College students’ stigmatization of people with mental illness: familiarity, implicit person theory, and attribution

Impact of a Virtual Reality Intervention on Stigma, Empathy, and Attitudes Toward Patients With Psychotic Disorders Among Mental Health Care Professionals: Randomized Controlled Trial

BACKGROUND

Previous studies have found that psychotic disorders are among the most stigmatized mental disorders. Of note, virtual reality (VR) interventions have been associated with improvements in attitudes and empathy and reduced stigma toward individuals with psychotic disorders, especially among undergraduates, but this has not been examined among mental health care professionals.

OBJECTIVE

We aimed to evaluate the effectiveness of a newly developed VR intervention for mental health care professionals to improve attitudes and empathy and reduce stigma toward people with psychotic disorders.

METHODS

We conducted a randomized controlled trial and recruited eligible mental health care professionals from a tertiary mental health care institution. Both arms (VR intervention and VR control groups) were evaluated at baseline, postintervention, and 1-month follow up. The evaluation included outcomes related to attitudes (modified attitudes toward people with schizophrenia scale), stigma (social distance scale, personal stigma scale), and empathy (empathetic concern subscale of the Interpersonal Reactivity Index). The experience with the VR intervention was assessed using a user satisfaction questionnaire, and qualitative feedback was gathered.

RESULTS

Overall, 180 mental health care professionals participated and completed the study. Both groups showed improvements in attitude, social distance, and stigma scores but not the empathy score following the intervention. The VR intervention group had better user satisfaction than the VR control group. In addition, certain outcome measures were positively associated with specific factors including female gender, higher education level, certain job roles, years of work, and presence of loved ones with a mental disorder.

CONCLUSIONS

Both the intervention and control VR groups of mental health care professionals showed improvements in attitudes, stigma, and social distance toward people with psychotic disorders. Future longitudinal studies may want to evaluate the impact of VR on caregivers and the public on these same and other outcome measures to reduce stigma and improve empathy toward individuals with psychotic disorders.

TRIAL REGISTRATION

clinicaltrials.gov NCT05982548; https://clinicaltrials.gov/study/NCT05982548.

Mental Health Awareness: Stigma and Help-Seeking Among Portuguese College Students

BACKGROUND/OBJECTIVES

Help-seeking-that is, the attempt to attain external help for mental health, be it from formal or informal sources-can be described as an adaptive coping process. Mental illness stigma is the most frequently identified barrier that prevents students from seeking psychological help. This study analyzed college students' beliefs about mental illness and attitudes toward formal psychological help-seeking.

METHODS

Two hundred and eighty-two students from the first and third undergraduate years of Psychology, Sociology, Fashion Design, and Sports Science courses participated. The majority of the sample (75.4%) was female, while only 24.6% was male, with a mean age of 20.04 years. The scales used were the Inventory of Beliefs about Mental Illness (IBMI), the Inventory of Attitudes Toward Seeking Mental Health Services (IATSMHS), and a sociodemographic questionnaire.

RESULTS

The results revealed that females, third-year students, and Psychology students had fewer stigmatizing beliefs about mental illness and more positive attitudes towards help-seeking. Moreover, there were statistically significant differences in beliefs and attitudes in relation to psychological support and familiarity with mental illness. We also glimpsed the impact of the COVID-19 pandemic on students' mental health, and observed a change in opinions and attitudes toward mental illness during this period. Correlation analysis showed negative correlations between stigmatizing beliefs and attitudes toward seeking help. Finally, a cluster analysis identified two profiles of individuals that reflected different levels of stigma and help-seeking attitudes.

CONCLUSIONS

This study delineated two distinct groups of students, which is relevant as it allows us to trace profiles to outline more uniform intervention groups and, in turn, implement new and improved interventions that are better adapted to the specific needs of college students.

Chinese College Students' Stigmatization towards People with Mental Illness: Familiarity, Perceived Dangerousness, Fear, and Social Distance

BACKGROUND

Attribution models have been examined in Western countries. However, little is known about the applicability of the attitude-emotion-behavior model within Chinese culture. This study aimed to examine the association between familiarity, perceived dangerousness, fear, and social distance towards persons with mental illness (PMI) in the Chinese context.

METHODS

An online cross-sectional survey was conducted from October to November 2022 in mainland China. A total of 1493 college students completed a questionnaire evaluating familiarity, perception of dangerousness, fear, and social distance regarding PMI. Path analysis was employed to validate the model proposed in this study.

RESULTS

Participants expressed moderate to high levels of stigma towards PMI. Familiarity was negatively associated with social distance (p < 0.01). Participants who perceived PMI as dangerous were more prone to exhibit a reaction of fear (p < 0.001), consequently leading to social distance (p < 0.01). However, the mediating effect of perceived dangerousness and fear on the relationship between familiarity and social distance was not significant (p > 0.05).

CONCLUSIONS

The results of this study provide support for Corrigan's attributional model of stigma in the Chinese context. Contact-based interventions for stigma reduction should emphasize multiple elements of contact, including the quality of contact, rather than familiarity.

People with mental illness stigmatize mental illness less: A comparison study between a hospital-based sample of people with mental illness and a non-clinical general population sample in urban India

Evidence shows that stigma negatively influences the quality of life of persons with severe mental illness. Nonetheless, stigma towards mental illness is lower among persons with a lived experience of mental illness compared to the rest of the population. Understanding the association between stigma of mental illness and the mental status of individuals living in urban India and whether this association is moderated by demographic factors opens a new avenue for prevention of social exclusion. Persons diagnosed with schizophrenia, bipolar disorder, or severe unipolar depression (cases, n  =  647) were recruited from among hospital patients in New Delhi between November 2011 and June 2012 and matched with non-psychiatric urban dwellers by age, sex, and location of residence (controls, n  =  649). Propensity score matching with multivariable linear regression was used to test whether stigma towards mental illness, measured by a 13-item Stigma Questionnaire, differed between cases and controls. Cases reported significantly lower stigma scores than controls (b  =  -0.50, p < 0.0001). The strength of the association between mental illness and stigma was not affected after controlling for age, caste, sex, education, and employment status, while wealth marginally reduced the strength of the association. These findings suggest individuals with a lived experience of mental illness, in New Delhi, India, may be more tolerant towards mental illness and support the need to involve persons with lived experience in the development and implementation of health promotional campaigns and programs aimed at reducing stigma towards mental illness.

Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis

BACKGROUND

The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization.

METHODS

We conducted a multifactorial vignette survey experiment (2⁸-design, i.e., N_Vignettes = 256) in Germany (N_Respondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19.

RESULTS

Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less.

CONCLUSION

Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.

Ethnic Differences in Attitudes and Preventive Behaviors Related to Alzheimer's Disease in the Israeli Survey of Aging

OBJECTIVES

To examine ethnic differences in attitudes and preventive behaviors related to Alzheimer's Disease (AD) in Israel.

METHODS

A household representative sample included 1198 older adults (M age = 70.78, SD = 9.64) who participated in the Israeli branch of the Survey of Health, Aging, and Retirement in Europe (SHARE-Israel), collected during 2015 and 2017. Descriptions of the groups (long term Israeli Jews (LTIJ), immigrants from the Former Soviet Union (FSU) and Palestinian Citizens of Israel (PCI)) were computed, and hierarchical regressions tested whether group differences were maintained after controlling for demographic, human and economic resources, Internet use, and AD familiarity.

RESULTS

Attitudes towards AD were the most negative among FSU and more accepting among PCI while AD-related preventive behaviors were highest among FSU, lowest among PCI, with LTIJ between them. After including demographic, human and economic resources, and familiarity with AD, differences in AD-preventive behaviors significantly decreased. In contrast, differences in attitudes among the groups remained stable even after other variables were accounted for, so that PCI were the most accepting and FSU manifested greatest avoidance of contact with persons with AD.

CONCLUSIONS

The findings provide directions for culturally sensitive psycho-educational and other interventions for both the public and healthcare providers.

Public stigma profile toward mental disorders across different university degrees in the University of Valencia (Spain)

BACKGROUND

A large proportion of studies carried out in recent years in different populations have shown that stigma toward mental disorders is highly prevalent. In the present study we conducted a comprehensive assessment of stigma to describe and compare stigma toward mental disorders in students enrolled in five different university degrees.

METHODS

Three hundred and twenty-five students from the University of Valencia (Spain), attending the second term of their first-degree courses in the faculties of medicine, psychology, teaching, economics, and data science participated in this cross-sectional study. Stigma was measured using: the Reported and Intended Behavior Scale (RIBS), the Scale of Community Attitudes toward Mental Illness (CAMI), the Attribution Questionnaire (AQ-27), and the Knowledge about Mental Illness test (KMI).

RESULTS

We found different patterns of stigma according to gender, the fact of knowing or living with a person with mental disorders and the university degree studied. Overall, women show fewer stigmatizing attitudes than men but similar stereotypes and prejudice toward people with mental disorders. However, the pattern of results across degrees is more complex. Overall, students of medicine, psychology and teaching showed fewer stigmatizing attitudes than students of economics and data science but differences between degrees were more subtle in stereotypes and prejudice toward people with mental disorders.

CONCLUSION

Our study suggests the existence of different profiles of stigma in relation to mental disorders in university students. These profiles varied in relation with the degree being studied, gender and already knowing or living with a person with mental disorders.

Stigma toward people with COVID-19 among the Lebanese population: a cross-sectional study of correlates and mediating effects

INTRODUCTION

Stigma develops during outbreaks such as the COVID-19 pandemic due to the human fear that arises from the anxiety about a disease of an unknown etiology, with the associated detrimental consequences on both the individual and society. This study was conducted to assess if knowledge about COVID-19, attitude, practice and behavior regarding preventive measures against COVID-19, fear, and anxiety towards COVID-19 will affect the level of stigma and evaluate the mediating effect of fear, anxiety, and diagnosis of COVID-19 on stigma.

METHODS

A cross-sectional online survey conducted between December 20, 2020, and January 05, 2021, enrolled 405 participants recruited from the Lebanese population. Two scales were created and adapted to the Lebanese context to measure the current stigma (stigma discrimination scale, self-stigma scale) toward COVID-19.

RESULTS

More than half of the sample had moderate to severe stigma discrimination (62%) and self-stigma (65.9%). The multivariable analysis showed that higher fear of COVID-19 scale (Beta = .143) was significantly associated with a higher stigma discrimination scale. Whereas, higher knowledge score (Beta =  -.153) was significantly associated with a lower stigma discrimination scale. Fear of COVID-19, anxiety from COVID-19, being diagnosed with COVID-19, and having a family member with COVID-19 partially mediated the association between knowledge and stigma discrimination scale. No mediation effect of fear and anxiety scale was found between the knowledge and self-stigma score.

CONCLUSION

Our main findings indicate that a considerable proportion of the Lebanese population has stigma discrimination behaviors toward COVID-19 patients and that those who were infected with the virus experienced COVID-19-related stigmatization.

Mental Health of Nursing Students amid Coronavirus Disease 2019 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is a global disaster, and recent studies have shown its association with increasing mental health problems such as post-traumatic stress disorder (PTSD), depression, anxiety, and stress. Nursing students, especially nursing interns, may be shunned, harassed, and even blamed as potential COVID-19 spreaders, though they were an important reserve force against COVID-19 and other diseases. Of note, the psychological influences of COVID-19 on nursing students remained unclear. The aim of this study was to evaluate the mental health of nursing students during the COVID-19 pandemic. A cross-sectional online survey was conducted on nursing students in a vocational college from April 12 to 23, 2020. The Impact of Event Scale-Revised, 21-item Depression, Anxiety and Stress Scale, and Pittsburgh Sleep Quality Index were used to assess the degree of symptoms of PTSD, depression, anxiety, stress, and insomnia, respectively. Multivariable logistic regression analysis was performed to determine the potential risk factors for the psychological symptoms. A total of 1,780 college nursing students were asked to participate in this online survey, with 1,532 complete responses. In total, 682 (44.5%) college nursing students reported having PTSD, 358 (22.8%) students reported insomnia, and few students reported depression (n = 45, 2.9%), anxiety (n = 44, 2.9%), and stress (n = 17, 1.1%) symptoms. As compared with junior, female, and rural nursing students, the senior, male, and urban nursing students had higher rates of PTSD, depression, anxiety, stress, respectively, whereas male nursing students had a higher insomnia rate. Multivariable analysis showed that senior nursing students had higher risks of PTSD, depression, anxiety; being male was associated with higher risks of PTSD, depression, anxiety, stress, and insomnia; and urban nursing students had higher risks of PTSD, depression, anxiety, and stress. In summary, a considerable number of nursing students reported mental symptoms of PTSD and insomnia, though few reported mental symptoms of depression, anxiety, and stress. Furthermore, senior, male, and urban nursing students are at risk for developing mental symptoms. Appropriate psychological interventions should be implemented to assure the mental health of nursing students.

Public Stigma Toward Female and Male Opium and Heroin Users. An Experimental Test of Attribution Theory and the Familiarity Hypothesis

Drug abuse and addiction exist around the world. People addicted to drugs such as opium or heroin often encounter dehumanizing discriminatory behaviors and health-care systems that are reluctant to provide services. Experiencing discrimination often serves as a barrier to receiving help or finding a home or work. Therefore, it is important to better understand the mechanisms that lead to the stigmatization of drug addiction and who is more prone to stigmatizing behaviors. There is also a dearth of research on whether different patterns of stigma exist in men and women. Therefore, this study investigated factors affecting gender-specific stigmatization in the context of drug addiction. In our vignette study (N _Mensample = 320 and N _Womensample = 320) in Iran, we experimentally varied signals and signaling events regarding a person with drug addiction (i.e., N _Vignettes = 32 per sample), based on Attribution Theory, before assessing stigmatizing cognitions (e.g., blameworthiness), affective responses (e.g., anger), and discriminatory inclinations (e.g., segregation) with the Attribution Questionnaire. We also tested assumptions from the Familiarity Hypothesis by assessing indicators of respondents' familiarity with drug addiction (e.g., knowledge about addiction). Results, for example, show higher stigma if the person used "harder" drugs, displayed aggressive behavior, or had a less controllable drug urge. Self-attributed knowledge about addiction or prior drug use increased some forms of stigma, but diminished others. These findings only partially converged between men and women. We suggest that anti-stigma initiatives should consider information about the stigmatized person, conditions of the addiction, and characteristics of stigmatizers.

Status, causes and consequences of physicians' self-perceived professional reputation damage in China: a cross-sectional survey

BACKGROUND

Conflict between physicians and patients is an increasingly serious problem, leading to the disrepute attached to Chinese physicians' social image and position. This study assesses the status of physicians' self-perceived professional reputation damage and explains it's the adverse outcomes including withdrawal behavior and workplace well-being. Moreover, potential causes of Chinese physicians' disrepute have been outlined.

METHODS

Primary data were collected through a cross-sectional online survey of physicians from 10 provinces in China, who were invited to complete an anonymous survey from December 2018 to January 2019. A total of 842 physicians (effective response rate: 92.22%) were recruited as participants.

RESULTS

About 83% of the participants self-perceived professional reputation damage from the sense of the public opinion concept. Approach half of participants exhibited the idea of turnover intention (47.3%) and one or more symptoms of burnout (46.4%). About 74.9% of the participants experienced a degree of stress. Additionally, three out of five participants reported low-level subjective well-being. More than 70% of the participants disapproved of their offspring becoming a physician. Four factors leading to physicians' damaged professional reputations are those addressed: conflict transfer, cognitive bias, improper management, and individual deviance. Stigmatised physicians are more likely to practice high-frequent defensive medicine (β = 0.172, P <0.001), intend to leave the profession (β = 0.240, P <0.001), disapprove of their children becoming physicians (β = 0.332, P<0.001) and yield worse levels of workplace well-being, including high levels of perceived stress (β = 0.214, P <0.001), increasing burnout (β = 0.209, P <0.001), and declining sense of well-being (β = - 0.311, P<0.001).

CONCLUSION

Chinese physicians were aware of damaged professional reputations from the sense of the public opinion concept, which contributes to increasing withdrawal behaviors and decreasing workplace well-being-a worsening trend threatening the entire health system. This novel evidence argues a proposal that Chinese health policy-makers and hospital administrators should promote the destigmatization of physicians immediately.

Knowledge, Attitude, and Practice about Mental Health Challenges among Healthcare Students of a Private University

OBJECTIVE

The objective of this study was to evaluate the knowledge, attitude, and practice of healthcare students (Medicine, Pharmacy, and Dentistry) in a private university about mental health challenges (MHC).

MATERIALS AND METHODS

A research cross-sectional observational was conducted to evaluate the knowledge, attitude, and practice of students towards MHC at a private university in Malaysia. A validated questionnaire was distributed to 284 students studying in three different selected faculties, namely the Faculty of Medicine, Pharmacy, and Dentistry. The Statistical Package for Social Science (SPSS) Version 24.0 was used to analyze the data.

RESULTS

Upon evaluation of knowledge, male students were having less-adequate knowledge than females (P = 0.006). Malay students were having adequate knowledge than other races about MHC. Faculty of Medicine was having adequate knowledge than other faculties (P ≤ 0.001). Regarding attitude, the Faculty of Pharmacy students had the highest positive attitudes (P = 0.001). Final year students were having a more positive attitude than pre-final year students. For the evaluation of practice, the Faculty of Dentistry students had the lowest practice compared with other faculties.

CONCLUSION

In conclusion, overall, good knowledge was seen among the students of the private medical university about MHC. The medical students had adequate knowledge when compared with other faculties in the university.

Factors Predicting Intent to Intervene with a Potentially Suicidal Peer

The current study examined how the theory of planned behavior (TPB) constructs predict college students' intent to ask about suicide and refer a potentially suicidal peer to support. Using an experimental design, 420 college students (M_age = 19.61, SD = 1.50 yrs) were randomly assigned to read one of four vignettes depicting a peer in distress that varied suicide risk severity (low vs. high) and perceived causes of the distress (internal vs. external). Participants read their vignette and answered questions measuring TPB constructs and items assessing intent to ask about suicide and intent to refer the peer to services. Results indicated that subjective norms were associated with intent to ask about suicide and attitudes impact intent to refer. Only the interaction between risk severity and perceived behavioral control in predicting intent to refer and intent to ask were significant. Peers who perceive risk to be high are more likely to refer peers regardless of perceived behavioral control and are increasingly more likely to ask about suicide as perceived behavioral control increases. When risk severity is low and perceived behavioral control is low, peers are less likely to refer or ask about suicide. The theory of planned behavior has relevance to understanding peer intent to intervene with an at-risk peer and may be beneficial to guiding the development of effective suicide prevention programs.

Associations of childhood trauma experiences with religious and spiritual struggles

Childhood trauma is associated with many interpersonal and psychosocial problems in adulthood. The aim of this study was to explore the associations with a spiritual area of personality, namely religious and spiritual struggles (R/S struggles). A nationally representative sample of 1,000 Czech respondents aged 15 years and older participated in the survey. All types of CT were associated with an increased level of all six types of R/S struggles, with the highest values for demonic struggles. Thus, the findings of this study might be important for clinical practice and pastoral care as well as a further research.

Social Stigma during COVID-19 and its Impact on HCWs Outcomes

The COVID-19 emergency has significantly transformed the working environment and job demands. Providing care was emotionally difficult for healthcare workers. Uncertainty, stigmatisation, and potentially exposing their families to infection were prominent themes for healthcare workers (HCWs) during the crisis, which first broke out in China at the end of 2019, and then in Italy in early 2020. This study examined the effects of stigma, job demands, and self-esteem, and the consequences of working as a “frontline care provider” with patients infected with the coronavirus (COVID-19). A correlational design study involved 260 healthcare workers (HCWs) working in a large hospital in southern Italy. The following questionnaires were administered: (1) the Job Content Questionnaire (JCQ), for assessing psychological and physical demands; (2) the Professional Quality of Life Scale (ProQOL) to measure the quality individuals feel in relation to their work as “frontline care providers”, through three dimensions: compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS); (3) the Rosenberg Self-Esteem Scale, for evaluating individual self-esteem; (4) a self-administered multiple-choice questionnaire developed by See et al. about attitudes of discrimination, acceptance, and fear towards HCWs exposed to COVID-19. The findings suggest that stigma has a high impact on workers’ outcomes. Stigma may influence worker compliance and can guide management communication strategies relating to pandemic risk for HCWs.

Can stigmatizing attitudes be prevented in psychology students?

BACKGROUND

Stigmatizing attitudes have been found among psychology students in many studies, and they are becoming more common with time.

AIMS

This study examines whether participation in clinical psychology lessons reduces levels of stigmatization in a population of psychology students and whether it leads to any change in stigmatization.

METHODS

The study is a pre/post evaluation of the effectiveness of clinical psychology lessons (63 hours of lectures) as a tool to fight stigma. The presence of stigmatizing attitudes was detected using the Italian version of the Attribution Questionnaire-27 (AQ-27-I). Stigmatization was described before and after the lessons with structured equation modeling (SEM).

RESULTS

Of a total of 387 students contacted, 302 (78.04%) agreed to be involved in the study, but only 266 (68.73%) completed the questionnaires at both t0 and t1. A statistically significant reduction was seen in all six scales and the total score on the AQ-27-I. The models defined by the SEM (pre- and post-intervention) showed excellent model fit indices and described different dynamics of the phenomenon of stigma.

CONCLUSIONS

A cycle of clinical psychology lessons can be a useful tool for reducing stigmatizing attitudes in a population of students seeking a psychology degree.