Combating the stigma of schizophrenia

Data-mining analysis of media frame effects on social perception of schizophrenia renaming in Korea

BACKGROUND

In 2011, Korean Neuropsychiatric Association renamed schizophrenia from 'mind split disorder' ('Jungshinbunyeolbyung' in Korean) to 'attunement disorder' ('Johyeonbyung' in Korean), in a strategic way to reduce social stigma toward people with schizophrenia. However, there remains an elusive consensus that how the renaming effort has contributed to changes in the social perception of schizophrenia in Korea.

METHODS

With this regard, we explored whether media frames alter the social perception, in ways of respecting or disrespecting schizophrenia patients before and after the renaming. This study extensively investigated media keywords related to schizophrenia across the time by applying both language and epidemiologic analyses.

RESULTS

In results, the media keywords have been negatively described for schizophrenia patients both before and after the renaming. Further, from an analysis using the regression model, a significant correlation was observed between the frequency of negative keywords and the hospitalization frequency of schizophrenia patients.

CONCLUSIONS

These findings suggest that the social perception of schizophrenia has been scarcely changed, but rather remained negatively biased against schizophrenia patients, in spite of the renaming effort. Notably, the biased media frames have been demonstrated to negatively impact on the social perception, and even on the medical use patterns of general schizophrenia patients. In conclusion, we suggest that the unbiased media frames along with the renaming effort may collectively help reduce the negative social perception of schizophrenia.

TRIAL REGISTRATION

This study was approved from the Institute of Review Board (IRB) of the Yoing-In Mental Hospital (IRB No. YIMH-IRB-2019-02).

Mass media interventions for reducing mental health-related stigma

BACKGROUND

Mental health-related stigma is widespread and has major adverse effects on the lives of people with mental health problems. Its two major components are discrimination (being treated unfairly) and prejudice (stigmatising attitudes). Anti-stigma initiatives often include mass media interventions, and such interventions can be expensive. It is important to know if mass media interventions are effective.

OBJECTIVES

To assess the effects of mass media interventions on reducing stigma (discrimination and prejudice) related to mental ill health compared to inactive controls, and to make comparisons of effectiveness based on the nature of the intervention (e.g. number of mass media components), the content of the intervention (e.g. type of primary message), and the type of media (e.g. print, internet).

SEARCH METHODS

We searched eleven databases: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 7, 2011); MEDLINE (OvidSP),1966 to 15 August 2011; EMBASE (OvidSP),1947 to 15 August 2011; PsycINFO (OvidSP), 1806 to 15 August 2011; CINAHL (EBSCOhost) 1981 to 16 August 2011; ERIC (CSA), 1966 to 16 August 2011; Social Science Citation Index (ISI), 1956 to 16 August 2011; OpenSIGLE (http://www.opengrey.eu/), 1980 to 18 August 2012; Worldcat Dissertations and Theses (OCLC), 1978 to 18 August 2011; metaRegister of Controlled Trials (http://www.controlled-trials.com/mrct/mrct_about.asp), 1973 to 18 August 2011; and Ichushi (OCLC), 1903 to 11 November 2011. We checked references from articles and reviews, and citations from included studies. We also searched conference abstracts and websites, and contacted researchers.

SELECTION CRITERIA

Randomised controlled trials (RCTs), cluster RCTs or interrupted time series studies of mass media interventions compared to inactive controls in members of the general public or any of its constituent groups (excluding studies in which all participants were people with mental health problems), with mental health as a subject of the intervention and discrimination or prejudice outcome measures.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed the risk of bias of included studies. We contacted study authors for missing information. Information about adverse effects was collected from study reports. Primary outcomes were discrimination and prejudice, and secondary outcomes were knowledge, cost, reach, recall, and awareness of interventions, duration/sustainability of media effects, audience reactions to media content, and unforeseen adverse effects. We calculated standardised mean differences and odds ratios. We conducted a primarily narrative synthesis due to the heterogeneity of included studies. Subgroup analyses were undertaken to examine the effects of the nature, content and type of mass media intervention.

MAIN RESULTS

We included 22 studies involving 4490 participants. All were randomised trials (3 were cluster RCTs), and 19 of the 22 studies had analysable outcome data. Seventeen of the studies had student populations. Most of the studies were at unclear or high risk of bias for all forms of bias except detection bias.Findings from the five trials with discrimination outcomes (n = 1196) were mixed, with effects showing a reduction, increase or consistent with no evidence of effect. The median standardised mean difference (SMD) for the three trials (n = 394) with continuous outcomes was -0.25, with SMDs ranging from -0.85 (95% confidence interval (CI) -1.39 to -0.31) to -0.17 (95% CI -0.53 to 0.20). Odds ratios (OR) for the two studies (n = 802) with dichotomous discrimination outcomes showed no evidence of effect: results were 1.30 (95% CI 0.53 to 3.19) and 1.19 (95% CI 0.85 to 1.65).The 19 trials (n = 3176) with prejudice outcomes had median SMDs favouring the intervention, at the three following time periods: -0.38 (immediate), -0.38 (1 week to 2 months) and -0.49 (6 to 9 months). SMDs for prejudice outcomes across all studies ranged from -2.94 (95% CI -3.52 to -2.37) to 2.40 (95% CI 0.62 to 4.18). The median SMDs indicate that mass media interventions may have a small to medium effect in decreasing prejudice, and are equivalent to reducing the level of prejudice from that associated with schizophrenia to that associated with major depression.The studies were very heterogeneous, statistically, in their populations, interventions and outcomes, and only two meta-analyses within two subgroups were warranted. Data on secondary outcomes were sparse. Cost data were provided on request for three studies (n = 416), were highly variable, and did not address cost-effectiveness. Two studies (n = 455) contained statements about adverse effects and neither reported finding any.

AUTHORS' CONCLUSIONS

Mass media interventions may reduce prejudice, but there is insufficient evidence to determine their effects on discrimination. Very little is known about costs, adverse effects or other outcomes. Our review found few studies in middle- and low-income countries, or with employers or health professionals as the target group, and none targeted at children or adolescents. The findings are limited by the quality of the evidence, which was low for the primary outcomes for discrimination and prejudice, low for adverse effects and very low for costs. More research is required to establish the effects of mass media interventions on discrimination, to better understand which types of mass media intervention work best, to provide evidence about cost-effectiveness, and to fill evidence gaps about types of mass media not covered in this review. Such research should use robust methods, report data more consistently with reporting guidelines and be less reliant on student populations.

Use of the terms "schizophrenia" and "schizophrenic" in the South Korean news media: a content analysis of newspapers and news programs in the last 10 years

OBJECTIVE

In this study, we explored the meaning attributed to the words "jungshinbunyeolbyung" (schizophrenia) and "jungshinbunyeol" (schizophrenic) in South Korean newspapers and news programs in the last 10 years.

METHODS

We screened the websites of three national newspapers and the broadcasts of three nationwide television news programs from January 1, 2001, to December 31, 2010. We classified a total of 490 articles and 257 news segments by category and quantitatively and qualitatively analyzed them. The articles and news segments were assigned to one of the following categories based on their use of the term "schizophrenia": 1) negative, 2) neutral or positive, 3) incidental, and 4) metaphorical.

RESULTS

The negative viewpoint accounted for 349 incidences (46.7%), while the neutral and positive viewpoints included 225 incidences (30.1%). Incidental uses accounted for 95 incidences (12.7%), and metaphorical uses accounted for 78 incidences (10.4%). The majority of the negative uses focused on violence or dangers posed by patients (137 mentions, 37.8%), while the metaphorical uses mainly focused on the idea of splitting (51 mentions, or 65%).

CONCLUSION

This study showed that the South Korean news media do not provide balanced information about schizophrenia to the public. This study also showed that no significant move has been made toward a more positive use of the term since a previous study was conducted on the subject. Although the term schizophrenia has given way to "attunement disorder," it will be difficult to establish the new term as the standard if the South Korean media continue to use the term "schizophrenic symptom." Even though the term has been changed, guidelines are necessary to encourage the mass media to provide balanced articles and reduce prejudice.

Community attitudes towards mental illness and socio-demographic characteristics: an Italian study

Aim — To assess the association between socio-demographic characteristics and community attitudes towards mentally ill people. Method — We assessed a sample of 280 subjects, stratified for sex and age, which has identified using the electoral registers of Brescia. A letter was sent to everyone in order to introduce the future potential study participant to the topics of the public attitudes towards mental illness and it included an invitation to take part in the study. After, 280 subjects were contacted by telephone. Finally, 174 persons, who expressed their willingness to collaborate, were visited by a team of four trained interviewers. The instruments used were: a semi-structured interview; the Community Attitudes to the Mentally III (CAMI) inven-tory, which is composed by 40 statements, concerning the degree of acceptance of mental health services and mentally ill patients in the community; and the Fear and Behavioural Intentions (FABI) inventory, which is composed by 10 items, concerning fears and behavioural intentions towards mentally ill people. 106 subjects refused to participate. Results — Factor analysis of the CAMI revealed three components Physical distance and fear, Social isolation and Social responsibility and tolerance. Factor 1 is associated with: people >61 years old; people being divorced/widowed/living separated; people who haven't participated in social or volunteer activities. Factor 2 is associated with: people > 41 years old; people being schooled at a level that's higher than elementary level; unemployed people. Factor 3 doesn't present any associations. Conclusions — The results of this study outline the need to: a) promote interventions focused to improve the general attitude towards people with mental illness; b) to favour specific actions in order to prevent or eliminate prejudices in subgroups of the population.

Declaration of Interest: in the last two years the authors have been paid by the IRCCS Centra San Giovanni di Dio Fatebenefratelli in Brescia (Italy), as employees and free professionals.

Metaphoric and non-metaphoric use of the term "schizophrenia" in Italian newspapers

PURPOSE

This study examines how the term "schizophrenia" is used in Italian newspapers.

METHODS

The survey was carried out on the 22 Italian newspapers which allow word scanning on their online website. In each newspaper, the terms "schizophrenia" and "schizophrenic" were scanned in all articles, from January 1, 2008 to December 31, 2008. Each article containing these terms was analyzed in relation to metaphorical usage to describe or denigrate people or groups not diagnosed "schizophrenic" and in relation to non-metaphoric, direct descriptions of people using mental health services, or the illness itself.

RESULTS

"Schizophrenia/schizophrenic" was reported in 1,087 articles. It was used far more frequently as a metaphor (73.7%) than in reference to people actually given the diagnosis (19.2%) or to the disorder itself (7.1%). The 801 metaphoric uses were classified into the following categories: incoherence/contradiction/split (682, 85.1%), dangerousness/aggressiveness (34, 4.4%), and eccentricity/oddness (84, 10.5%). 117 out of 209 (55.9%) articles on people diagnosed with the disorder were in news section of which 57 (48.7%) referred to homicides, 17 (14.5%) to other assaults by the person, and 33 (28.2%) to assaults directed at the person.

CONCLUSIONS

These data confirm previous studies showing that the media disproportionately report negative stories about people diagnosed with "schizophrenia", and in particular, equate the diagnosis with violence. The study also demonstrates that the metaphorical use of the term to denigrate groups or individuals may be an equal or greater contributor to the stigma and prejudice experienced by people with this mental disorder.

Physical proximity in anticipation of meeting someone with schizophrenia: the role of explicit evaluations, implicit evaluations and cortisol levels

It has been suggested that the study of the stigma of mental illness should include more behavioral measures and further investigation of the possible importance of implicit evaluations in predicting responses to those with such illness. In the current paper, we report a study testing the relationship of implicit and explicit evaluations to physical proximity and cortisol levels in anticipation of meeting someone with schizophrenia. The results showed that both explicit evaluations and cortisol levels independently predicted physical proximity. Implicit evaluations were not related to either physical proximity or cortisol levels. The findings suggest that there are aspects of emotional response to those with mental illness that are not reflected in explicit measures of evaluation and that these, as well as explicit responses, can contribute to the prediction of behavior.

The role of perceived norms in the stigmatization of mental illness

BACKGROUND

Past research on stigmatization of the mentally ill has emphasized the importance of beliefs about mental illness in determining preferred social distance to those with such illnesses. In the current paper we examine the importance of perceived social norms in improving the prediction of social distance preferences.

METHODS

Two hundred university students completed scales measuring their beliefs about either depression or schizophrenia; their perception of relevant social norms and their preferred level of social distance to someone with schizophrenia or depression. Measures of social desirability bias were also completed.

RESULTS

The proportion of variance in preferred social distance was approximately doubled when perceived norms were added to beliefs about illness in a regression equation. Perceived norms were the most important predictor of social distance to an individual with either illness. A general preference for social distance towards a control, non-ill person was also an independent predictor of behavioral intentions toward someone with either schizophrenia or depression.

CONCLUSIONS

Perceived social norms are an important contributor to an individual's social distance to those with mental illness. Messages designed to influence perceived social norms may help reduce stigmatization of the mentally ill.

Mass-media, violence and mental illness. Evidence from some Italian newspapers

AIMS

Media reports related to people suffering from mental illness appear to deal prevalently with acts of violence and crimes. The present study focused on all newspaper reports relating to homicides, suicide, and other acts of violence, in an attempt to ascertain whether a different pattern emerged in some Italian newspapers in describing deeds committed by the mentally ill.

MATERIALS AND METHODS

All articles published over a six-month period in the two main national and two main regional newspapers relating to homicides, suicides, and other acts of violence were selected. A comparison of reports regarding events attributed to mentally ill people was performed according to quantitative parameters.

RESULTS

2279 articles were considered; 54% regarded homicides, 8.2% suicides and attempted suicides, 2.1% homicides/suicides; the remaining 35.8% regarded other acts of violence. A significantly higher number of words, accompanying photos and a more stigmatizing language were used in reporting deeds when attributed to mentally ill people.

CONCLUSION

An excessive emphasis on deeds related to a psychopathological condition still emerged in media reports, almost as though acts of violence committed by the mentally insane should be viewed in a different light. These findings support the hypothesis that media portrayal mirrors the enduring stereotype of "diversity" of the mentally ill.

[A survey on the prejudice and the stereotypes of mental illness in two communities with or without psychiatric Residential Facilities]

AIMS

Description of prejudice and stereotypes of mental illness in two samples with or without psychiatric Residential Facilities in their communities. It has been evaluated if the ongoing naturalistic relationship with the mentally ill was sufficient to modify the stigma of mental illness.

METHODS

The study has been carried out in 7 small towns with Residential Facilities and in 7 small towns without Residential Facilities on a sample of 560 people. Each respondent was asked to fill the Questionnaire on the Opinions about Mental Illness-General Population's version (QO-GP).

RESULTS

Data on 557 respondents (99.5%) were collected. The most frequent opinion in the general sample was to reject the possibility to admit patients to Psychiatric Hospital. The significance (p < .01) between the two samples was found for only 5 items that concern the "treatment-outcome", while no difference was found about the stereotypes of mental illness.

CONCLUSIONS

The results outline that the ongoing naturalistic relationship do not modify the stereotypes of mental illness, but only some aspects of prejudice (care and civil rights). As a consequence we need to plan structured, effective and more specific educational campaigns on mental illnesses.