Challenging mental illness stigma in healthcare professionals and students: a systematic review and network meta-analysis

The Effectiveness of Interventions on Improving the Mental Health Literacy of Health Care Professionals in General Hospitals: A Systematic Review of Randomized Controlled Trials

BACKGROUND

Suboptimal mental health literacy levels among general hospital health care professionals negatively impact the care coordination of patients with physical-mental comorbidity.

AIMS

This review is to examine the evidence on the effectiveness of interventions to improve the mental health literacy of general hospital health care professionals.

METHODS

A systematic search of literature was conducted in 13 electronic databases with manual searching of reference lists from 1980 to 2021. Studies were screened by pre-set eligibility criteria, that is, participants who were general hospital health care professionals taking care of adult patients, the interventions aimed at improving any components of participants' mental health literacy, comparisons were alternative active intervention or no intervention, and the primary outcomes were any aspects of mental health literacy.

RESULTS

Eight randomized controlled trials (N = 1,732 participants) were included in this review. Evidence indicated that mental health literacy interventions with educational components can improve components of the health care professionals' mental health literacy, in terms of mental health knowledge and mental illness-related attitudes/stigma. In addition, few studies evaluated all components of participants' mental health literacy.

CONCLUSIONS

Based on the available evidence, educational interventions had a positive effect on components of general hospital health care professionals' mental health literacy. Health care organizations should provide educational programs to enhance general hospital health care professionals' mental health literacy. Further studies are needed to explore interventions that target all components of general hospital staff's mental health literacy and to evaluate its impact on the psychiatric consultation-liaison service utilization in general hospitals, as well as patient outcomes.

The moderating role of stigma in the relationship between depression and resilience: results of a cross-sectional study in university students

Background/objective

Depression is a growing concern in university students and resilience has shown to play a protective role. The impact of stigma is still under-explored, with reference to its moderating role between depression and resilience. The present study investigate such a relationship among Italian university students.

Methods

A cross-sectional design was applied in a simple of 1,912 students to examine the interrelationships between depression (Patient Health Questionnaire-9), resilience (Nicholson McBride Resilience questionnaire), and stigma (Stigma-9). Correlation, predictor, and moderation analyses were applied in RStudio.

Results

A negative correlation was found between depressive symptoms and resilience (r = -0.455, p < 0.001). A positive correlation was found between depressive symptoms and stigma (r = 0.207, p < 0.001). Lower levels of resilience and higher levels of stigma were significant predictors of depressive symptoms [F(df, n) = 190.8(3, 1884), p < 0.001, R2 = 0.236]. The moderation analysis showed a weakening of resilience protective effect against depression as stigma levels increase [F(df,n) = 186.7(3,1908), p < 0.001, R2 = 0.226].

Conclusion

Stigma influences the relationship between depression and resilience. Anti-stigma interventions and programs empowering resilience, should be implemented in university settings to protect students from depression.

Effectiveness of educational interventions in reducing the stigma of healthcare professionals and healthcare students towards mental illness: A systematic review and meta-analysis

AIM

To examine the effectiveness of educational interventions in reducing stigma among healthcare professionals and students towards people with mental illness.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster RCTs.

DATA SOURCES

Articles published from database inception to October 2023 were systematically searched from seven databases (CINAHL, Embase, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Random-effect meta-analyses were conducted. Heterogeneity was evaluated using the I2 statistics and Cochran's Q chi-squared test. A quality appraisal conducted at the study level used the Cochrane risk of bias tool and an outcome-level quality assessment utilized the Grades of Recommendation, Assessment, Development and Evaluation Approach. Publication bias was assessed using the funnel plot.

RESULTS

Twenty-five articles were included in this review. Meta-analysis reported statistically significant medium and small effect sizes for attitudes towards mental illness and attitudes towards people with mental illness respectively, showing the association between educational interventions and improved attitudes among healthcare professionals and students. However, a statistically non-significant effect was reported for knowledge of mental illness. Subgroup analyses indicated that face-to-face and contact-based interventions were particularly effective at reducing stigma. Notably, single-session interventions were just as effective as multiple sessions, suggesting a potential for resource-efficient approaches.

CONCLUSION

Educational interventions demonstrate promise in fostering more positive attitudes towards mental health issues. Future research should aim to determine the long-term effects of these interventions and include patient feedback on the stigmatizing behaviours of healthcare professionals and students, to holistically evaluate the effect of interventions.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a secondary review and does not require relevant contributions from patients or the public. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Face-to-face contact-based educational sessions have proven to be the most effective. Reinforcing learning may be achieved through a series of repeated single-session interventions.

A video-based intervention to overcome pregnancy smoking stigma among healthcare students: a randomised controlled trial

OBJECTIVES

This study tests a video intervention to reduce pregnancy smoking stigma among French healthcare students.

DESIGN

The participants were randomly selected to watch online either an experimental video (presenting educational content regarding stigma and contact with pregnant smokers) or a control video (presenting standard educational content about the risks of smoking). The students completed scales assessing stigma, intention to address smoking cessation and self-efficacy to do so, before the intervention (T0, n = 252), one week after the intervention (T1, n = 187), and one month after the intervention (T2, n = 131).

RESULTS

Compared to the medical students, especially men, the midwifery students reported lower derogative cognitions (η2p = .18), negative behaviours (η2p = .07) and personal distress (η2p = .06). However, the midwifery students also reported lower levels of intention to address smoking (η2p = .02) than the medical students. The experimental video decreased derogative cognitions to a greater extent than the control video (η2p = .23) in both the short and medium term. This study is the first intervention designed to reduce the stigmatisation of pregnant smokers by healthcare students. We recommend that the issue of stigma should receive more attention in the medical curriculum.

The stigma of smoking among women: A systematic review

BACKGROUND

Smoking stigma has been well documented, but little is known regarding its specific features and effects on women. Notably, women face unique social, cultural, and economic challenges that may interact with smoking stigma and impact health outcomes. This review investigates the extent to which smoking women encounter and internalise stigma, while examining the various coping mechanisms they employ to manage these negative experiences.

METHODS

In November 2022, major databases were systematically searched with no time restrictions. After applying inclusion and exclusion criteria, 23 studies (three quantitative and 20 qualitative) met our criteria. We conducted a quality assessment and summarised the findings pertaining to public stigma, self-stigma, and coping strategies.

RESULTS

The stigma about smoking emerges from a variety of sources, such as family, healthcare providers, or internet forums. Women smokers are universally aware of the negative image they have in society. Yet, their experiences and management of the stigma of smoking are shaped by other variables such as cultural background, social class, or motherhood status. Smoking stigma produces ambivalent effects, such as concealment, reduced usage of support services, and to a lesser extent, smoking cessation motivation.

CONCLUSIONS

These results indicate that smoking stigma is an important social justice and public health issue and that further research is needed to better prevent its effects on women's well-being and health behaviours.

Healthcare professionals' knowledge, confidence and attitudes in relation to psychosis care: A systematic review

BACKGROUND

Psychosis is a mental disorder that, despite its low prevalence, causes high disease and economic burden. Inadequate knowledge, lack of confidence and stigmatising attitudes of healthcare professionals (HCPs) may lead to suboptimal care.

AIM

To review the literature exploring HCPs' knowledge, confidence and attitudes in relation to psychosis care.

METHOD

A systematic search was undertaken across three databases (MEDLINE, Embase, PsycINFO) using a search strategy encompassing the concepts: 'healthcare professionals', 'knowledge, attitude, and confidence in care' and 'psychotic illnesses and symptoms' to identify relevant records published from 1st January 2002 to 18th March 2022. Results were screened against predetermined inclusion and exclusion criteria by title and abstract, followed by full text. Data were extracted into tables and synthesised narratively.

RESULTS

Initially, 7,397 studies were identified. Following two-stage screening, 24 studies were eligible for inclusion. Of these studies, 16 explored attitudes, four explored knowledge and attitudes, one explored knowledge, one explored confidence, one explored attitudes and confidence in care and one explored all three constructs. Most HCPs in the included studies demonstrated stigmatising attitudes towards people with psychosis. Furthermore, certain HCPs, including nurses and general practitioners, demonstrated low levels of knowledge, while psychiatrists, occupational therapists, psychologists and nurses had low levels of confidence in caring for people with psychosis. Conversely, positive attitudes were also observed in some HCPs resulting from having acquaintances with lived experience of psychosis. The need for additional education and training to improve HCPs' knowledge and confidence in relation to caring for people living with psychosis was identified.

CONCLUSIONS

Most attitudes identified were negative and stemmed from stigma, while some were positive due to HCPs' compassion and familiarity with psychosis. The level of knowledge and confidence identified were mostly suboptimal, and so further research is required to develop and evaluate tailored interventions to address this gap.

Stigma Toward Substance Dependence: Causes, Consequences, and Potential Interventions

Substance dependence is a prevalent and urgent public health problem. In 2021, 60 million Americans reported abusing alcohol within the month prior to being surveyed, and nearly 20 million Americans reported using illegal drugs (e.g., heroin) or prescription drugs (e.g., opioids) for nonmedical reasons in the year before. Drug-involved overdose rates have been steadily increasing over the past 20 years. This increase has been primarily driven by opioid and stimulant use. Despite its prevalence, drug dependence is one of the most stigmatized health conditions. Stigma has myriad negative consequences for its targets, including limiting their access to employment and housing, disrupting interpersonal relationships, harming physical and mental health, and reducing help-seeking. However, because research on stigma toward people with substance use disorders (SUDs) is relatively sparse compared with research on stigma toward other mental illnesses, the field lacks a comprehensive understanding of the causes and consequences of SUD stigma. Moreover, it remains unclear how, if at all, these factors differ from other types of mental illness stigma. The goal of this review is to take stock of the literature on SUD stigma, providing a clear set of foundational principles and a blueprint for future research and translational activity.

Effectiveness of an intervention to reduce stigma towards people with a mental disorder diagnosis in university students of healthcare careers

Students in healthcare careers present stigma towards people with psychiatric diagnoses, so the development of interventions to reduce it is essential. This study aimed to evaluate the effectiveness of an intervention to reduce stigma towards people diagnosed with mental disorders in healthcare students in Chile. A randomized clinical trial with a before and after measurement was carried out. The intervention was part of a compulsory course and combined educational and contact strategies. A total of 244 fourth-semester students of medicine, nursing, dentistry, obstetrics, psychology, and social work participated. The intervention was effective in reducing stigmatizing attitudes and the desire for social distance. For almost all variables, the magnitude of the stigma reduction depended on the initial level of stigma, not on the profession. The intervention had positive effects on all careers. In conclusion, incorporating a stigma reduction intervention into mandatory professional training, with the active participation of the teacher in charge and experts by experience, can be a valuable tool to promote humanized and non-stigmatizing treatment.

"Let me tell you what I think about online psychological help." A thematic analysis of voluntary opinions collected at the onset of the COVID-19 pandemic

Introduction

The COVID-19 pandemic shifted many aspects of life from face-to-face to an online form, including psychological help. Many people had to face the choice of adjourning contact with a psychologist or shifting it to the Internet. This study aimed to develop an understanding of attitudes and opinions toward relatively new phenomenon in Poland - online psychological help.

Method

Seventy two (N=72) statements about relationship between COVID-19 pandemic and online psychological help from (potential) patients were included in this research. The statements were collected from a community sample via open-ended question for volunteers added to an online survey conducted regarding an existing project. The statements were exclusively written responses to the following question: If you want to provide us with something about the relationships between the COVID-19 pandemic and online help/psychotherapy, please let us know below. By reason of exploratory character of our study and general phenomenological philosophical approach and constructionist approach, a thematic analysis method was used to analyze the data.

Results

The analysis led us to identify three general themes with sub-themes that refer to meaningful aspects of online psychological help: 1. Online psychological help situates in the shadow of face-to-face help, 1.1. It frustrates the needs, especially the need for psychological contact, 1.2. It contributes to negative emotions, 1.3. It is sometimes better than the face-to-face help; 2. Online psychological help is a solution during the COVID-19 pandemic, 2.1. It provides a sense of continuity during lockdown, 2.2. It is a means to adapt to exceptional circumstances, 3. The concerns about the credibility and effectiveness of online psychological help.

Discussion

The results show (potential) patients' attitudes (including emotions, thoughts, and concerns) toward online psychological help. The perspective presented here could be beneficial to professionals. A better understanding of client/patient attitudes will allow for more accurate customization of the online help and sensitize psychologists to the emotions that may occur about online psychological help. It could also be beneficial for patients to understand how other people would feel about online psychological help and develop ones' own self-awareness of the attitudes toward online psychological help.

Network meta-analysis in psychology and educational sciences: A systematic review of their characteristics

Network meta-analysis (NMA) allows the combination of evidence on the effectiveness of several interventions. NMA has mainly been applied in the medical science field, whereas in the domain of psychology and educational sciences its use is less frequent. Consequently, systematic reviews that describe the characteristics of published NMAs are limited to the field of medicine, and nothing is known about the characteristics of NMAs published in the psychology and educational sciences field. However, this information is still relevant for the design of future simulation studies and for detecting good and bad research practices. Thus, this study describes the features of the meta-analytic datasets of NMAs published in the field of psychology and educational sciences, as well as their methodological characteristics, and compares them to those observed in the medical domain. Results show that the number of studies included is larger in NMAs from psychology and educational sciences, the most commonly used effect size is the standardized mean difference (unlike the odds ratio in medicine), the sample size is smaller, more intervention groups are included, and inconsistent effects are observed more often. These results can be used in future simulation studies to generate realistic datasets. Finally, we warn about the poor quality of reporting of some technical aspects of the NMA, such as the statistical model used.

Effectiveness of Interventions in Reducing Substance-Related Stigma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The purpose of this study was to undertake a quantitative analysis to determine the effectiveness of interventions designed in reducing different types of stigma (self-stigma, social stigma, and structural stigma) for the substance use. This study followed the Cochrane Handbook for Systematic Reviews of Interventions guideline. This study followed the Cochrane Handbook for Systematic Reviews of Interventions guideline. Systematic searches were conducted in PubMed, Science Direct, Web of Science, Scopus, and MEDLINE. These electronic databases were searched research published in English from date of their inception to July 15, 2021. Randomized controlled trials that evaluated interventions on stigma associated with substance use were included. Studies should include at least one stigma outcome involving self-stigma, social stigma, or structural stigmatization. Ten randomized controlled studies were included. The overall Hedges'g for the interventions' impact on reducing stigma was 0.301, 95%CI = [-0.154- 0.755], p = 0.195, that there was no statistically significant difference. However, the meta-analysis showed that interventions had no significant impact on self-stigma [0.682, 95% CI=(-0.015-1.380), p = 0.055] and social stigma [0.198, 95% CI=(-1.271-0.876), p = 0.718] but had a small but significant impact in favor of the experimental group on reducing structural stigma [0.360 (95% CI= 0.156-0.564), p = 0.00]. According to subgroup analyses, there was no difference in the effects of stigma according to the type of intervention, the number of sessions, or the type of group. The interventions for reducing stigma related to substance use are promising. It seems to have a small but significant positive impact on structural stigma.

Teaching psychiatry to medical students in the time of COVID-19: experiences from UK medical schools

AIMS AND METHOD

Education leads for undergraduate psychiatry in UK medical schools completed questionnaires on adaptations made to undergraduate psychiatry education, their impact and what lessons could be learnt for the future.

RESULTS

Respondents from 24 medical schools across the UK reported a major shift to online teaching delivery, with reduced workplace learning and increased use of teleconferencing, online tasks and self-directed learning. Changes were implemented with some faculty training provided, but little additional funding or resources from medical schools or National Health Service trusts. A variety of challenges and opportunities were reported.

CLINICAL IMPLICATIONS

Despite the extraordinary efforts of education leads to maintain undergraduate psychiatry education, the pandemic may affect the development of students' professional competencies and recruitment into psychiatry. Individual clinicians, trusts and medical and foundation schools have much to offer, and need to work with students to replace what has been lost during the pandemic.

Effectiveness of a Co-Production with Dialogue Program for Reducing Stigma against Mental Illness: A Quasi-Experimental Study with a Pre- and Post-Test Design

For people with mental illnesses, stigma represents a barrier to social participation. Health professionals, including students, often hold stigma toward such individuals, Further, people with a mental illness often have self-stigma. This study aimed to both develop and examine the effectiveness of a new program based on co-production with dialogue for reducing stigma among both health science students and people with mental illnesses. This was a quasi-experimental study, with a pre- and post-test design and no control group. The sample comprised 28 university students majoring in occupational therapy and 20 community-dwelling people with mental illnesses. The Co-Production with Dialogue Program for Reducing Stigma (CPD-RS) was administered to this sample. Link's Devaluation Discrimination Scale (DDS) was used to assess whether the program reduced stigma. Compared to their preintervention scores, the students' postintervention DDS scores significantly decreased, persisting for at least one month, but those of people with mental illnesses showed no significant change. Both the students and the people with mental illnesses evaluated the program as "positive" through a questionnaire administered two months after the intervention. These results suggest that the CPD-RS reduces health science students' stigma toward people with mental illnesses and fosters mutual understanding between the two groups.

COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective

The association between coronavirus disease (COVID-19) vaccine acceptance and perceived stigma of having a mental illness is not clear. This study examined the association between COVID-19 vaccine acceptance and perceived stigma among patients with recurrent depressive disorder (depression hereafter) using network analysis. Participants were 1149 depressed patients (842 men, 307 women) who completed survey measures of perceived stigma and COVID-19 vaccine attitudes. T-tests, chi-square tests, and Kruskal-Wallis tests were used to compare differences in demographic and clinical characteristics between depressed patients who indented to accepted vaccines and those who were hesitant. Hierarchical multiple regression analyses assessed the unique association between COVID-19 vaccine acceptance and perceived stigma, independent of depression severity. Network analysis examined item-level relations between COVID-19 vaccine acceptance and perceived stigma after controlling for depressive symptoms. Altogether, 617 depressed patients (53.7%, 95 confidence intervals (CI) %: 50.82-56.58%) reported they would accept future COVID-19 vaccination. Hierarchical multiple regression analyses indicated higher perceived stigma scores predicted lower levels of COVID-19 vaccination acceptance (β = -0.125, P < 0.001), even after controlling for depression severity. In the network model of COVID-19 vaccination acceptance and perceived stigma nodes, "Feel others avoid me because of my illness", "Feel useless", and "Feel less competent than I did before" were the most influential symptoms. Furthermore, "COVID-19 vaccination acceptance" had the strongest connections with illness stigma items reflecting social rejection or social isolation concerns ("Employers/co-workers have discriminated", "Treated with less respect than usual", "Sense of being unequal in my relationships with others"). Given that a substantial proportion of depressed patients reported hesitancy with accepting COVID-19 vaccines and experiences of mental illness stigma related to social rejection and social isolation, providers working with this group should provide interventions to reduce stigma concerns toward addressing reluctance in receiving COVID-19 vaccines.

Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings

WHAT IS KNOWN ON THE SUBJECT?: Individuals with a severe mental illness (SMI) are less physically active and have a lower life expectancy than the general population due to increased risks of cardiometabolic diseases (obesity, diabetes and respiratory diseases) and other health risks. Physical activity has been used as an adjunct therapy for individuals with SMI yielding improvements in cognitive functioning, quality of life and a reduction in psychiatric symptoms. Individuals with SMI residing within a secure forensic setting have reduced physical activity opportunities, possibly due to a number of factors including low motivation and restricted access to exercise facilities combined with a lack of knowledge and/or confidence in staff members to assist in physical activity programmes. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review demonstrates that little is known around the effects of physical activity for people with SMI who reside in secure forensic settings, with little to no long-term effects reported. Physical activity interventions have shown some positive results through decreasing weight and waist circumference as well as a reduction in negative symptom scores in an exercise group compared with the "no treatment" control group post-intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Service users' reluctance to engage in physical activity may be overcome by improving staff commitment, creating a motivational atmosphere and promoting service user decision making.

ABSTRACT

INTRODUCTION: Participating in physical activity has many benefits, yet those with severe mental illness (SMI) living in forensic settings are less likely to be active, and more likely to experience ill-health. The aim of this study was to systematically review the effectiveness of physical activity programmes on mental and physical health and specifically on reducing symptoms of SMI in forensic settings.

METHOD

A systematic search of six databases was conducted, in addition to a grey literature search. Studies were included if they had participants with SMI; were based in a forensic setting; involved a physical activity programme and reported physical and mental health outcomes.

RESULTS

A total of 112 participants were included in four studies. One study showed a significant improvement in negative symptom scores in the exercise group compared with a treatment as usual group. Two studies reported improvements in psychiatric symptoms with no significant difference between groups; however, statistically significant changes in weight and waist circumference were evident (p < .001). No adverse effects were reported.

CONCLUSION

Only a small number of studies were included and of limited design and quality, with no follow-up assessments; therefore, more research is needed to determine the true effects of physical activity for improving SMI symptoms in a forensic setting. This review highlights the need for further studies exploring the barriers and facilitators of physical activity in secure forensic settings. Studies are required that include a more thorough research design. Furthermore, interventions if designed with patients and caring staff in mind may lead to lowered psychiatric symptoms and increased physical health benefits for all in forensic settings.

Sağlık Öğrencileri İçin Ruh Sağlığı Okuryazarlık Ölçeğinin Türkçeye Uyarlanması: Geçerlik ve Güvenirlik Çalışması

Amaç: Bu çalışmada, Sağlık Öğrencileri için Ruh Sağlığı Okuryazarlık Ölçeğinin (RSOÖ-SÖ) Türkçe uyarlaması için geçerlilik ve güvenilirlik yapılması amaçlanmıştır. Method: Çalışma örneklemi 18-27 yaş arasında İstanbul Tıp Fakültesinde öğrenim gören 275 kişiden oluşmaktadır. RSOÖ-SÖ ölçeği, Ruhsal Hastalıklara Yönelik İnanç Ölçeği (RHYİÖ) ve Pozitif Mental Sağlık Ölçeğini (PMSÖ) veri toplamada kullanılmıştır. Dil uyarlaması için çeviri, geri çeviri, uzman görüşleri ve pilot uygulama yapılmıştır. Geçerlik için kapsam geçerlilik indeksi, doğrulayıcı faktör analizi ve güvenilirliği test etmek için Cronbach alfa analizi, test-tekrar test yöntemi kullanılmıştır. Bulgular: Ölçeğin kapsam geçerlilik indeksi 0.99 ve doğrulayıcı faktör analizine göre madde yükleri 0.38-0.94 olduğu bulunmuştur. Cronbach alfa katsayısı tüm ölçek için 0.79, beş alt boyutu için ise 0.60-0.89 arasında olduğu belirlenmiştir. Eşdeğer ölçüt geçerliliğinde RHYİÖ ile negatif yönlü zayıf korelasyon (r=-0.391, p

Continuum beliefs and the perception of similarities and differences to a person with depression

OBJECTIVE

Both continuum beliefs (i.e., that mental disorder exists on a spectrum of normative behavior patterns) and the perception of similarities to a person with schizophrenia have shown mixed effects on reducing mental illness stigma. To our knowledge, this is the first study to address continuum beliefs and the perception of similarities to a person with depression in the context of depression-related stigma.

METHODS

This work is based on an online intervention study in an ethnically diverse sample recruited on Amazon MTurk including previously unanalyzed qualitive responses. Within this cross-sectional, mixed-methods online investigation (N = 304), we examined the relation of perceived similarities to continuum beliefs, social distance, and negative stereotypes in relation to a vignette about depression. A randomly assigned continuum beliefs intervention attempted to induce continuum beliefs about depression. An open-writing task asked participants to describe similarities and/or differences between themselves and the person depicted in the vignette.

RESULTS

The continuum beliefs intervention was associated to a greater number of perceived similarities to and fewer perceived differences from the target vignette. Moreover, perceived similarities were associated with increased continuum beliefs, less social distance, and less-negative stereotypes. Perceived differences from a person with depression were associated with increased social distance.

LIMITATIONS

Even though the continuum beliefs intervention did not significantly alter stigma measures directly, expressed continuum beliefs were associated to decreased mental illness stigma.

CONCLUSIONS

The findings emphasize that perceived similarities to an outgroup member (i.e., a person with depression) might augment the stigma-reducing mechanism of continuum beliefs.

Estigma hacia personas con enfermedad mental en estudiantes y profesores de terapia ocupacional,

Resumen Introducción Las personas con enfermedad mental experimentan actitudes estigmatizadoras desde la población general, incluyendo profesionales y estudiantes de la salud. Estudios internacionales han estimado el estigma en estudiantes de terapia ocupacional hacia personas con enfermedad mental como moderado. Objetivo Describir el estigma hacia personas con enfermedad mental en estudiantes y profesores de terapia ocupacional en una universidad chilena. Método Estudio descriptivo transversal con docentes y estudiantes en 1er y 4° año de terapia ocupacional en una universidad en Santiago de Chile, año 2020. Se aplicó formato online de cuestionario Opening Minds Stigma Scale for Health Care Providers (OMS-HC), versión adaptada a Chile, y formulario de datos sociodemográficos. Se calculó puntajes promedio para cuestionario de 20 ítems y ajustado a tres dimensiones con 15 ítems. Se usó pruebas de UMann-Whitney y t student para diferencias entre grupos. Los datos sociodemográficos fueron analizados mediante estadística descriptiva. Resultados Muestra de 87 personas, edad promedio 27 años (18-58), 81 (93%) mujeres, 41 (47%) estudiantes de 4to año, 28 (24%) estudiantes de 1er año, y 22 (25%) docentes. Puntaje promedio OMS-HC para muestra total fue 42,2 puntos (28-57), indicando nivel moderado-bajo de actitudes estigmatizadoras. Estudiantes de 1er año obtuvieron mayores puntajes, pero diferencias no fueron significativas. Conclusión Los resultados son consistentes con literatura previa refiriendo nivel moderado-bajo de actitudes estigmatizadoras hacia personas con enfermedades mentales. Las diferencias incipientes entre estudiantes de 1er y 4to año hacen pertinentes nuevos estudios con mayor tamaño muestral y en otros contextos.

The impact of lockdown stress and loneliness during the COVID-19 pandemic on mental health among university students in Germany

The COVID-19 pandemic led to a shutdown of universities in Germany. In a longitudinal design, we compared mental health (depression, anxiety, somatic complaints) of university students in Germany before (June to August 2019) and in the course of the COVID-19 pandemic (June 2020) and determined the impact of pandemic-related stress and loneliness on students' mental health in self-report online surveys. We investigated 443 participants (mean age 22.8 years), among them 77% female, and 10.4% medical students. A small increase of depression mean scores was observed (F(1,420) = 5.21; p = .023), anxiety and somatic complaints have not significantly changed. There was a medium increase in loneliness from pre-pandemic scores to the pandemic situation (F(1,423) = 30.56; p < .001). Analyzed with regression analyses, current loneliness and pre-pandemic distress represented the strongest associations with mental health during the pandemic. Additionally, health-related concerns during the pandemic were associated with symptoms of depression [b = 0.21; 95%CI(0.08; 0.34); t = 3.12; p = .002], anxiety [b = 0.07; 95%CI(0.01; 0.12); t = 2.50; p = .013], somatic complaints [b = 0.33; 95%CI(0.18; 0.47); t = 4.49; p < .001], and loneliness [b = 0.10; 95%CI(0.03; 0.17); t = 2.74; p = .006]. Social stress due to the pandemic situation was associated with loneliness [b = 0.38; 95%CI(0.32; 0.45); t = 11.75; p < .001]. The results imply that university students represent a risk group for psychosocial long-term ramifications of the pandemic.

Effects of Renaming Schizophrenia on Destigmatization among Medical Students in One Taiwan University

The stigma associated with serious mental illnesses causes a huge burden on patients, their families, and society. In October 2012, in Taiwan, schizophrenia was renamed to reduce the stigma associated with this disease. The aim of this study was to compare the differences of public stigma, self-stigma, and social distance associated with schizophrenia between old and new name of schizophrenia in medical students. A cross-sectional survey was administered to 180 medical students of Taipei Medical University from October 2014 to February 2015. In total, 123 complete questionnaires were included in this study. Participants completed the modified attribution questionnaire, the perceived psychiatric stigma scale, and modified social distance scale to assess public stigma, self-stigma, and social distance, respectively. We also collected basic demographic data and previous experience of contact with people with mental illness. In total, 52 and 71 of the first- and fourth-year medical students, respectively, participated in the study. Among them, there were 51 females and 72 males. A significant difference in age was observed between the first- and fourth-year groups (20.2 ± 1.7 years vs. 22.7 ± 0.9 years, p < 0.001). After renaming schizophrenia, we noted significant differences in the scores in the modified attribution questionnaire, the perceived psychiatric stigma scale, and the modified social distance scale in all participants and the fourth-year students, respectively. Female gender (Beta = 0.230, p = 0.018) was significantly associated with the difference in the score of the modified attribution questionnaire after name change. The difference in the score of the perceived psychiatric stigma scale after the name change (Beta = 0.277, p = 0.004) and age (Beta = −0.186, p = 0.049) were significantly associated with the difference in the score of the modified social distance scale after name change. In conclusion, renaming was associated with the changes in the scores of the modified attribution questionnaire, the perceived psychiatric stigma scale, and the modified social distance scale toward individuals with schizophrenia in medical students of one Taiwan university. Further studies with large sample sizes, diverse participant backgrounds, and that monitor the subsequent behavioral changes are warranted.

Efficacy of an Intervention to Reduce Stigma Beliefs and Attitudes among Primary Care and Mental Health Professionals: Two Cluster Randomised-Controlled Trials

Although it may seem paradoxical, primary care and mental health professionals develop prejudices and discriminatory attitudes towards people with mental health problems in a very similar way to the rest of the population. The main objective of this project was to design, implement and evaluate two awareness-raising interventions respectively tailored to reduce stigmatising beliefs and attitudes towards persons with a mental health diagnosis among primary care (PC) and mental health (MH) professionals. These interventions were developed by Obertament, the Catalan alliance against stigma and discrimination in mental health. Activists from this organisation with lived experience of mental health diagnosis carried out awareness-raising interventions in PC and MH health centres. The Targeted, Local, Credible, Continuous Contact (TLC3) methodology was adapted to the Catalan healthcare context. The efficacy of these interventions was evaluated using two prospective double-blind cluster-randomised-controlled trials. Stigmatizing beliefs and behaviours were measured with the Opening Minds Stigma Scale for Health Care Providers in PC centres and with the Beliefs and Attitudes towards Mental Health Service users’ rights in MH centres. Reductions in both PC and MH professionals’ stigmatising beliefs and attitudes were found in the 1-month follow-up, although a ‘rebound effect’ at the 3-month follow up was detected. This emphasizes the importance of the continuity of the presence of anti-stigma activities and messages. Attrition rates were high, which can hamper the reliability of the results. Further follow-up studies should enquiry effects of long-term interventions aimed at reducing stigmatising beliefs and attitudes among primary care and mental health professionals using assessment systems that include the measurement of knowledge acquired and actual behavioural change.