| | - Johannes Klackl
- Department of Psychology, Social Psychology, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria
| | - Dmitrij Agroskin
- Department of Psychology, Social Psychology, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria
| | - Igor Grossmann
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Yuri Alexandrov
- Laboratory of Neural Bases of Mind, Institute of Psychology, Russian Academy of Sciences, Yaroslavskaya Str. 13, Moscow, Russia 129366.,Department of Psychology, National Research University Higher School of Economics, 20 Myasnitskaya Ulitsa, Moscow, Russia 101000
| | - Vladimir Apanovich
- Laboratory of Neural Bases of Mind, Institute of Psychology, Russian Academy of Sciences, Yaroslavskaya Str. 13, Moscow, Russia 129366
| | - Boris Bezdenezhnykh
- Laboratory of Neural Bases of Mind, Institute of Psychology, Russian Academy of Sciences, Yaroslavskaya Str. 13, Moscow, Russia 129366
| | - Eva Jonas
- Department of Psychology, Social Psychology, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria
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Chen SX, Mak WWS, Lam BCP. Is It Cultural Context or Cultural Value? Unpackaging Cultural Influences on Stigma Toward Mental Illness and Barrier to Help-Seeking. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2020. [DOI: 10.1177/1948550619897482] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There have been growing interests in sampling underrepresented populations to test whether psychological processes are universal. The present cross-sectional study examined cultural influences on stigma toward mental illness and perceived barrier to help-seeking among Hong Kong Chinese, Chinese Americans, and European Americans ( N = 555 university students). Significant cultural differences were found in the mean levels, with the two Chinese groups reporting higher levels of stigma toward mental illness and perceived barrier to help-seeking than European Americans, and these cultural differences were accounted for by face concern. In addition, the strengths of paths from face concern to stigma toward mental illness and perceived barrier to help-seeking were equivalent across the three cultural groups. These findings tease apart the source of cultural influences and underscore the importance of comparing cultural differences both at the mean level and the structural level, but more importantly, to unpackage the observed differences by testing the mediating role of cultural values.
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Affiliation(s)
- Sylvia Xiaohua Chen
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | | | - Ben C. P. Lam
- The University of Queensland, Brisbane, Queensland, Australia
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Gill BK, Cant R, Lam L, Cooper S, Lou VWQ. Non-pharmacological depression therapies for older Chinese adults: A systematic review & meta-analysis. Arch Gerontol Geriatr 2020; 88:104037. [PMID: 32135393 DOI: 10.1016/j.archger.2020.104037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To conduct a systematic review of randomized controlled trials to evaluate the evidence for the use of non-pharmacological depression therapies in older Chinese adults. MATERIALS AND METHODS The population was individuals of Chinese extraction over the age of 60 who meet the criteria for depression. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Six healthcare databases were systematically searched for publications to the end date July 2018. Included study variables were extracted and methodological quality assessments were performed. Ten studies reported sufficient data for meta-analysis. RESULTS Fifteen experimental and quasi-experimental studies fulfilled the selection criteria (N = 904 participants). Twelve studies provided sufficient data to evaluate the therapies using Effect Size (ES) (Cohen'sd); ranged from low to high. In the Qigong studies ES varied d = 0.31-0.81, Reminiscence d = 0.20-2.37, and for single studies of Tai Chi d = 1.7 and for Life Story d = 1.46. From the meta-analyses, Qigong was the only treatment that had a significant effect on the severity of depression (Z = -4.47, p < 0.01) with acceptable statistical heterogeneity between studies (I2 = 52 %). CONCLUSION Overall, there was a large methodological heterogeneity between studies attributed to differing treatments, duration and designs. Reminiscence and Life Story showed an overall effect from a range of measures, as did the exercise therapies Qigong and Tai Chi. Qigong was the only therapy having a significant effect on depression. This therapy may be useful to alleviate depression due to the group and social interaction.
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Affiliation(s)
- Baljit Kaur Gill
- School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong.
| | - Robyn Cant
- School of Nursing and Healthcare Professions, Federation University, Victoria, Australia
| | - Louisa Lam
- School of Nursing and Healthcare Professions, Federation University, Victoria, Australia
| | - Simon Cooper
- School of Nursing and Healthcare Professions, Federation University, Victoria, Australia
| | - Vivian Wei Qun Lou
- School of Social Work and Social Administration, The University of Hong Kong, Hong Kong; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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Kohrt BA, Turner EL, Rai S, Bhardwaj A, Sikkema KJ, Adelekun A, Dhakal M, Luitel NP, Lund C, Patel V, Jordans MJD. Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers. Soc Sci Med 2020; 250:112852. [PMID: 32135459 PMCID: PMC7429294 DOI: 10.1016/j.socscimed.2020.112852] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 11/24/2022]
Abstract
Initiatives for integration of mental health services into primary care are underway through the World Health Organization's mental health Gap Action Programme (mhGAP) and related endeavors. However, primary healthcare providers' stigma against persons with mental illness is a barrier to success of these programs. Therefore, interventions are needed to reduce stigma among primary healthcare providers. We developed REducing Stigma among HealthcAre ProvidErs (RESHAPE), a theoretically-grounded intervention that draws upon the medical anthropology conceptual framework of "what matters most." RESHAPE addresses three domains of threats to what matters most: survival, social, and professional. In a proof-of-concept study, mental health service users and aspirational healthcare providers (primary healthcare providers actively incorporating mental health services) were trained to co-facilitate the RESHAPE intervention embedded within mhGAP training in Nepal. Two trainings with the RESHAPE anti-stigma component were held with 41 primary healthcare providers in Nepal. Evaluation of the training included four focus groups and 25 key informant interviews. Stigmatizing attitudes and role play-based clinical competency, assessed with the ENhancing Assessment of Common Therapeutic factors tool (ENACT), were evaluated pre-training and followed-up at four and 16 months. The study was conducted from February 2016 through June 2017. In qualitative interviews, primary healthcare providers described changes in perceptions of violence (survival threats) and the ability to treat mental illness effectively (professional threats). Willingness to interact with a person with mental illness increased from 54% pre-training to 81% at 16 months. Observed clinical competency increased from 49% pre-training to 93% at 16-months. This proof-of-concept study supports reducing stigma by addressing what matters most to healthcare providers, predominantly through mitigating survival and professional threats. Additional efforts are needed to address social threats. These findings support further exploration of service user and aspirational figure involvement in mhGAP trainings based on a "what matters most" conceptual framework.
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Affiliation(s)
- Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA; Duke Global Health Institute, Duke University, Durham, USA.
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, USA.
| | - Sauharda Rai
- Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA; Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Anvita Bhardwaj
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Durham, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
| | - Adesewa Adelekun
- Department of Psychiatry, University of California, Los Angeles, USA.
| | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, USA; Sangath, Goa, India.
| | - Mark J D Jordans
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Vaccari P, Ramírez-Vielma R, Saldivia S, Cova F, Vielma-Aguilera A, Victoriano V, Ulloa-Vidal N, Grandón P. Stigma towards people with a diagnosis of severe mental disorder in primary healthcare centers: perspectives of service users and health teams in Chile. Int J Ment Health Syst 2020; 14:6. [PMID: 32047532 PMCID: PMC7006126 DOI: 10.1186/s13033-020-0340-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stigma towards people diagnosed with a severe mental disorder (SMD) is one of the main obstacles for these service users to receive timely and relevant healthcare. This study was undertaken to understand how stigmatizing attitudes are demonstrated towards people with SMD in primary healthcare centers (PHC) from the perspective of those affected and primary healthcare professionals. Methods We used a qualitative exploratory research design to contrast the differences and similarities regarding stigmatizing attitudes towards people with SMD in primary healthcare centers (PHC) from the perspective of two groups: (i) people diagnosed with a severe mental disorder, and (ii) healthcare professionals. Data was collected through semi-structured interviews and discussion groups and subsequently analyzed using Atlas.ti software. Results Our results indicate that both service users and healthcare professionals manifest stereotypes, prejudices, and discriminatory behavior in health care. In addition, structural aspects of the health system and organizational culture appear to contribute to stigmatization. Both groups agreed that there is a need for healthcare professionals to have more education, specialization, and skill development related to mental health issues. Conclusions Interventions to reduce the stigma towards people with SMD in PHC must consider delivery of information about mental disorders, development of skills in the healthcare professionals, and modifications in the culture of the health centers.
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Affiliation(s)
- Pamela Vaccari
- 1Departamento de Psicología, Universidad de Concepción, Concepción, Chile
| | | | - Sandra Saldivia
- 2Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Félix Cova
- 1Departamento de Psicología, Universidad de Concepción, Concepción, Chile
| | - Alexis Vielma-Aguilera
- 2Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | | | | | - Pamela Grandón
- 1Departamento de Psicología, Universidad de Concepción, Concepción, Chile
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Liu CH, Li H, Wu E, Tung ES, Hahm HC. Parent perceptions of mental illness in Chinese American youth. Asian J Psychiatr 2020; 47:101857. [PMID: 31715469 PMCID: PMC7056581 DOI: 10.1016/j.ajp.2019.101857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although parents are often the first to facilitate help-seeking in their children, parental perceptions regarding mental health serve as a significant barrier to the access of mental health services. This study examined mental health perceptions held by Chinese immigrant parents of youth. METHODS Eighteen parents (13 female, 5 male), who identified as having children between the ages of 13 and 21 years, participated in audio-recorded interviews using five vignettes depicting depression with and without a somatic emphasis, schizophrenia with paranoid features, attenuated psychosis syndrome, and social anxiety in youth. Questions about potential causes, likely diagnosis, and health-seeking behaviors in relation to these vignettes were asked. Interviews were analyzed for themes using a deductive-inductive hybrid approach, informed by the explanatory models that have shed light on Asian perceptions of mental illness and approaches to help-seeking. RESULTS While Asian groups are often considered as lacking in mental health knowledge, we found that Chinese immigrant parents were comfortable with psychological terminology as it pertained to identifying causes and describing supportive strategies and the seeking of Western-based providers. However, the majority of Chinese immigrant parent respondents did not easily note suicidality. Furthermore, respondents did not consider social anxiety as a major mental health issue among Chinese immigrant parents and attributed social anxiety to personality or cultural differences. DISCUSSION These findings provide an understanding of how Chinese immigrant parents conceptualize mental illness and help-seeking, which may be helpful for providers when working with Chinese immigrant parents of children that have a mental health concern.
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Affiliation(s)
- Cindy H Liu
- Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Huijun Li
- Florida A&M University, 1601 S. Martin Luther King Jr Blvd, Tallahassee, FL 32307, USA.
| | - Emily Wu
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
| | - Esther S Tung
- Department of Psychology, Boston University, 900 Commonwealth Ave. Floor 2, Boston, MA 02215, USA.
| | - Hyeouk C Hahm
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA 02215, USA.
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Shi W, Shen Z, Wang S, Hall BJ. Barriers to Professional Mental Health Help-Seeking Among Chinese Adults: A Systematic Review. Front Psychiatry 2020; 11:442. [PMID: 32508688 PMCID: PMC7251144 DOI: 10.3389/fpsyt.2020.00442] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A large number of Chinese suffer from common mental disorders (e.g., depression, anxiety, stress, and post-traumatic stress disorder), but treatment seeking is typically low in this population. It is unclear what barriers influence professional mental health help-seeking behavior within the Chinese population. Identifying these barriers could assist in implementation science efforts to reach this population. OBJECTIVE This review systematically synthesizes findings related to the barriers to professional mental health help-seeking among Chinese adults. METHODS Two English language databases (PubMed and PsycINFO) and two Chinese databases (WANFANGDATA and CNKI) were searched to find relevant studies. Quality assessment was conducted in identified studies. Quantitative findings were tabulated and frequently reported barriers were ranked. Primary data obtained from qualitative studies were thematically analyzed. RESULTS Of 6,933 citations identified, 17 met inclusion criteria. There were 11 (64%) studies that reported quantitative methods; 3 (18%) employed qualitative research, and 3 (18%) mixed methods. Results indicated that frequently reported barriers to mental health help seeking among Chinese adults included a preference on self-reliance, seeking help from alternative sources, low perceived need toward help-seeking, a lack of affordability, negative attitude toward, or poor experiences with help-seeking. Less frequently mentioned barriers included stigma, families' opposition, limited knowledge about mental illness, a lack of accessibility, unwillingness to disclose mental illness, and fear of burdening family. CONCLUSIONS The current review identified a number of key barriers to help-seeking behavior. Effective strategies are needed to promote professional help-seeking among Chinese adults. Additional factors influencing professional mental health help-seeking need to be further investigated, as they may contribute to a better understanding the help-seeking behavior among Chinese.
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Affiliation(s)
- Wei Shi
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Zhuozhuo Shen
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Siyuan Wang
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
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Zhang Z, Sun K, Jatchavala C, Koh J, Chia Y, Bose J, Li Z, Tan W, Wang S, Chu W, Wang J, Tran B, Ho R. Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010280. [PMID: 31906068 PMCID: PMC6981757 DOI: 10.3390/ijerph17010280] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Abstract
Background: In psychiatry, stigma is an attitude of disapproval towards people with mental illnesses. Psychiatric disorders are common in Asia but some Asians receive inadequate treatment. Previous review found that Asians with mental illness were perceived to be dangerous and aggressive. There is a need for renewed efforts to understand stigma and strategies which can effectively reduce stigma in specific Asian societies. The objective of this systematic review was to provide an up-to-date overview of existing research and status on stigma experienced by psychiatric patients and anti-stigma campaigns in China, Hong Kong, Japan, Singapore, Korea, and Thailand. Methods: A systematic literature search was conducted in the following databases, including PubMed, PsycINFO, Embase, Web of Science, and local databases. Studies published in English and the official language of included countries/territories were considered for inclusion in the systematic review. Any article on stigma related to any form of psychiatric illness in the six Asian societies was included. Results: One hundred and twenty-three articles were included for this systematic review. This review has six major findings. Firstly, Asians with mental illnesses were considered as dangerous and aggressive, especially patients suffering from schizophrenia and bipolar disorder; second, psychiatric illnesses in Asian societies were less socially-acceptable and were viewed as being personal weaknesses; third, stigma experienced by family members was pervasive and this is known as family stigma; fourth, this systemic review reported more initiatives to handle stigma in Asian societies than a decade ago; fifth, there have been initiatives to treat psychiatric patients in the community; and sixth, the role of supernatural and religious approaches to psychiatric illness was not prevailing. Conclusion: This systematic review provides an overview of the available scientific evidence that points to areas of needed intervention to reduce and ultimately eliminate inequities in mental health in Asia.
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Affiliation(s)
- Zhisong Zhang
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore;
| | - Kaising Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China;
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand;
| | - John Koh
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Yimian Chia
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.C.); (J.B.)
| | - Jessica Bose
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.C.); (J.B.)
| | - Zhimeng Li
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
| | - Wanqiu Tan
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore;
- The China-Singapore (Chongqing) Demonstration Initiative on Strategic Connectivity Think Tank, Chongqing 400043, China
| | - Sizhe Wang
- School of Mathematics, Jilin University, Changchun 2699, China;
| | - Wenjing Chu
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
| | - Jiayun Wang
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
- Correspondence:
| | - Bach Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Roger Ho
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore;
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.C.); (J.B.)
- Centre of Excellence in Behavioural Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam
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Cai C, Zhang X, Sheng Q, Ding L. Affiliate Stigma and Psychosocial Adaption Among Adolescents Who Have a Parent With Serious Mental Illness: Mediation Role of Family Cohesion. J Psychosoc Nurs Ment Health Serv 2019; 57:39-47. [PMID: 31566703 DOI: 10.3928/02793695-20190920-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
Abstract
The current cross-sectional study examined the relationship between affiliate stigma and externalizing and internalizing problems by investigating the role of family cohesion among adolescents having a parent with serious mental illness (SMI). One hundred sixty-four adolescents were recruited from two community mental health centers. Family cohesion, affiliate stigma, and adolescent internalizing and externalizing problems were assessed. A significant relationship was found between adolescent externalizing and internalizing problems and family cohesion (r = -0.462, p < 0.01 and r = -0.534, p < 0.001, respectively) and affiliate stigma (r = 0.512, p < 0.01 and r = 0.656, p < 0.001, respectively). Family cohesion partially mediated the relation between affiliate stigma and externalizing problems (Z = -4.97, p < 0.001) and fully mediated the relation between affiliate stigma and internalizing problems (Z = -5.18, p < 0.001). The current study highlights the need for effective interventions aimed at families to support parents with SMI in their parenting role and enhance family cohesion. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 39-47.].
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Zhang Y, Wang Z, Huang S, Sun L, Zhao S, Zhong Y, Xiao H, Ding X. Parents' perceptions of diagnostic genetic testing for children with inherited retinal disease in China. Mol Genet Genomic Med 2019; 7:e916. [PMID: 31373165 PMCID: PMC6732314 DOI: 10.1002/mgg3.916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 01/20/2023] Open
Abstract
Background In this study, we aim to investigate the awareness of, attitudes toward, and experiences with diagnostic genetic testing among parents of children suspected of having inherited retinal disease (IRDs) in China. Methods Semistructured, face‐to‐face, and in‐depth interviews were carried out with parents of children with suspected IRDs in this qualitative study. Inductive content analysis was used for data processing. Results Forty‐six parents participated in our interviews, and 47.8% of them supported genetic testing for following four main reasons: to help in making informed reproductive health decisions, to prepare for novel potential treatment, to identify the underlying causes of IRDs, and to satisfy curiosity about the heredity of IRDs. Among them, 19.6% were opposed to the testing for four main reasons, namely lack of therapeutic benefit, difficulty in affording the testing cost, doubt in the accuracy of clinical diagnosis, and the presence of concerns about the limitations of genetic testing. 47.8% of the parents expressed concerns that the genetic findings might lead to potential psychological stress. Conclusion In this study, we showed that nearly half of the parents supported genetic testing mainly for family planning, and a fifth of the parents were opposed to the testing mainly for lack of therapeutic benefit. Moreover, half of the parents expressed concern that a positive genetic result may create potential psychological burden to the parents and children.
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Affiliation(s)
- Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Sijian Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shiying Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yimin Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huiming Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Li J, Zhang W, Chen W, Yuan H, Zhang S, Tian M, Qu Z. Applications of the Chinese version of the primary care PTSD screen for DSM-5 (PC-PTSD-5) for children. J Affect Disord 2019; 254:109-114. [PMID: 31158781 DOI: 10.1016/j.jad.2019.05.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/11/2019] [Accepted: 05/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Effective screening is important for public mental health services. Although the primary care PTSD screen for DSM-5 (PC-PTSD-5) is useful in screening for post-traumatic stress disorder (PTSD) in adults, its reliability and validity for use in children remain unclear. This study aimed to examine the performance characteristics of the Chinese PC-PTSD-5 for children in children aged 8 to 16 years. METHODS 4,022 rural children from Grades 4 to 9 in China were included in this study. All participants were assessed for PTSD using the Chinese PC-PTSD-5 for children and the PTSD Checklist for DSM-5 (PCL-5), and assessed for anxiety using the Chinese version of the State Anxiety Scale for Children (CSAS-C), and for depression using the Children's Depression Inventory - Short Form (CDI-S). The performance characteristics of the PC-PTSD-5 for children were evaluated using receiver operating characteristic analyses. RESULTS The mean scores on the PCL-5 and the PC-PTSD-5 were 17.45 (SD = 14.78) and 1.78 (SD = 1.33), respectively. There was a significant correlation between the PC-PTSD-5 and PCL-5 (r = 0.54, p < 0.001), and small but significant correlations of the PC-PTSD-5 with the CSAS-C (r = 0.31, p < 0.001) and CDI-S (r = 0.27, p < 0.001). In this study, 2 and 3 were both found to be acceptable cutoff values. A cutoff value of 2 yielded a sensitivity of 0.87 and a specificity of 0.52, while a cutoff of 3 had sensitivity = 0.57, and specificity = 0.77. LIMITATIONS A clinical interview was not used to validated diagnostic findings. CONCLUSIONS The reliability and validity of the Chinese PC-PTSD-5 were statistically acceptable for screening for probable PTSD in children. Additionally, the Chinese PC-PTSD-5 had a favorable sensitivity at a cut off 2 and a favorable specificity at a cut off 3, based on PCL-5 results.
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Affiliation(s)
- Jina Li
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Weijun Zhang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China.
| | - Wenrui Chen
- The India China Institute, The New School, New York, NY 10011, United States.
| | - Hui Yuan
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China.
| | - Shengfa Zhang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Meng Tian
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Zhiyong Qu
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China.
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Han M, Diwan S, Sun K. Exploring caregiving-related experiences among Chinese American and European American family caregivers of persons with mental illness. Transcult Psychiatry 2019; 56:491-509. [PMID: 30758257 DOI: 10.1177/1363461519827690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Family caregivers (FCs) of people with mental illness (PMI) experience caregiving-related distress. These challenges tend to be greater for Asian American families due to acculturative stress and structural barriers to services. However, little is known about caregiving-related experiences among FCs of PMI within a cultural context. By using an exploratory approach, we examined the experience of caregiver distress and the influence of cultural values on caregiving in European American and Chinese American FCs. In collaboration with community-based agencies, a combination of convenience and snowball sampling methods were used to recruit Chinese American and European American caregivers who co-reside with PMIs. Two focus groups with each ethnic group with 57 participants (30 Chinese and 27 European American) were conducted. Thematic analysis indicates that FCs experience intense emotions, health/mental health problems, and a negative impact on their personal/social lives. Whereas Chinese American FCs reported shame, lack of knowledge, and over-protectiveness of PMIs, European American FCs reported the need for advocacy on behalf of the PMI. Findings indicate a need for: 1) greater awareness of the caregiving experience on wellbeing of FCs; 2) an understanding of how cultural values may influence caregiver experience; and 3) developing culturally relevant prevention and intervention services that can support FCs from diverse cultural contexts.
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Zhou Y, Lemmer G, Xu J, Rief W. Cross-Cultural Measurement Invariance of Scales Assessing Stigma and Attitude to Seeking Professional Psychological Help. Front Psychol 2019; 10:1249. [PMID: 31214074 PMCID: PMC6554279 DOI: 10.3389/fpsyg.2019.01249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/13/2019] [Indexed: 11/13/2022] Open
Abstract
There has been a growing interest in research on stigma and attitude toward psychotherapy, and these variables are expected to show cross-cultural variations. The Stigma Scale for Receiving Psychological Help (SSRPH), the Self-Stigma of Seeking Help (SSOSH) and the Inventory of Attitudes to Seeking Mental Health Services (IASMHS) are widely used and this study examined their measurement invariance as this is a prerequisite for use in cross-cultural studies. Data were collected online from groups of Chinese students in China (n = 413) and German students in Germany (n = 416). Confirmatory factor analyses in single samples and measurement invariance testing in a multi-group framework were conducted to test the cross-group equivalence. Findings demonstrate that the SSRPH and the modified model of IASMHS had partial scalar measurement invariance, but the SSOSH showed cultural variance in factor structure. Comparisons of latent means indicated no differences between the two groups with respect to the social stigma attached to professional psychological help, but a higher psychological openness of Chinese students toward help-seeking. Findings are discussed from intercultural and methodological perspectives. In the future, intercultural cooperation should be promoted in order to develop a cross-culturally valid concept of stigma against psychological help that could be used as the basis for intercultural comparison and developing interventions to reduce stigma.
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Affiliation(s)
- Yan Zhou
- Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Gunnar Lemmer
- Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Jing Xu
- Department of Marxism, Zhengzhou University, Zhengzhou, China
| | - Winfried Rief
- Department of Psychology, Philipps University of Marburg, Marburg, Germany
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Sun Y, Chen G, Wang L, Li N, Srisurapanont M, Hong JP, Hatim A, Chen CH, Udomratn P, Bae JN, Fang YR, Chua HC, Liu SI, George T, Bautista D, Chan E, Rush AJ, Yang H, Su YA, Si TM. Perception of Stigma and Its Associated Factors Among Patients With Major Depressive Disorder: A Multicenter Survey From an Asian Population. Front Psychiatry 2019; 10:321. [PMID: 31156476 PMCID: PMC6529583 DOI: 10.3389/fpsyt.2019.00321] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 04/25/2019] [Indexed: 01/22/2023] Open
Abstract
Stigma of major depressive disorder (MDD) is an important public health problem. This study aimed to examine the level of perceived stigma and its associated factors in MDD patients in five Asian countries, including China, Korea, Malaysia, Singapore, and Thailand. A total of 547 outpatients with MDD were included from Asian countries. We used the stigma scale of the Explanatory Model Interview Catalogue (EMIC) to assess stigma. The Montgomery-Asberg Depression Rating Scale (MADRS), Symptoms Checklist 90-Revised (SCL-90-R), Fatigue Severity Scale (FSS), Sheehan Disability Scale (SDS), 36-Item Short-Form Health Survey (SF-36), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess symptoms, clinical features, functional impairment, health status, and social support. The stigma scores of patients under 55 years old were significantly higher than those equal to or greater than 55 years old (P < 0.001). The stigma scores exhibited significant negative correlation with age; MSPSS scores of family, friends, and others; and SF-36 subscale of mental health, but significant positive correlation with MADRS, FSS, SDS, and SCL-90-R subscale scores of depression, interpersonal sensitivity, obsession-compulsion, psychoticism, and somatization. Multivariate regression analysis revealed that age, SCL-90-R interpersonal sensitivity, obsession-compulsion, psychoticism, MSPSS scores of friends and others, and SF-36 of mental health were significantly associated with the level of perceived stigma. These findings suggest that MDD patients who are young, have a high degree of interpersonal sensitivity and psychoticism, have low health-related quality of life, and have low social support are the target population for stigma interventions in Asia.
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Affiliation(s)
- Yan Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
- Department of Psychiatry, Shanxi Dayi Hospital, Taiyuan, China
| | - Gang Chen
- Department of Psychiatry, Huai’an No.3 People’s Hospital, Jiangsu, China
| | - Li Wang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Nan Li
- Department of Epidemiology, Peking University Third Hospital, Beijing, China
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Muang, Thailand
| | - Jin Pyo Hong
- Department of Psychiatry, University of Ulsan College of Medicine, Asian Medical Center, Seoul, South Korea
| | - Ahmad Hatim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chia-hui Chen
- Department of Psychiatry, Chang Gung Medical Center and Chang Gung University, Tao-Yuan, Taiwan
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jae Nam Bae
- Department of Psychiatry, Faculty of Medicine, Inha University Hospital, Incheon, South Korea
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Choon Chua
- Institute of Mental Health, Woodbridge Hospital, Singapore, Singapore
| | - Shen-Ing Liu
- Department of Psychiatry, Faculty of Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tom George
- North West Specialist Centre, Everton Park, QLD, Australia
| | - Dianne Bautista
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Edwin Chan
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - A. John Rush
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Hong Yang
- Department of Psychiatry, Shanxi Dayi Hospital, Taiyuan, China
| | - Yun-Ai Su
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Tian-Mei Si
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
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Sun KS, Lam TP, Lo TL, Wu D. How Chinese psychiatrists see and manage stigmatisation of psychiatric patients: a qualitative study in Hong Kong. EVIDENCE-BASED MENTAL HEALTH 2019; 22:51-55. [PMID: 30923052 PMCID: PMC10270371 DOI: 10.1136/ebmental-2018-300078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Health professionals including psychiatrists were reported to have stigmatising opinions on psychiatric patients. Their views may be affected by clinical, social and cultural factors. OBJECTIVE This study explored the views of Chinese psychiatrists on stigmatisation of psychiatric patients. METHODS Focus group discussions with psychiatrists were conducted in Hong Kong. Their views towards stigmatisation of psychiatric patients and strategies to reduce stigmatisation were discussed. FINDINGS The psychiatrists perceived the clinical needs to classify the patients according to the diagnoses and they did not see it as stigmatisation. They believed that some mental illnesses are characterised with violence or deviance, and were not completely curable. Instead of trying to eliminate stigma, they managed in ways that took social expectations into consideration. They might offer a relative vague diagnostic label to save the 'face' of the patients and secure greater acceptance for the illness from the public. They tended to accept family members to make decisions on behalf of the patients. Reconciling public interest and patients' autonomy, they encouraged stable psychotic patients to live in the community but agreed to institutionalise those patients with violent behaviours. CONCLUSION While the psychiatrists argued that the diagnosis was not a form of stigma, they were sensitive enough and framed responses to patients in ways to minimise stigma. They tended to believe that stigma was inevitable given the nature of some psychotic disorders. Disguising the stigma appeared to be the common approach to deal with stigma in a Chinese context. CLINICAL IMPLICATIONS The psychiatrists, especially those practicing in a Chinese context, may consider a wider perspective of community mental health rehabilitation which is not limited to social stability but also social life.
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Affiliation(s)
- Kai Sing Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | | | - Dan Wu
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Lien YJ, Kao YC. Public beliefs and attitudes toward schizophrenia and depression in Taiwan: A nationwide survey. Psychiatry Res 2019; 273:435-442. [PMID: 30684789 DOI: 10.1016/j.psychres.2019.01.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 01/05/2023]
Abstract
Beliefs about and attitudes toward mental illness may be influenced by cultural- or country-specific contexts. Through a national survey, the current study investigated beliefs and attitudes toward people with schizophrenia and depression among the general public in Taiwan. A random-digit-dialing telephone-based cross-sectional survey was administered to Taiwanese adults aged 20-64 years (n = 1600). The data were analyzed through binary logistic regressions to test for differences between these disorders in causal beliefs, stereotypes, emotional reactions, desire for social distance, and help-seeking behavior. The results revealed that respondents were more concerned with biogenetic causal explanations for people with schizophrenia than for those with depression. Significantly more respondents perceived people with schizophrenia as more likely to be unpredictable and violent toward others. A similar trend was observed for the desire for social distance. For both disorders, respondents were significantly more likely to express compassion than to express anger toward the person described in the vignette. Respondents also expressed more desire for social distance from someone like the vignette who have received psychiatric treatment. These findings provide useful directions for the implementation of optimal psychoeducation among such communities. .
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Affiliation(s)
- Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan; Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.
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Yasuhara K, Formon DL, Phillips S, Yenne EM. Development of a measure of mental health stigma including police behaviors. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2019; 26:520-529. [PMID: 31984093 PMCID: PMC6762149 DOI: 10.1080/13218719.2018.1507845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/01/2018] [Indexed: 06/10/2023]
Abstract
Various stigmatizing notions are associated with mental illness, resulting in negative personal (e.g. employment discrimination) and societal (e.g. public treatment of the mentally ill as 'dangerous' and/or 'criminal') outcomes. This study develops and validates a new multi-scale assessment tool to assess several dimensions of mental illness stigma, including perceived dangerousness, self-care, social distance, treatment amenability and predicted police behavior. A total of 641 undergraduate students from various American universities completed the new stigma measure along with two other existing measures. The results indicate that the new stigma measure has an acceptable three-factor solution consisting of self-care, dangerousness and police behavior. The self-care and dangerousness factors were found to have concurrent validity with the corresponding scales of the existing measures. Future research involving different populations, as well as the policy implications of the new police behavior factor, are discussed.
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Affiliation(s)
- Kento Yasuhara
- College of Arts and Sciences, University of New Haven, West Haven, CT, USA
| | - Dana L. Formon
- College of Humanities and Social Sciences, Sam Houston State University, Huntsville, AL, USA
| | - Sarah Phillips
- College of Arts and Sciences, Drexel University, Philadelphia, PA, USA
| | - Elise M. Yenne
- College of Humanities and Social Sciences, Sam Houston State University, Huntsville, AL, USA
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Huang D, Yang LH, Pescosolido BA. Understanding the public's profile of mental health literacy in China: a nationwide study. BMC Psychiatry 2019; 19:20. [PMID: 30642305 PMCID: PMC6332702 DOI: 10.1186/s12888-018-1980-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/11/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND In the wake of China's massive economic development, attention has only recently turned to the enormous treatment gap that exists for mental health problems. Our study is the first comprehensive, national examination of the levels and correlates of the public's ability to recognize mental illness in the community and suggest sources of help, setting a baseline to assess contemporary Chinese efforts. METHODS Data were collected in China as part of the Stigma in Global Context - Mental Health Study (SGC-MHS) through face-to-face interviews using vignettes meeting clinical criteria for schizophrenia and major depression. Our analysis targets the Han Chinese participants (n = 1812). Differences in the recognition of mental health problems were assessed using a chi-square test and further stratified by vignette illness type and urban vs. rural residence. Adjusted regression models estimated the effects of each predictor towards the endorsement three types of help-seeking: medical doctor, psychiatrist, and mental health professional. RESULTS As expected, recognition of mental health problems is low; it is better for depression and most accurate in urban areas. Perceived severity increases endorsement of the need for care and for treatment by all provider types. Recognition of a mental health problem specifically decreases endorsement of medical doctors while increasing recommendations for psychiatrists and mental health professionals. Neurobiological attributions decrease recommendations for mental health professionals as opposed to general or specialty physicians. CONCLUSIONS Continued efforts are needed in China to promote mental illness recognition within rural areas, and of schizophrenia specifically. Promoting recognition of mental illness, while balancing the special challenges among individuals who understand the neurobiological roots of mental illness, may constitute a key strategy to reduce the sizeable mental health treatment gap in China.
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Affiliation(s)
- Debbie Huang
- 0000000419368729grid.21729.3fMailman School of Public Health, Columbia University, 722 W. 168th St., New York, NY 10032 USA
| | - Lawrence H. Yang
- 0000000419368729grid.21729.3fMailman School of Public Health, Columbia University, 722 W. 168th St., New York, NY 10032 USA ,0000 0004 1936 8753grid.137628.9New York University College of Global Public Health, 715 Broadway, Room 1212, New York, NY 10003 USA
| | - Bernice A. Pescosolido
- 0000 0001 0790 959Xgrid.411377.7Department of Sociology, Indiana University, 1022 E Third St, Bloomington, IN 47405 USA
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Lien YJ, Chang HA, Kao YC, Tzeng NS, Yeh CB, Loh CH. Self-Stigma Mediates the Impact of Insight on Current Suicide Ideation in Suicide Attempters with Schizophrenia: Results of a Moderated Mediation Approach. Suicide Life Threat Behav 2018; 48:661-676. [PMID: 28869800 DOI: 10.1111/sltb.12384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/28/2017] [Indexed: 12/12/2022]
Abstract
This study examined the relationships among insight, self-stigma, self-esteem, hope, quality of life, and suicidal behavior in individuals diagnosed as having schizophrenia. Hypotheses concerning mediating and moderating effects were examined. A total of 170 community-dwelling patients with schizophrenia participated in the study. The results revealed a negative association between insight and suicide ideation, which was partially mediated by self-stigma. Moreover, this indirect link was stronger among patients with suicide attempts than among those without attempts. We discuss the implications of these results for preventing or reducing the considerable risks of suicide in this population.
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Affiliation(s)
- Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Hui Loh
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Tanaka C, Tuliao MTR, Tanaka E, Yamashita T, Matsuo H. A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines. BMC Psychiatry 2018; 18:325. [PMID: 30290782 PMCID: PMC6173886 DOI: 10.1186/s12888-018-1902-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 09/20/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP's own experiences of being stigmatised in the Philippines. METHODS A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well. RESULTS The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP's mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual's reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God's will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma. CONCLUSIONS The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.
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Affiliation(s)
- Chika Tanaka
- Graduate School of Health Sciences, Kobe University, 701, 2-6-2, Yamamoto-dori, Chuo-ku, Kobe, Hyogo, 650-0003, Japan.
| | | | - Eizaburo Tanaka
- 0000 0004 0466 6360grid.474282.fHyogo Institute for Traumatic Stress, Kobe, Japan
| | | | - Hiroya Matsuo
- 0000 0001 1092 3077grid.31432.37Graduate School of Health Sciences, Kobe University, 701, 2-6-2, Yamamoto-dori, Chuo-ku, Kobe, Hyogo 650-0003 Japan
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Dardas LA, Silva SG, Scott J, Gondwe KW, Smoski MJ, Noonan D, Simmons LA. Do beliefs about depression etiologies influence the type and severity of depression stigma? The case of Arab adolescents. Perspect Psychiatr Care 2018; 54:547-556. [PMID: 29570796 DOI: 10.1111/ppc.12270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/20/2018] [Accepted: 02/10/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Research has documented that holding certain etiological beliefs about depression can determine the level of stigma experienced by individuals with depression. To date, no studies have yet examined this relationship among adolescents. Using a sample of Arab adolescents, the purpose of this study was to describe adolescents' beliefs about the etiology of depression, and examine whether these beliefs influence the type and severity of depression stigma. METHODS A nationwide school survey was conducted in a representative sample of Jordanian public and private schools located in Jordan, a Middle-Eastern Arab country. A total of 2,349 adolescents aged 12-17 (59% female) completed and returned an anonymous survey that included measures on adolescents' sociodemographic and health characteristics, depression symptoms, depression stigma, and depression etiological beliefs. An exploratory factor analysis with principal components analysis (PCA) was used to examine the factor structure of the Depression Etiological Beliefs Scale. The stability of the PCA findings was tested using a cross-validation method. Regression analyses were performed to examine whether depression etiological beliefs, depression severity, or their interaction are associated with depression stigma. RESULTS Adolescents endorsed multiple etiological beliefs about depression. The beliefs in which likely or very likely was most often reported were stressful events in one's life (72%), social factors (65%), and one's weak will (56%). On the other hand, the least reported beliefs were genetic or inherited problems (24%), chemical imbalance (30%), and punishment for wrong doings (35%). The interaction between adolescents' depression severity and depression beliefs significantly predicted personal stigma. Adolescent sex, age, and region of residence significantly affected the relationship between depression beliefs and stigma. CONCLUSIONS Nurses need to consider the beliefs and attitudes their patients have around depression, as these can influence symptom severity, comprehensive treatment plans, and adherence to provider recommendations. This study provides a better understanding of how depression beliefs affect Jordanian adolescents' attitudes toward depression, which can guide intervention programs to increase awareness about depression and promote treatment utilization.
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Affiliation(s)
| | - Susan G Silva
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jewel Scott
- School of Nursing, Duke University, Durham, NC, USA
| | | | - Moria J Smoski
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Devon Noonan
- School of Nursing, Duke University, Durham, NC, USA
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Sun KS, Lam TP, Wu D. Chinese perspectives on primary care for common mental disorders: Barriers and policy implications. Int J Soc Psychiatry 2018; 64:417-426. [PMID: 29781372 DOI: 10.1177/0020764018776347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China. AIMS This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings. METHODS A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed. RESULTS Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time. CONCLUSION Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients' intention to seek help and PCPs' competency in mental health care are other fundamental factors to be addressed.
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Affiliation(s)
- Kai Sing Sun
- 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Tai Pong Lam
- 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Dan Wu
- 2 University of North Carolina at Chapel Hill Project-China, Guangzhou, China
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Rayan A, Fawaz M. Cultural misconceptions and public stigma against mental illness among Lebanese university students. Perspect Psychiatr Care 2018; 54:258-265. [PMID: 28726343 DOI: 10.1111/ppc.12232] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/06/2017] [Accepted: 07/02/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to examine cultural misconceptions about mental illness and how they are associated with the public stigma against mental illness among Lebanese university students. METHODS A sample of 203 participants completed the study. Data about cultural misconceptions, attitudes about mental illness, and public stigma of mental illness were obtained. The researchers examined the mean difference in public stigma according to cultural beliefs about mental illness. RESULTS The majority of students believe that mental health professionals have inadequate knowledge and expertise to treat mental disorders. Various cultural misconceptions about mental illness were reported. Public stigma significantly differed based on these cultural misconceptions. CONCLUSION Psychiatric nurses should play a vital role in reshaping the inappropriate cultural view about mental illness.
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Affiliation(s)
- Ahmad Rayan
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Mirna Fawaz
- Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
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Insight, self-stigma and psychosocial outcomes in Schizophrenia: a structural equation modelling approach. Epidemiol Psychiatr Sci 2018; 27:176-185. [PMID: 27974084 PMCID: PMC6998951 DOI: 10.1017/s2045796016000950] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIMS Poor insight is prevalent in patients with schizophrenia and has been associated with acute illness severity, medication non-adherence and poor treatment outcomes. Paradoxically, high insight has been associated with various undesirable outcomes, including low self-esteem, depression and low subjective quality of life (QoL) in patients with schizophrenia. Despite the growing body of studies conducted in Western countries supporting the pernicious effects of improved insight in psychosis, which bases on the level of self-stigma, the effects are unclear in non-Western societies. The current study examined the role of self-stigma in the relationship between insight and psychosocial outcomes in a Chinese population. METHODS A total of 170 outpatients with schizophrenia spectrum disorders were recruited from two general university hospitals. Sociodemographic data and clinical variables were recorded and self-report scales were employed to measure self-stigma, depression, insight, self-esteem and subjective QoL. Structural equation modelling (SEM) was used to analyse the cross-sectional data. RESULTS High levels of self-stigma were reported by 39% of the participants (n = 67). The influences of insight, self-stigma, self-esteem and depression on subjective QoL were confirmed by the SEM results. Our model with the closest fit to the data (χ 2 = 33.28; df = 20; p = 0.03; χ 2/df = 1.66; CFI = 0.98; TLI = 0.97; RMSEA = 0.06) demonstrated that self-stigma might fully mediate the association of insight with low self-esteem, depression and poor subjective QoL. High insight into illness contributed to self-stigma, which caused low self-esteem and depression and, consequently, low QoL. Notably, insight did not directly affect self-esteem, depression or QoL. Furthermore, the association of insight with poor psychosocial outcomes was not moderated by self-stigma. CONCLUSIONS Our findings support the mediating model of insight relevant to the poor psychosocial outcomes of individuals diagnosed with schizophrenia in non-Western societies, in which self-stigma plays a pivotal role. These findings elucidate the direct and indirect effects of insight on psychosocial outcomes and imply that identifying and correcting self-stigma in people with schizophrenia could be beneficial. Additional studies are required to identify whether several other neurocognitive or psychosocial variables mediate or moderate the association of insight with self-esteem, depression and QoL in patients with schizophrenia. Studies with detailed longitudinal assessments are necessary to confirm our findings.
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Sun KS, Lam TP, Lam KF, Lo TL. Barriers and facilitators for psychiatrists in managing mental health patients in Hong Kong-Impact of Chinese culture and health system. Asia Pac Psychiatry 2018; 10. [PMID: 28371455 DOI: 10.1111/appy.12279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 01/02/2017] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study investigated the barriers and facilitators for psychiatrists in managing mental health patients under a Chinese context and a mixed private-public health system. METHODS Two focus group interviews were conducted to explore the in-depth opinions of psychiatrists in Hong Kong. The themes identified from the focus groups were investigated in a questionnaire survey with data from 83 psychiatrists working in public and private sectors. RESULTS No insurance coverage of mental health problems, patients' poor compliance of medication, and stigma of seeing psychiatrists were rated as the top barriers in the survey. Some psychiatrists mentioned in focus groups that they might write down the associated physical symptoms of the patients rather than the mental disorder diagnoses on the medical certificate. They observed some patients suspecting that psychiatric drugs were prescribed to control their behavior and make them more muddleheaded. The survey also found that consultation time constraint, long patient waiting list, and difficulty in discharging patients to primary care mostly affected public psychiatrists rather than private ones. However, they perceived similar facilitators, including public campaign to promote positive results of help-seeking, adequate explanation by other health professionals to the patients before referrals, handling severe cases by casework approach, and having a regular primary care physician. DISCUSSION The top barriers are related to insufficient public awareness and negative attitudes towards mental illness and its treatment. Major solutions include promoting positive results of help seeking, enhancing collaboration with primary care physicians, and follow-up of severe cases by a casework approach.
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Affiliation(s)
- Kai Sing Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
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Yan Y, Rieger E, Shou Y. Reducing the stigma associated with anorexia nervosa: An evaluation of a social consensus intervention among Australian and Chinese young women. Int J Eat Disord 2018; 51:62-70. [PMID: 29197118 DOI: 10.1002/eat.22808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/13/2017] [Accepted: 11/18/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study examined the effectiveness of a social consensus intervention in reducing stigma toward individuals with anorexia nervosa (AN) among women from Australia and mainland China. Moreover, the different predictions of informational/normative social influence theory and the social identity approach in terms of the effectiveness of the social consensus intervention were investigated. METHOD Participants were female students from the Australian National University (n = 97) and Central China Normal University (n = 76) who reported their levels of stigma toward a fictional character with AN before and after receiving normative information regarding the attitudes of others toward people with AN. Three experimental conditions of normative information were utilized: in-group, out-group, and neutral. RESULTS Chinese participants reported higher levels of baseline stigma across all measures than Australian participants. Social consensus was effective in reducing most types of AN stigma, and supported the social identity approach in that improvements in attitudinal, affective, and behavioral aspects of stigma were significantly greater for participants in the in-group (but not the out-group) versus the neutral condition. The effectiveness of the social consensus approach was not moderated by nationality. DISCUSSION A social consensus approach holds potential as an additional strategy for reducing AN stigma, with its benefits extending across diverse cultural settings. Such an approach would entail ensuring that positive messages regarding people with AN are delivered by members of a valued in-group.
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Affiliation(s)
- Yuwen Yan
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Yiyun Shou
- Research School of Psychology, Australian National University, Canberra, Australia
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Min SY, Wong YLI. Association Between Community Contextual Factors and Stigma of Mental Illness in South Korea: a Multilevel Analysis. Psychiatr Q 2017; 88:853-864. [PMID: 28229346 DOI: 10.1007/s11126-017-9503-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study examined the association of subjective and objective community contextual factors with stigma of mental illness in a sample of users of community mental health services centers in South Korea. Five hundred thirty-two persons with MI were surveyed on perceived stigma and experienced stigma, and on two subjective measures of community characteristics-perceived disorder and perceived collective efficacy of their neighborhood. Objective community indicators at the neighborhood level were collected from a government administrative data base. Multilevel statistical analysis was conducted to identify the effects of individual-level characteristics and community-level objective indicators on stigma. Perceived neighborhood disorder was associated with both perceived stigma and experienced stigma. Perceived collective efficacy was associated with perceived stigma but not experienced stigma. The proportion of persons with disabilities in the neighborhood, an objective community indicator, was associated with experienced stigma. Mental health practitioners and policy planners need to examine the relevance of neighborhood characteristics in the design of policy and practice interventions in order to enhance the social inclusion of persons with MI.
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Affiliation(s)
- So-Young Min
- Department of Social Welfare, Kyonggi University, 154-42, Gwanggyosan-ro, Yeongtong-gu, Suwon-si, Gyeonggi, 16227, South Korea.
| | - Yin-Ling Irene Wong
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA
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Dako-Gyeke M. Courtesy stigma: A concealed consternation among caregivers of people affected by leprosy. Soc Sci Med 2017; 196:190-196. [PMID: 29195190 DOI: 10.1016/j.socscimed.2017.11.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/21/2017] [Accepted: 11/16/2017] [Indexed: 01/14/2023]
Abstract
This study explored experiences of courtesy stigma among caregivers of people affected by leprosy. Using a qualitative research approach, twenty participants were purposively selected and in-depth interviews conducted. The interviews were audio-recorded, transcribed, and analyzed to identify emerging themes that addressed objectives of the study. The findings indicated that caregivers of people affected by leprosy experienced courtesy stigma. Evidence showed that fear of contagion underpinned caregivers' experiences, especially in employment and romantic relationships. In addition, participants adopted different strategies (disregarding, concealment, education, faith-based trust) to handle courtesy stigma. The findings demonstrate that psychosocial support and financial assistance to caregivers are necessary considerations for attainment of effective care for people affected by leprosy.
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Affiliation(s)
- Mavis Dako-Gyeke
- Department of Social Work, School of Social Sciences, University of Ghana, Legon, Accra, Ghana.
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