Politically correct labels and schizophrenia: a rose by any other name?

The Impact of Linguistic Form of Labels on Desire for Social Distance in Mental Health

The American Psychological Association, among other influential bodies, make recommendations on language for describing people with mental health conditions. The present studies test the impact of the recommended language on stigma. In Study 1, participants (n = 294) were asked to complete measures of desire for social distance from individuals given a diagnostic label in either person-first possessive, identity-first noun, or identity-first adjective forms. Familiarity with the diagnoses was considered as a potential influence on the outcome. The 3*2 (linguistic form * experience) factorial design was repeated for three diagnoses - schizophrenia, anorexia and alcoholism. In Study 2, the research was replicated with a sample recruited from the UK population via social media (n = 230). Factorial ANOVA was used for analysis. In contrast with previous literature, the studies found neither an effect of linguistic form (hypothesis 1) nor an interaction effect with familiarity (hypothesis 2). Research on this topic is in an early stage and, above all, it remains important to use language, which shows respect when talking to or about others.

Gambling Disorder and Stigma: Opportunities for Treatment and Prevention

Purpose of Review

Gambling disorder is among the most stigmatized mental health problems. More research is needed to understand the mechanisms that underlie this stigma and the effects of stigma-reduction interventions. This paper reviews extant literature on the stigma of gambling disorder and highlights evidence from this research and the broader mental illness stigma literature to help advance research on the prevention and reduction of gambling-related stigma.

Recent Finding

The public stigma of gambling disorder includes stereotypes of affected individuals as “greedy” and “irresponsible,” beliefs that affected individuals are to blame for their problems, and desire to avoid social contact with affected individuals. Stigmatizing attitudes held by the public are often internalized by individuals with gambling disorder, which leads to problem concealment, reduced treatment-seeking, and decreased self-esteem. Women with gambling disorder, as well as those with more severe gambling problems and who perceive greater stigma by the public, are most vulnerable to self-stigma. There is evidence that certain beliefs may underlie the stigmatization of gambling disorder, including beliefs about its causes. Contact- and education-based interventions show efficacy for the reduction of mental illness-related stigma more broadly; additional research is needed to determine the efficacy of various stigma reduction strategies for gambling disorder specifically.

Summary

Gambling disorder is highly stigmatized relative to other mental health problems, in part because it is viewed as more likely to be caused by controllable factors. Interventions that emphasize the biopsychosocial etiology of gambling disorder may help to prevent and reduce the blame and stigmatization of affected individuals. Structural stigma within domains such as legislation, healthcare, and the gambling industry, interventions to reduce self-stigma, stigma among mental health professionals, and the influence of culture on stigma and its reduction are critical issues for future research.

Integrating cognitive dissonance and social consensus to reduce weight stigma

Weight stigma is pervasive and has a range of deleterious effects. Among the most promising approaches for modifying this form of stigma are cognitive dissonance and social consensus. Due to their theoretical connection, this study tested the effects of an experimental manipulation of cognitive dissonance blended with social consensus for targeting weight stigma. It also added to research investigating the effects of cognitive dissonance on weight stigma by investigating a broader range of stigma measures. Participants were university students aged 18-35 years (N = 98) who were randomly allocated to one of four experimental conditions: blended cognitive dissonance, standard cognitive dissonance, blended control or standard control. Stigma measures included the perceived characteristics of, affective reactions towards, social avoidance of, and blameworthiness attributed to a higher-weight individual, and general weight stigma. Results showed that those in the cognitive dissonance conditions reported significantly lower weight stigma than those in the non-dissonance, control conditions. Moreover, those in the blended cognitive dissonance condition with higher in-group identification reported less negative affective reactions than those with lower in-group identification. The results provide consistent support for cognitive dissonance as an approach for reducing weight stigma and some additive support for an integrated cognitive dissonance and social consensus approach.

What's in a Name? Evaluating the Public Stigma of Gambling Disorder

Public stigma of gambling disorder has negative effects on the mental health and functioning of affected individuals and impedes treatment-seeking. One factor thought to be implicated in stigma is the label used to describe the condition. The aims of this research were to: (1) evaluate whether different labels for problematic gambling behavior influence public stigma; and (2) compare public stigma of gambling disorder to other health conditions. Separate samples of university student (Study 1) and general population (Study 2) participants were randomly assigned to label conditions and completed questionnaires assessing stigma and attitudes towards the assigned label. In Study 1, the eight conditions included four gambling labels (problem gambling, pathological gambling, gambling disorder, and gambling addiction) and four psychiatric or health comparison labels (depression, obsessive-compulsive disorder, alcohol use disorder, and asthma). In Study 2, compulsive buying disorder was added as a fifth psychiatric comparison for a total of nine conditions. The results indicated that the four gambling label conditions elicited similar attitudes and stigma. Those conditions were also more stigmatized than the depression, obsessive-compulsive disorder, and asthma conditions. The gambling conditions elicited similar stigmatizing attitudes as alcohol use disorder but were slightly more stigmatized than compulsive buying disorder, with these conditions showing both similarities and differences across the stigma-related outcomes. The results were largely consistent across both samples and contribute to knowledge of the nature and origins of gambling-related stigma.

The Relationship between Terminology Preferences, Empowerment and Internalised Stigma in Mental Health

People with a mental illness may be exposed to stigma which, when internalised, negatively influences self-esteem, personal goal attainment and quality of life. However, people who are empowered may actively challenge stigma by engaging in meaningful opportunities, furthering their self-worth as they achieve control within their lives. People who are empowered through active treatment participation are more likely to reach recovery goals and experience the benefits of evidence-based practices. Hence, empowerment can be viewed as essential to the recovery and well-being of people with a mental illness. Participants in this quantitative study (N = 173) were diagnosed with a mental illness and were recruited via convenience sampling from mental health support groups in Australia. Internalised stigma was less common and empowerment more prevalent in this study than was found in previous studies. However high internalised stigma and low empowerment were present. The terms 'individual' and 'person with lived experience' which have been identified as the preferred terms in a previous study were highlighted as both empowering and recovery focussed.

The abbreviation "PWE" may carry a negative connotation compared with the labels "person with epilepsy" and "epileptic"

PURPOSE

Ways of labeling a person with epilepsy (PWE) may have an impact on public position towards affected persons. This study analyzed college students position changes, influenced by three different labels of PWE.

METHODS

Observational, descriptive, cross-sectional study. Students of three schools answered one of three questionnaires whose content changed in the labeling form: person with epilepsy, epileptic or PWE. Proportions were compared with Chi square test or Fisher's exact test to explore considering age, gender, religion practicing, socioeconomic status, knowing an affected person and by faculty.

RESULTS

A total of 273 questionnaires were included were distributed in medicine 133 (48.7 %), engineering 108 (39.6 %) and law 32 (11.7 %) schools. Labeling type distribution was person with epilepsy 94 (34.4 %), epileptic 93 (34.1 %) and PWE 86 (31.5 %. No statistical differences were found according the labels person with epilepsy and epileptic. The abbreviation PWE had statistical significant connotation in aspects of academic achievement p = 0,007, selecting a PWE in your work team p = 0,009, self control p < 0,000, being dangerous p < 0,000 and having any disturbance in thought or behavior p = 0,05. Religion practicing, socioeconomic status and knowing a person with epilepsy did not impact in attitude related to labeling. Engineering and law students expressed their concern in employability.

CONCLUSION

The abbreviation PWE may have negative connotations when used in written questionnaires. No differences were found with the labels person with epilepsy and epileptic in college students. More studies are needed to explore the stigmatizing or destigmatizing effects of labeling a person with epilepsy on different populations.

Addicts and Admits: Metonymy in Medical Students' Reflective Writing

Phenomenon: Metonymy refers to the substitution of the name of an attribute or adjunct for the name of the object or person being described. In medical contexts, this may involve referring to a person as a disease, body part, or other health-related noun. In this study, we explore the use of metonymy in medical students' reflective writing. Approach: Using content analysis, we identified all usages of metonymy in a sample of 802 medical student reflective essays. We analyzed them for associated themes and used the Fisher's exact test to compare frequencies of clinical ethics themes that occurred in the essays with metonymy to those without metonymy. Findings: Metonymy was used 60 times in the essays. The uses were grouped into thematic clusters of substance abuse (n = 27), illness (n = 9), body part (n = 4), clinical status (n = 6), reproductive health (n = 5), challenging clinical situations (n = 6), and other thoughts on patients as people (n = 3). Several ethical themes associated with essays using metonymy (p < .05): moral distress, substance abuse, adequate treatment, jumping to conclusions, awakening, and pain. Insights: Metonymy was relatively uncommon, and some students explicitly described the practice as dehumanizing to patients. Even so, metonymy did present in a variety of forms and was used most frequently to describe individuals with substance use disorders. Essays involving metonymy were more likely to describe a scenario that elicited moral distress in the students, which may indicate that metonymy occurs more frequently in some troubling situations.

Does public attitude change by labeling a person as epileptic, person with epilepsy or the acronym PWE? A systematic review

PURPOSE

It is still unknown if attitudinal differences by diverse labeling of persons with epilepsy could be universally accepted with the actual literature evidence. The manner in which questions are constructed could also have an impact in final results. The purpose of this systematic review was to examine the published articles regarding changes in public´s attitude towards epilepsy by labeling a person as epileptic, person with epilepsy or with the acronym PWE.

METHODS

We undertook a systematic review of the literature using common databases with specific keywords and combinations searching for original articles, meta-analysis and systematic reviews. Sociodemographic variables, attitude results and questions style were analyzed in included articles.

RESULTS

Four original articles were found. Significant attitudinal changes were described in three studies with the label person with epilepsy. One study failed to demonstrate an attitudinal change by distinct labeling of a person with epilepsy. All questions were formulated in a personal way. Few neutral and mostly induced questions were found in the studies.

CONCLUSION

By the use of the label "person with epilepsy" there is a trend towards positive changes in public's attitudes, although evidence is scarce to consider this tendency as universally applicable. More studies are needed considering widespread social and cultural backgrounds and patient opinion. Language power by wording type could be a key consideration for future studies.

Gaming With Stigma: Analysis of Messages About Mental Illnesses in Video Games

BACKGROUND

Video game playing is a daily activity for many youths that replaces other media forms (eg, television); it serves as an important source of knowledge and can potentially impact their attitudes and behaviors. Researchers are, thus, concerned with the impact of video gaming on youth (eg, for promoting prosocial or antisocial behavior). Studies have also begun to explore players' experience of gameplay and video game messages about violence, sexism, and racism; however, little is known about the impact of commercial video games in the sharing and shaping of knowledge, and messages about mental illness.

OBJECTIVE

The aim of this review was to identify how mental illness, especially psychosis, is portrayed in commercial video games.

METHODS

We performed keyword searches on games made available between January 2016 and June 2017 on Steam (a popular personal computer gaming platform). A total of 789 games were identified and reviewed to assess whether their game content was related to mental illness. At the end of the screening phase, a total of 100 games were retained.

RESULTS

We used a game elements framework (characters, game environment/atmosphere, goals, etc) to describe and unpack messages about mental health and illness in video games. The majority of the games we reviewed (97%, 97/100) portrayed mental illness in negative, misleading, and problematic ways (associating it with violence, fear, insanity, hopelessness, etc). Furthermore, some games portrayed mental illness as manifestations or consequences of supernatural phenomena or paranormal experiences. Mental illness was associated with mystery, the unpredictable, and as an obscure illness; its treatment was also associated with uncertainties, as game characters with mental illness had to undergo experimental treatment to get better. Unfortunately, little or no hope for recovery was present in the identified video games, where mental illness was often presented as an ongoing struggle and an endless battle with the mind and oneself.

CONCLUSIONS

The game elements of the identified commercial video games included mental illness, about which many perpetuated well-known stereotypes and prejudices. We discuss the key findings in relation to current evidence on the impact of media portrayals of mental illness and stigma. Furthermore, we reflect on the ability of serious video games to promote alternative messages about mental illness and clinical practices. Future research is needed to investigate the impact that such messages have on players and to explore the role that video games can play in fostering alternative messages to reduce the stigma associated with mental illness.

Reducing anorexia nervosa stigma: an exploration of a social consensus intervention and the moderating effect of blameworthy attributions

Background: Research suggests that blameworthy attributions towards individuals with anorexia nervosa are common, which in turn elicit more stigmatising attitudes towards those with the disorder. The social consensus approach has been found to reduce stigmatising attitudes in various domains and, as such, is a promising avenue to pursue for ameliorating stigma in anorexia nervosa.Aims: The present study primarily sought to investigate the effectiveness of a social consensus approach in reducing stigma towards individuals with anorexia nervosa. The study also examined if blameworthy attributions were associated with change in stigma.Method: An experimental design was employed, where female undergraduate students (N= 126) completed self-report measures that assessed anorexia nervosa stigma at baseline (Time 1) and 6-10 days after allocation to one of two conditions: social consensus and control (Time 2).Results: The social consensus intervention was more effective than the control condition in reducing stigmatising attitudes on measures assessing affective reactions (p= 0.025) and characteristics attributed to a target with anorexia nervosa (p < 0.001). Level of blame-based attributions did not moderate change in stigma.Conclusions: Results suggest that a social consensus intervention is promising irrespective of the endorsement of blameworthy attributions.

Psychiatry and the media

Aspects of print, broadcast, film and ‘new media’ are related to their interactions with psychiatry. Frequent representations of mental health issues are paralleled by the adoption of psychological theories into media studies. Key areas are covered where psychiatric items diverge from other medical specialities, such as the depiction of suicide, the dominance of ‘human interest’ stories and negative representation of people with mental illness. Although the language of mental disorders is important, the power of the image needs to be examined. Media items also have implications for public mental health (children as vulnerable viewers) and the clinical practice of psychiatry that are not uniformly negative. Television has limitations and clinicians are encouraged to participate in radio and other media. Resources and practical advice for media contact are provided.

Newspaper coverage of mental illness in Hong Kong between 2002 and 2012: impact of introduction of a new Chinese name of psychosis

AIM

In Hong Kong, 'si-jue-shi-tiao' () was officially adopted as the Chinese translation of psychosis in 2001. The new term covered a broader aspect of psychosis, compared with the original term, 'jing-shen-fen-lie' (), which gave a negative stereotype as a 'mental split-mind disorder'. The current study compared the usage of the two terms, and added evidence to the name changing as anti-stigma strategy.

METHODS

The usage and themes of the new Chinese name of psychosis 'si-jue-shi-tiao' was examined in 1217 local newspaper articles in comparison with the traditional Chinese name of schizophrenia 'jing-shen-fen-lie'.

RESULTS

Results show that an increase use of 'si-jue-shi-tiao' was found equally across themes, whereas 'jing-shen-fen-lie' was decreasingly used in positive/neutral themes over time. The association of 'jing-shen-fen-lie' with dangerous wordings increased over time, but no change was found with the new name.

CONCLUSIONS

Our finding adds to literature on effects of changing new name on public stigma.

Zeroing in on the Effect of the Schizophrenia Label on Stigmatizing Attitudes: A Large-scale Study

The idea that psychiatric diagnoses are not mere descriptors of a symptomatology but create incrementally negative effects in patients has received considerable support in the literature. The flipside to this effect, that calling someone by a psychiatric diagnosis also has an effect on how this person is perceived by others, however, has been less well documented and remains disputed. An experimental study was conducted with a large sample (N = 2265) to ensure statistical power to detect even small effects of such adding a psychiatric diagnosis to a description of symptoms or not. Dependent variables were chosen in an exploratory manner and tests were corrected for alpha inflation. Results show that calling the identical symptomatology schizophrenia (vs not labeling it) led to greater perceptions of aggressiveness, less trustworthiness, more anxiety toward this person, and stronger assumptions this person feels aggression-related emotions. Although stigmatizing attitudes were generally lower for persons with personal experiences with mental illnesses as either a patient or a close relative, such personal involvement did not moderate the effect. Implications of these findings and limitations of the study are discussed.

Quality and predictors of adolescents' first aid intentions and actions towards a peer with a mental health problem

While peers are a common source of informal help for young people with a mental health problem, evidence suggests that the help they provide is inadequate. By examining predictors of the quality of mental health first aid provided by adolescents to their peers, future interventions can be targeted to adolescents most at risk of providing poor help. Students (n = 518) from Australian secondary schools were presented with two vignettes, depicting persons experiencing depression with suicidal thoughts, and social phobia. Participants were asked what they thought was wrong with the person, and how they would help them. Stigma towards the person was also assessed. Additionally, participants were asked if they had recently helped anyone in their own lives with a mental health problem, and, if so, what they did. The overall quality of help reported in response to the vignettes or an actual person was low; a particular inadequacy was the low rate of engaging the help of an adult. Being female, and believing that the person is sick rather than weak, consistently predicted better help-giving.

#Schizophrenia: Use and misuse on Twitter

BACKGROUND

The role and prevention of stigma in mental illness is an area of evolving research.

AIMS

The present study is the first to examine the use and misuse of the word 'schizophrenia' on Twitter.com in comparison with another illness (diabetes) by analyzing Tweets that use the adjective and noun forms of schizophrenia and diabetes.

METHOD

Tweets containing one of four search terms (#schizophrenia, #schizophrenic, #diabetes, #diabetic) were collected over a forty-day time period. After establishing inter-rater reliability, Tweets were rated along three dimensions: medical appropriateness, negativity, and sarcasm. Chi square tests were conducted to examine differences in the distributions of each parameter across illnesses and across each word form (noun versus adjective).

RESULTS

Significant differences were seen between the two illnesses (i.e., among "schizophrenia", "schizophrenic", "diabetes", and "diabetic") along each parameter. Tweets about schizophrenia were more likely to be negative, medically inappropriate, sarcastic, and used non-medically. The adjective ("schizophrenic") was more often negative, medically inappropriate, sarcastic, and used non-medically than the noun "schizophrenia." Schizophrenia tweets were more likely to be negative and sarcastic when used non-medically and in a medically inappropriate manner.

CONCLUSIONS

Our findings confirm the presence of a great deal of misuse of the term schizophrenia on Twitter, and that this misuse is considerably more pronounced by the adjectival use of the illness. These findings have considerable implications for efforts to combat stigma, particularly for youth anti-stigma efforts.

Should the label "schizophrenia" be abandoned?

The term schizophrenia is increasingly contested by researchers, clinicians, patients and families. Mental health users and professionals around the world have started calling for a change of the name, seeing it as stigmatizing and harmful. This paper reviews the literature published so far on the issue of renaming schizophrenia, carefully weighing the pros and cons of the proposed changes. Forty seven papers have been published so far, encompassing editorials, research papers, commentaries to editorials, letters, forum papers and narrative reviews. The advantages of renaming schizophrenia far outweigh the disadvantages. It would reduce stigma and benefit communication between clinicians, patients and families. The most conservative option for renaming schizophrenia would be the use of eponyms since they are neutral and avoid adverse connotations. Renaming schizophrenia is not only a matter of semantics, but also an attempt to change the stigma carried by the present name. Nevertheless, a change will not be useful unless accompanied by parallel changes in legislation, services and the education of professionals and the public.

Punitive attitudes against pedophiles or persons with sexual interest in children: does the label matter?

In the present research, we addressed the question of whether people harbor punitive attitudes against individuals sexually interested in children even if no sexual offense is mentioned and whether this effect is amplified by the clinical label pedophilia. In two online studies (total N = 345), participants rated the extent to which they saw individuals sexually interested in children as necessarily committing child sexual abuse (dangerousness), responsible for their sexual interest (intentionality), and clinically disordered (deviance) before judging their endorsement of means of punishment (punitive attitudes). Participants were randomly assigned to one of two conditions in which either the "pedophilia" label or the descriptive term "sexual interest in (prepubescent) children" was included in all items. Across both studies, results showed high degrees of punitive attitudes against sexually deviant men, an effect that was particularly pronounced if the pedophilia label was present. Whereas this was only latently observable in Study 1 (concealed by a suppression effect of reduced ascriptions of intentionality), in Study 2 no such suppression was observed. Unlike any other stigma we know of, punitive attitudes against pedophiles were associated positively with social desirability, suggesting that participants saw it as particularly socially desirable to condemn someone based on their deviant sexual interest.

Students with autism spectrum disorder in the university context: peer acceptance predicts intention to volunteer

With growing numbers of individuals with autism spectrum disorder (ASD) entering post-secondary institutions, strategies are needed to facilitate the social integration of these students. The goal of this study was to examine the role of various factors in university students’ acceptance of, and intention to volunteer with, a peer with ASD. Both contact quantity and quality emerged as significant predictors of acceptance; however, for those who had experienced direct contact with individuals with ASD, only perceived quality emerged as significant. Moreover, acceptance played a significant role in participants’ likelihood of signing up to volunteer. These findings point to the central role that positive experiences play in attitude formation for this population.

Reinforcing stigmatization: coverage of mental illness in Spanish newspapers

Because the media influences society's perceptions of reality, the treatment of mental illness in the news can have an effect on the societal stigma related to it. This study aimed to analyze the content and form of news items related to mental illness in Spanish newspapers in order to understand their role in propagating or attenuating stereotypes, prejudices, and stigma. The authors conducted a cross-sectional descriptive study on the basis of a review of news items related to mental illness appearing in the Spanish print media. A sample was taken from articles published on the subject in the 20 Spanish newspapers with the widest circulations over the course of the year 2010. Formal elements and content were analyzed by means of a structured evaluation system. The authors analyzed 695 news items. The content of 47.9% (n = 333) of the articles was not strictly related to mental illness, but rather clinical or psychiatric terms were used metaphorically, and frequently in a pejorative sense. The remaining 52.1% (n = 362) consisted of news items related specifically to mental illness. Of these, news items linking mental illness to danger were the most common (178 texts, 49.2%), specifically those associating mental illness with violent crime (130 texts, 35.9%) or a danger to others (126 texts, 34.8%). The results confirm the hypothesis that the press treats mental illness in a manner that encourages stigmatization. The authors appeal to the press's responsibility to society and advocate an active role in reducing the stigma towards mental illness.

The associations between psychiatric label use and young people's help-seeking preferences: results from an Australian national survey

Aims. Emerging evidence suggests that psychiatric labels may facilitate help seeking in young people. This study examined whether young people's use of accurate labels for five disorders would predict their help-seeking preferences. Methods. Young people's help-seeking intentions were assessed by a national telephone survey of 3021 Australian youths aged 15-25. Respondents were presented with a vignette of a young person portraying depression, depression with suicidal thoughts, psychosis, social phobia or post-traumatic stress disorder (PTSD). They were then asked what they thought was wrong with the person, and where they would go for help if they had a similar problem. Results. Accurate psychiatric label use was associated with a preference to seek help from a general practitioner or mental health specialist. Accurately labelling the psychosis vignette was also associated with a preference to not seek help from family or friends. Conclusions. Findings add to the emerging evidence that accurate psychiatric labelling may facilitate help seeking for various mental disorders in young people, and support the promise of community awareness campaigns designed to improve young people's ability to accurately identify mental disorders.

Stereotypes of problem gambling

Introduction: Research supports the notion that problem gambling is stigmatized, yet little is known about stereotypes, a key variable in the stigmatization process. Method: University students (41 male, 110 female) generated words when presented with one of three labels: gambler, problem gambler, and gambling addict. An adjective checklist permitted participants to select words characteristic of problem gamblers and was administered to additional student (N=790) and problem gambling samples (N=74). Results: Content and frequency analyses revealed that problem gamblers were considered compulsive, impulsive, desperate, irresponsible, risk-taking, depressed, greedy, irrational, antisocial, and aggressive. Problem gambling and gambling addict labels generated more words regarding negative gambling consequences. Gambler resulted in more miscellaneous words (e.g., casino, money). Conclusions: Stereotype content was not entirely inaccurate and the label gambler was not neutral. Future research could examine which aspect of stereotype content invites stigmatization.

The Experience of Cognitive Impairment in People with Psychosis

Cognitive impairment has been widely studied in people with psychosis. However, research is lacking into the subjective experience of cognitive impairment, its impact and ways in which individuals cope. This study aimed to provide an account of the experience of cognitive impairment in people with a diagnosis of schizophrenia, including what difficulties people experience, how these difficulties are understood, how people respond to these difficulties and how they perceive others' views of these difficulties. A semi-structured interview was carried out with eight participants with a diagnosis of schizophrenia focusing on participants' experiences of difficulties with cognitive functioning. Interpretative phenomenological analysis was used to analyse interview transcripts. Experience of cognitive impairment was understood in terms of six master themes: impaired controlled thinking, physical sensations and impaired movement, explanations for the impairment and comparisons to the past, managing the impairment, how others see the impairment and anticipating the future. This study is the first rigorous qualitative study of the subjective experience of cognitive impairment in people with psychosis, and it provides greater context for empirical findings. The results have significant implications for clinical psychology, including education about cognitive difficulties and the importance of cognitive functioning to formulation. New areas for research include coping strategies in relation to functioning and future perspectives, ascertaining staff understanding of cognitive impairment, and reflective conversation style as an intervention for metacognitive difficulties. Key Practitioner Message Difficulties with cognitive functioning should be considered in clinical practitioners' formulations of clients' difficulties in the context of psychosis. Services should consider providing service user and carer education about cognitive impairment in psychosis. Staff may need further training in order to support people with psychosis who have difficulties with cognitive functioning.

Psychiatric labels and other influences on young people's stigmatizing attitudes: Findings from an Australian national survey

BACKGROUND

Stigma is a major impediment to help seeking for mental disorders by young people. To reduce stigma and improve help seeking, a better understanding of the influences on different components of stigma for different disorders is required.

METHODS

In 2011, a telephone interview was conducted with a national sample of 2522 Australians aged 15-25 years. Participants were presented with a vignette of a young person portraying either depression, depression with suicidal thoughts, social phobia, post-traumatic stress disorder or psychosis. They were then asked what they thought was wrong with the person, exposure to mental health problems in themselves and in family or friends, stigmatizing attitudes, and their awareness of beyondblue.

RESULTS

Accurate psychiatric labeling of the mental disorder presented in the vignette and beyondblue awareness were the best predictors of less stigmatizing attitudes, followed closely by exposure to family or friends with mental health problems. Across vignettes, the personally held stigmatizing perception of mental health problems as a weakness rather than an illness was most strongly associated with these predictors.

LIMITATIONS

Stigma and labeling were assessed with reference to a vignette character and may not reflect actual experience or behaviors. Other limitations include the cross-sectional design and potential for social desirability bias in the stigma measure.

CONCLUSIONS

Findings suggest that community awareness campaigns (such as those by beyondblue) that encourage appropriate close contact with others affected by mental health problems and improved accurate psychiatric label use may have potential to counter various aspects of stigma, especially personal beliefs that mental illness is a weakness.

Does labeling matter? An examination of attitudes and perceptions of labels for mental disorders

PURPOSE

Labeling research in various domains has found that attitudes and perceptions vary as a function of the different labels ascribed to a group (e.g., overweight vs. obese). This type of research, however, has not been examined extensively in regards to labels for mental disorders. The present study examined whether common psychiatric labels (i.e., mental disease, mental disorders, mental health problems, and mental illness) elicited divergent attitudes and perceptions in a group of participants. These labels were also compared to the specific label of depression.

METHODS

Undergraduate psychology students (N = 124) were given identical questionnaire packages with the exception of the label used. That is, each participant received a set of questionnaires that referred to only one of the five labels. The questionnaire package contained various quantitative measures of attitudes and social distance, in addition to a short qualitative measure.

RESULTS

Analyses demonstrated equivalence among the four general psychiatric labels on measures of attitudes, social distance, and general perceptions. However, results also suggested that the general labels diverged from the depression label, with the latter being generally more negatively perceived. Some analyses demonstrated that participants' understanding of the terminology might be incorrect. The results of the investigation are discussed with a focus on its relationship with current research in stigma.

CONCLUSION

Within the current sample, general psychiatric labels did not appear to distinguish themselves from each other on measures of attitude and social distance but did so when compared to a relatively more specific term. Future research should examine the underlying mechanism driving this finding, with the ultimate goal of reducing the stigma faced by those with mental disorders.

Measuring mental illness stigma with diminished social desirability effects

BACKGROUND

For persons with mental illness, stigma diminishes employment and independent living opportunities as well as participation in psychiatric care. Public stigma interventions have sought to ameliorate these consequences.

AIMS

Evaluation of anti-stigma programs' impact is typically accomplished with self-report questionnaires. However, cultural mores encourage endorsement of answers that are socially preferred rather than one's true belief. This problem, social desirability, has been circumvented through development of faux knowledge tests (KTs) (i.e., Error-Choice Tests); written to assess prejudice.

METHOD

Our KT uses error-choice test methodology to assess stigmatizing attitudes. Test content was derived from review of typical KTs for façade reinforcement. Answer endorsement suggests bias or stigma; such determinations were based on the empirical literature.

RESULTS

KT psychometrics were examined in samples of college students, community members and mental health providers and consumers. Test-retest reliability ranged from fair (0.50) to good (0.70). Construct validity analyses of public stigma indicated a positive relationship with the Attribution Questionnaire and inverse relationships with Self-Determination and Empowerment Scales. No significant relationships were observed with self-stigma measures (recovery, empowerment).

CONCLUSIONS

This psychometric evaluation study suggests that a self-administered questionnaire may circumvent social desirability and have merit as a stigma measurement tool.

Disclosure of Psychiatric Disabilities in Vocational Rehabilitation

Vocational professionals aware of the stigma associated with psychiatric disability, generally exercise caution when disclosing psychiatric or disability related information to employers. However, few professionals directly address stigma or specify disclosure strategies in vocational rehabilitation plans. Integrated information tailored to vocational professionals is needed to guide this aspect of vocational rehabilitation practice. We review recent evidence with legal and ethical information relevant to vocational rehabilitation. Key elements of disclosure and stigma-countering strategies are identified which can be incorporated into the career planning, job preparation, job securing and job retaining phases of vocational rehabilitation plans.

Labeling of mental disorders and stigma in young people

Mental disorders are common in young people, yet many do not seek help. The use of psychiatric labels to describe mental disorders is associated with effective help-seeking choices, and is promoted in community awareness initiatives designed to improve help-seeking. However these labels may also be coupled with stigmatizing beliefs and therefore inhibit help-seeking: lay mental health or non-specific labels may be less harmful. We examined the association between labeling of mental disorders and stigma in youth using data from a national telephone survey of 2802 Australians aged 12-25 years conducted from June 2006 to August 2006. Label use and stigmatizing beliefs were assessed in response to vignettes of a young person experiencing depression, psychosis or social phobia. Logistic regressions examined the association between a range of labels commonly used, including psychiatric labels, and a range of stigma components. There were no significant associations between label use and the stigma components of "stigma perceived in others", "reluctance to disclose" and for the most part "social distance". Most mental health labels were associated with seeing the person as "sick" rather than "weak" and accurate psychiatric labels had the strongest effect sizes. However, for the psychosis vignette, the "dangerous/unpredictable" component was predicted by the labels "schizophrenia/psychosis", "mental illness" and "psychological problem", and the accurate psychiatric label showed the strongest association. For all vignettes, generic lay labels were not associated with stigma, but also rarely had a counter stigma effect. These findings suggest that the use of accurate psychiatric labels by young people is seldom associated with stigma and may assist young people by reducing perceptions of weakness. However, community education that promotes accurate labeling of psychosis should proceed with caution and address beliefs about dangerousness and unpredictability.

Standardized measures for substance use stigma

Despite indications that the stigma associated with substance use is high and may play a role in discouraging treatment participation, there is limited research in this area and only a few psychometrically sound measures of substance use stigma exist. The purpose of this study was to formulate and evaluate the psychometric properties of three substance use stigma measures. College students (N=565) completed three measures of substance use stigma that were modified from three established measures of mental illness stigma. Two of the three modified measures (Social Distance Scale for Substance Users and Affect Scale for Substance Users) emerged as having acceptable psychometric properties, whereas one modified measure (Dangerousness Scale for Substance Users) had inadequate psychometric properties. In regard to sex differences, women had significantly higher substance use stigma on the two psychometrically sound measures (p<.01). Perhaps, with standardized measures, there can be greater progress towards better understanding the mechanisms leading to high levels of substance use stigma and ultimately address failures to seek out treatment due to stigma.

An examination of two brief stigma reduction strategies: filmed personal contact and hallucination simulations

Mental illness stigma is quite prevalent with dire consequences. A number of interventions to decrease stigma have been formulated, but have variable effectiveness and limited dissemination. This research examined the impact of two brief interventions: a film depicting individuals with schizophrenia (filmed contact) and a simulation of auditory hallucinations. Participants (N = 143) were randomly assigned to one of three interventions: (1) filmed contact, (2) simulation, or (3) no intervention, and completed two stigma measures prior to, immediately after, and 1 week after the intervention. The filmed contact intervention led to decreases in stigma which persisted across 1 week. However, the simulation led to increases in stigma. The results suggest that a filmed contact intervention may decrease two aspects of mental illness stigma (social distance and negative emotions), which has implications for wide dissemination. The efficacy of a hallucination simulations intervention remains dubious.

"Obese people" vs "Fat people": impact of group label on weight bias

OBJECTIVE

The present study examined whether the terms "obese people" vs "fat people" impact evaluations of a target group.

METHOD

Participants answered a number of questions about obese people (N=300) or fat people (N=125), including how favorable their attitudes are toward the target group, how disgusted they are with the target group, and how similar they are to the target group.

RESULTS

Compared to fat people, obese people were rated as less favorable and as more disgusting. In addition, participants saw themselves as being less similar to obese people than to fat people, and as less likely to become an obese person than a fat person.

CONCLUSION

Overall, the term "obese people" evokes stronger negative evaluations than the term "fat people." Researchers investigating weight bias should be aware that the specific terms used to refer to overweight and obese people can impact study outcomes and interpretations.

Schizophrenia, "just the facts" 4. Clinical features and conceptualization

Although dementia praecox or schizophrenia has been considered a unique disease entity for the past century, its definitions and boundaries have continued to vary over this period. At any given time, the changing concept of schizophrenia has been influenced by available diagnostic tools and treatments, related conditions from which it most needs to be distinguished, extant knowledge and scientific paradigms. There is significant heterogeneity in the etiopathology, symptomatology, and course of schizophrenia. It is characterized by an admixture of positive, negative, cognitive, mood, and motor symptoms whose severity varies across patients and through the course of the illness. Positive symptoms usually first begin in adolescence or early adulthood, but are often preceded by varying degrees of negative and cognitive symptomatology. Schizophrenia tends to be a chronic and relapsing disorder with generally incomplete remissions, variable degrees of functional impairment and social disability, frequent comorbid substance abuse, and decreased longevity. Although schizophrenia may not represent a single disease with a unitary etiology or pathogenetic process, alternative approaches have thus far been unsuccessful in better defining this syndrome or its component entities. The symptomatologic, course, and etio-pathological heterogeneity can usefully be addressed by a dimensional approach to psychopathology, a clinical staging approach to illness course, and by elucidating endophenotypes and markers of illness progression, respectively. This will allow an approach to the deconstruction of schizophrenia into its multiple component parts and strategies to reconfigure these components in a more meaningful manner. Possible implications for DSM-V and ICD-11 definitions of schizophrenia are discussed.

Desire for social distance from people with mental disorders

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to make sense of this confusion, the present review focuses on research on the most commonly measured component: social distance. The review examines measurement of social distance; characteristics of people who desire greater social distance; experiences that affect social distance; characteristics of people that elicit social distance; the effects of psychiatric labelling; the effects of causal explanations for mental disorders; and interventions to reduce social distance. It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.

The public's stigmatizing attitudes towards people with mental disorders: how important are biomedical conceptualizations?

OBJECTIVE

This study examined hypotheses that stigmatizing attitudes are increased by use of psychiatric labels, by conceptualization of symptoms as a medical illness and by belief in genetic causes.

METHOD

A survey of 3998 Australian adults asked questions about one of four vignettes: early schizophrenia, chronic schizophrenia, depression and depression with suicidal thoughts. Attitudes were measured by a social distance scale and a question about likely dangerousness.

RESULTS

Social distance was unrelated to the hypothesized factors. For schizophrenia (but not depression), belief in dangerousness was predicted by medical illness conceptualizations and genetic causal attribution. However, more important factors were the behaviours in the vignette and the belief that they are because of weakness of character.

CONCLUSION

Biomedical conceptualizations are not the major cause of stigma, rather it is the behaviour associated with mental illness and the belief that this is because of personal weakness.

The construction of fear: Americans' preferences for social distance from children and adolescents with mental health problems

Debates about children's mental health problems have raised questions about the reliability and validity of diagnosis and treatment. However, little research has focused on social reactions to children with mental health problems. This gap in research raises questions about competing theories of stigma, as well as specific factors shaping prejudice and discrimination toward those children. Here, we organize a general model of stigma that synthesizes previous research. We apply a reduced version of this model to data from a nationally representative sample responding to vignettes depicting several stigmatizing scenarios, including attention-deficit/hyperactivity disorder (ADHD), depression, asthma, or "normal troubles." Results from the National Stigma Study-Children suggest a gradient of rejection from highest to lowest, as follows: ADHD, depression, "normal troubles," and physical illness. Stigmatizing reactions are highest toward adolescents. Importantly, respondents who label the vignette child's situation as a mental illness compared to those who label the problem as a physical illness or a "normal" situation report greater preferences for social distance, a pattern that appears to result from perceptions that the child is dangerous.

Renaming schizophrenia

Diagnosis and treatment are more important than semantics

Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach

OBJECTIVE

Many anti-stigma programmes use the 'mental illness is an illness like any other' approach. This review evaluates the effectiveness of this approach in relation to schizophrenia.

METHOD

The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes.

RESULTS

The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as 'illness', are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance.

CONCLUSION

An evidence-based approach to reducing discrimination would seek a range of alternatives to the 'mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.

Can a less pejorative Chinese translation for schizophrenia reduce stigma? A study of adolescents' attitudes toward people with schizophrenia

The term jing-shen-fen-lie-zheng (mind-split-disease) has been used to denote schizophrenia in Chinese societies. Many Asian countries, where the Chinese writing system is used, adopt a similar translation. This study examined whether a less pejorative name si-jue-shi-diao (dys-regulation of thought and perception) as a diagnostic label for symptoms of schizophrenia could reduce stigma. Secondary school students (n = 313) were randomly assigned to read a vignette with one of four labels: si-jue-shi-diao, jing-shen-fen-lie-zheng, jing-shen-bin (mental illness), and no label. Students expressed their social distance, stereotypes held, and attributions toward a young adult who met the Diagnostic and Statistical Manual-IV of Mental Health Disorders criteria for schizophrenia. It was found that psychiatric labeling did not have a statistically significant main effect on attitude measures. However, students with religious beliefs were more accepting toward the target individual associated with diagnostic label than one with no labeling. The results cast doubts that less pejorative labels can reduce the social stigma of schizophrenia. Some potential drawbacks in using politically correct terms to describe schizophrenia are highlighted.

The effects of stereotype suppression on psychiatric stigma

The effects of stereotype suppression on psychiatric stigma were investigated in two studies. In experiment 1, 52 participants were presented with a photograph of someone labeled with schizophrenia and instructed to write a passage describing a day in that person's life. Half of the participants were instructed to avoid using schizophrenia-related stereotypes in their passages (the stereotype suppression condition). Participants were then presented with a photograph of a different individual labeled with schizophrenia and asked to write another passage with stereotype suppression instructions omitted. The results showed that while stereotype suppression occurred for the first passage, the expected rebound effects were not observed in the second passage. Furthermore, the results were unchanged when participants' prior experience with persons with mental illness was considered. In a second study, the effects of stereotype suppression on behavior (i.e. seating distance from a person with schizophrenia) were examined in 58 participants. While the stereotype suppression instructions resulted in less stereotypical passages, replicating the results of study 1, no rebound effects on behavior were observed. A non-significant trend was observed whereby previous contact with persons with mental illness was associated with less social distance from someone with schizophrenia. Implications of the findings for reducing psychiatric stigma are discussed.