[Attempts to overcome the stigma of schizophrenia]

The potential of continuum versus biogenetic beliefs in reducing stigmatization against persons with schizophrenia: An experimental study

OBJECTIVE

A central aspect of previous anti-stigma campaigns was the promotion of biogenetic causes of schizophrenia. Although biogenetic beliefs have been shown to reduce the blame given to persons with schizophrenia, they tend to increase discrimination and stereotypes such as dangerousness and unpredictability. A novel anti-stigma approach is to incorporate continuum beliefs in order to oppose the perceived separation, which is a main component of the stigma process. The aim of the study was to compare the effects of a continuum, a biogenetic, and a control intervention on stereotypes, fear, and social distance towards persons with schizophrenia. Furthermore, it was intended to replicate earlier findings on the associations between continuum beliefs, biogenetic beliefs, and different facets of stigmatization.

METHOD

In an online-experiment, 1189 participants from the general population randomly received either a continuum, a biogenetic, or a control intervention, which consisted of written information texts.

RESULTS

The continuum group showed less endorsement of the stereotype incompetence/unpredictability than the biogenetic group. The biogenetic group ascribed less blame to persons with schizophrenia than the other groups. The correlation analyses indicated continuum beliefs to be consistently associated with lower stereotype scores, less fear, and less preferred social distance.

LIMITATIONS

The sample was not fully representative and the experimental manipulations in our study consisted of relatively short information texts.

CONCLUSION

It is concluded that continuum beliefs have the potential to reduce stigmatization against persons with schizophrenia. However, future studies need to investigate the effects of more powerful interventions to promote them.

'Stigma: the cul-de-sac of the double bind' the perspective of Turkiye; a phenomenological study

The aim of this study was to explore and describe the stigmatization experienced by individuals with mental health problems (IMHP) and the relationships between stigmas associated with mental health problems, psychiatric diagnoses, treatments, and social environments and their consequences. Thirty-three IMHP were recruited from outpatient and day clinics at the psychiatry department of a university hospital within a 5-month time period for this qualitative, descriptive study. Data were gathered using a structured interview form with open-ended questions to explore the changes in everyday life experienced by IMHP during the course of their illness. Data were analysed using the Colaizzi method of analysis. Our findings show that almost all IMHP were concerned about being stigmatized by others, society, their family, and health care professionals. Another concern that IMHP reported was self-stigmatization. Stigmatization serves as a barrier to treatment adherence and socialization in IMHP. Furthermore, stigmatization has a significant impact on the lives of IMHP, and methods of coping with stigmatization are commonly ineffective. However, stigmatization can be reduced by dealing with the illness, IMHP, their relatives, and professionals in an unprejudiced manner.

No matter of etiology: biogenetic, psychosocial and vulnerability-stress causal explanations fail to improve attitudes towards schizophrenia

Many anti-stigma campaigns emphasize biogenetic causes to convey that schizophrenia is an "illness like others". A growing body of studies shows that although biogenetic explanations reduce blame, they tend to reinforce prognostic pessimism and harsher treatment of people with schizophrenia. In contrast, psychosocial explanations attenuate prognostic pessimism and perceived otherness, but seem less suitable to reduce blame. We hypothesized that a vulnerability-stress model that combines biogenetic and psychosocial explanations would yield clearer stigma-reducing effects than the mono-causal models. In an online-experiment, 416 participants from the general population randomly received either a vulnerability-stress, biogenetic, psychosocial or control-intervention, which consisted of information text and video presentation of a case-example. Causal beliefs, stereotypes and desired social distance were assessed by self-report. Baseline causal beliefs were weakly associated with stereotypes. The vulnerability-stress intervention did not reduce stigma more effectively than the biogenetic or psychosocial intervention and was less effective in reducing perceived blame than the biogenetic intervention. Compared to the control-intervention, no intervention showed significant stigma-reducing effects, but the psychosocial and vulnerability-stress conditions both increased blame. We found no evidence for vulnerability-stress explanations as a mean to reduce stigma. We propose further research to identify more effective ways to tackle stigma.

[Stigmatization of patients with schizophrenia: the influence of university courses on the attitudes of prospective psychologists and doctors]

BACKGROUND

Some studies revealed that psychiatrists have more negative attitudes than psychologists towards patients with schizophrenia. This raises the question of whether different models of the aetiology of schizophrenia and the amount of personal contact influence the attitudes of mental health professionals.

SAMPLE AND METHODS

Explicit and implicit attitudes towards schizophrenia were assessed in medical and psychology students (n=60 and n=61, respectively) as well as their familiarity with the disorder and their subjective models of its aetiology.

RESULTS

Medical and psychology students showed a substantial level of negative attitudes. Personal contact was negatively associated with stereotypes among medical students and positively associated among psychology students. Positive attitudes were related to biogenetic causal beliefs among medical students and to psychosocial causal beliefs among psychology students.

CONCLUSIONS

The results emphasise the need to adapt antistigma campaigns to target groups. They also indicate the superiority of a multidimensional aetiology over monocausal aetiological models in reducing stigma.

Can antistigma campaigns be improved? A test of the impact of biogenetic vs psychosocial causal explanations on implicit and explicit attitudes to schizophrenia

Antistigma campaigns have been promoting a medical view of schizophrenia. Given the growing body of research finding negative associations between biogenetic (BG) causal attributions and stigmatizing attitudes, this approach must be reappraised. The present study investigates the impact of different psychoeducational interventions on the etiology of schizophrenia (BG and psychosocial [PS], vs a neutral condition) and on stigmatizing attitudes in medical (n = 60) and psychology students (n = 61). Information was presented via information brochures and a video presentation. Attitudes were assessed before and after the interventions on an explicit level using the stereotype questionnaire and the Social Distance Scale as well as on an implicit level, using the Implicit Association Test. Both educational interventions produced a significant decrease in several stereotype components, which was not the case in the neutral condition. The BG intervention decreased the attribution of blame in both groups. It also decreased the stereotype unpredictability/incompetence and social distance in the medical students but increased the negative outlook on prognosis in the psychology students. The PS intervention reduced the widespread stereotype of dangerousness as well as social distance in the group of medical students. While further research into antistigma interventions is necessary, the proposal for antistigma campaigns is to take a multidimensional and balanced approach, which is adapted to target groups and provides additional facts that challenge the myths maintaining stigma.

Effects of school-based interventions on mental health stigmatization: a systematic review

Stigmatizing, or discriminatory, perspectives and behaviour, which target individuals on the basis of their mental health, are observed in even the youngest school children. We conducted a systematic review of the published and unpublished, scientific literature concerning the benefits and harms of school-based interventions, which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization. Forty relevant studies were identified, yet only a qualitative synthesis was deemed appropriate. Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions: poor reporting quality, a dearth of randomized controlled trial evidence, poor methods quality for all research designs, considerable clinical heterogeneity, and inconsistent or null results. Nevertheless, certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development, implementation and evaluation of a curriculum, which fosters the development of empathy and, in turn, an orientation toward social inclusion and inclusiveness. These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct, structured contact with an infant, and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties. The possible value of using educational activities, materials and contents to enhance hypothesized benefits accruing to direct contact also requires investigation. Overall, the curriculum might serve as primary prevention for some students and as secondary prevention for others.