Prejudice, social distance, and familiarity with mental illness

Stay (Close to) Humble: Intellectual Humility Negatively Predicts Stigma Toward and Social Distance from Individuals with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) remains a highly stigmatized disorder despite its prevalence. Given that the origin of stigmatization is rooted in cognitive representations that people hold, stigma may be differentially exhibited by people with varying degrees of cognitive flexibility. Intellectual humility, the recognition of one's own intellectual shortcomings or flaws, may allow for flexibility in how people navigate knowledge surrounding PTSD, which may reduce stigma and improve interpersonal interactions with individuals with PTSD. The present study investigated whether intellectual humility would negatively predict PTSD stigma and social distance, above and beyond demographic factors and personal or social experience with individuals with PTSD. Participants (N = 421, 67.2% men, mean age = 37.45, SDage = 9.99) completed a multidimensional measure for intellectual humility and the Mental Illness Stigma Scale adapted to assess PTSD stigma. Results confirmed our preregistered predictions. Bivariate correlations demonstrated that overall intellectual humility was negatively correlated with overall PTSD stigma, and overall intellectual humility was negatively correlated with overall social distance. That is, intellectually humble people reported less PTSD stigma and desired closer social distance with individuals with PTSD. Additionally, hierarchical multiple regression revealed that intellectual humility predicted unique variance in PTSD stigma and social distance above and beyond the contribution of demographic factors and personal experience or social relationships with someone with PTSD. These results may provide a useful framework for approaching and minimizing stigma toward PTSD.

Coping with peer suicidality, help-seeking intentions, and suicidal attitudes among Asian adolescents: a mixed-methods study in Hong Kong

BACKGROUND

Adaptive responses to peer suicidality and the involvement of professional help are crucial for adolescent suicide prevention and may be influenced by suicidal attitudes. This study aimed to explore Hong Kong adolescents' responses to and help-seeking intentions for suicidal peers and to examine the influence of suicidal attitudes.

METHOD

This study used an exploratory sequential mixed-methods approach targeting Hong Kong adolescents aged 15-19 between September 2018 and October 2019. Adolescents' reactions to peer suicidality, suicidal attitudes, and willingness to help were examined through six focus groups and 12 individual interviews (N = 40). A cross-sectional survey (N = 1676) was subsequently conducted to investigate the prevalence of different responses to peer suicidality, help-seeking intentions, differences by background characteristics, and the impacts of suicidal attitudes.

RESULTS

Qualitative findings revealed three major themes: attitudes toward suicide, reactions to peer distress and suicidality, and willingness to help suicidal individuals. Most survey respondents reported actively responding and seeking informal help, but not professional support. Differences were observed based on sex, academic performance, and self-suicidality. Notably, a stigmatizing attitude was positively associated with both response types and informal help-seeking intentions. The belief that suicide is unpreventable was positively associated with passive responses but negatively associated with active responses and informal help-seeking intentions.

CONCLUSIONS

Our findings highlight variability in adolescents' responses to peer suicidality and help-seeking intentions, underscoring the need for attitude-tailored courses and more systematic, action-based gatekeeper training. Recommendations are provided to enhance the effectiveness of mental health first aid programs through public education, school interventions, and media campaigns.

'Zombie drugs': Dehumanising news frames and public stigma towards people who use drugs

BACKGROUND

News media is an important determinant of public understanding of drug policy topics. Recent media reporting around the use of synthetic drugs such as xylazine makes frequent use of non-human metaphors, including reference to the effects of 'zombie drugs'. We investigated whether presentation of news stories which included such dehumanising frames were associated with i) increased stigmatising attitudes towards people who use drugs; and ii) lower support for relevant harm reduction programmes.

METHODS

We undertook a cross-sectional online experimental study with a randomised factorial design, using a nationally representative sample (UK). Participants (N = 1417) were randomly presented with one of six simulated news stories based on recent reports of the identification of xylazine in the drug market. Stories differed with respect to text (neutral or referred to either a 'zombie drug', or a drug that 'turns people into zombies'); and accompanying imagery (neutral or depicting immobile people under the influence of drugs). Stigmatising attitudes and support for harm reduction were assessed using instruments including an adapted version of the Attribution Questionnaire-Substance Use Disorders (AQ-SUD) and analysed using MANOVA.

RESULTS

Data were obtained for 1235 participants (52 % female; mean age 47 ± 16). Attitudes towards people who use drugs were more stigmatising amongst participants presented with either of the dehumanising text conditions (both p < 0.001). There was no main effect of imagery and no interaction between text and imagery on stigma scores. Support for harm reduction programmes did not differ between conditions.

CONCLUSION

Our study is the first to show that dehumanising 'zombie' framing frequently used in news reporting is associated with higher public stigma towards people who use drugs. News media is an important source of public education on drugs, so to avoid reinforcing stigma the use of dehumanising language and framing, such as 'zombie' metaphors, should be avoided. Organisations working to reduce stigma towards people who use drugs should encourage news outputs and journalists to avoid this type of representation.

Who's at the Bottom of the Hiring List? Exploring the Compounding Effects of Applicant Race and Offense History on Employability

Justice-involved persons, especially people of color and those convicted of a sexual offense, experience bias and other barriers when seeking employment. However, there is no research on the synergistic effects of race and sexual offense history on employment-related outcomes. This study examined whether a hypothetical job applicant's race (Black vs. White) and/or sexual offense history (sexual, non-sexual, or no history) impacted hiring decisions and employment-related outcomes. Results revealed no significant main effects of applicant race and no interaction between applicant race and offense history across all employment-related outcomes. However, participants were less likely to endorse hiring the applicant and desired greater social distance from the applicant if he had a prior sexual offense compared with those having a non-sexual offense. This finding suggests applicants with a known sexual offense history may be more frequently passed up for jobs than other justice-involved applicants for reasons unrelated to the job itself.

Effects of clinical stage, behavioral and psychological symptoms of dementia, and living arrangement on social distance towards people with dementia

BACKGROUND

Dementia presents significant challenges, including social exclusion, which can be exacerbated by public stigma. This study aimed to clarify how social distances, a common measure of public stigma, towards people living with dementia and its associated factors vary with clinical stage, presence of behavioral and psychological symptoms of dementia (BPSD), and living arrangements.

METHODS

The study involved 2,589 Japanese participants aged 40 to 90 years. They were exposed to one of four vignettes depicting an 80-year-old woman progressing from normal ageing to mild, moderate, and severe dementia: Vignette A (living with husband, without BPSD); Vignette B (living with husband, with BPSD); Vignette C (living alone, without BPSD); and Vignette D (living alone, with BPSD).

RESULTS

Social distance showed no significant differences in the normal aging and mild stage of dementia across all vignettes. At the moderate stage, social distance was higher for individuals exhibiting BPSD, regardless of living arrangement. At the severe stage, the lowest social distance was observed towards individuals living with their family without BPSD, whereas the highest was towards those living alone, exhibiting BPSD. For Vignette A, possession of social capital (p<0.001) and having experience of social contact with people living with dementia (PLWD) (p = 0.001-0.007) were independently associated with lower social distance across all dementia stages. In addition, in the mild stage of dementia, high perceived social support (p = 0.005) and having knowledge about dementia (p = 0.036) were associated with lower social distance, but not in the moderate or severe stage of dementia. For Vignette D, possession of social capital (p≤0.001) and having experience of social contact with PLWD (p<0.001 to p = 0.006) were independently associated with lower social distance across all dementia stages. In mild dementia, female sex (p = 0.004) and knowledge about dementia (p = 0.026) were associated with lower social distance. Furthermore, in mild and moderate dementia, living in rural area (p = 0.003-0.048) was associated with lower social distance.

CONCLUSIONS

Social distance is higher toward PLWD who live alone and exhibit BPSD than toward those who live with family and/or do not show BPSD, indicating a higher risk of exclusion for the former. Moreover, factors affecting social distance towards PLWD vary across different clinical stages of dementia. While greater knowledge about dementia is associated with lower social distance toward PLWD, this effect appears to be most pronounced in the mild stage. In contrast, opportunities for social contact with PLWD are crucial for achieving lower social distance across all stages of dementia. The findings underscore the need for stage-specific interventions to address stigma, with a focus on education and opportunities for social contact. Targeted efforts are especially important for promoting the inclusion of PLWD who live alone and exhibit BPSD.

Public disclosures of mental health problems on social media and audiences' self-reported anti-stigma effects

Public disclosures of mental health problems on social media represent a potentially powerful informal avenue for increasing mental health literacy and reducing public stigma in relation to people with mental health problems. We investigated whether the audience reported any reduction in their own stigma toward people with mental health problems after exposure to disclosures. We also examined whether self-reported stigma reduction was associated with the characteristics of audience members, the disclosers and the disclosure messages. We used Prolific to obtain a convenience sample (N = 803) of adults who had been exposed to a disclosure. We administered an online survey to participants and conducted a series of logistic regressions to identify any associations between disclosure-related characteristics and audience self-reported stigma reduction. Our findings showed that certain aspects of the messaging process appeared to be associated with stigma reduction. These included explicit diagnoses from disclosers, particular message themes such as psychosocial causes of mental ill health, and positive and echoing comments from other users. In addition, audience members who reported greater levels of empathy toward, perceived similarity to and identification with disclosers tended to report reduced stigma. These findings contribute to the evidence base underpinning how, when and which public disclosures of mental health problems on social media have the potential for stigma reduction. They can further help inform future health promotion practices on social media aiming to mitigate mental health-related stigma at the population level. Future research may focus more on the dynamics and match between disclosers and audiences and their effects on stigma.

The Role of Diagnostic Models in Prejudice Toward People With Borderline Personality Disorder: An Experimental Investigation

We tested whether dimensional personality disorder models such as the Alternative Model for Personality Disorders (AMPD) cause less prejudice toward people with borderline personality disorder (BPD) than categorical models, and we sought to identify the mechanisms underpinning this reduction in prejudice. Undergraduate psychology students (n = 183) were randomly assigned to one of three conditions (AMPD, categorical, control) and given descriptive information about BPD. Participants in the AMPD and categorical conditions also received a presentation about their respective BPD diagnostic criteria. Students in all conditions then completed a survey assessing their prejudice toward people with BPD. There was no difference between conditions on overall prejudice toward people with BPD. However, the AMPD increased continuum beliefs and decreased categorical beliefs, and these, in turn, affected perceptions of people with BPD as ingroup members, which indirectly reduced prejudice. We have identified pathways through which the AMPD indirectly reduces prejudice toward people with BPD.

How to save a life: Public awareness of a national mass media take home naloxone campaign, and effects of exposure to campaign components on overdose knowledge and responses

BACKGROUND

Take home naloxone (THN) programmes are effective at reducing opioid related mortality, but require high levels of distribution, including to the general public. Mass media campaigns can be effective in improving public understanding of a topic and encouraging behavior change. Whilst mass media campaigns focusing on naloxone have been developed internationally, there is a lack of research on their potential impact. We investigated the effects of components of a recent national mass media campaign (Scotland, UK) designed to improve public awareness of drug related deaths, and readiness to intervene.

METHODS

We undertook a cross-sectional online experimental study with a randomized design, conducted with a nationally representative sample. Participants (N = 1551; 52.6% female; age 46.1±16.5 years) were assessed on overdose knowledge and readiness to intervene after presentation of eight combinations of campaign components.

RESULTS

Compared to a basic campaign description, exposure to all types of campaign component were associated with higher overdose knowledge (p < .001), but not knowledge of what to do in response to an overdose (p = .374), or readiness to intervene (p= .286). The greatest effects were associated with a media rich audio-visual resource (animated video with a popular song on the soundtrack, and narrated by a well-known actor).

CONCLUSION

Our data suggest that harm reduction is an appropriate topic for large-scale mass media campaigns. However, effects may be limited to knowledge and awareness raising in the general public, and may be related to the types of media used. Audience segmentation is important and more general messaging about drug related deaths may be more appropriate for the majority of audiences.

Prevalence of stigma towards mental illness among Portuguese healthcare professionals: a descriptive and comparative study

Background

Stigmatising attitudes among healthcare professionals can hinder access to healthcare, making it important to address this issue. This study aimed to investigate the prevalence of stigma related to mental illness among Portuguese healthcare professionals and to compare the results among mental health professionals, General Practitioners (GPs) and other health professionals.

Methods

An online cross-sectional observational study was conducted in Portugal using Google Forms® to collect data. The data collection process lasted five months, from September 2023 to January 2024. Participants were recruited from various professional associations and Health Centre Groups, through a purposive sampling. The study used the Portuguese version of the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) to measure stigma which assesses three dimensions: attitudes towards disclosure and help-seeking, attitudes towards people with mental illness, and attitudes towards social distance.

Results

A total of 292 healthcare professionals participated in the study. In Portugal, healthcare professionals displayed low to moderate levels of stigma towards mental illness (M = 22.17, SD = 5.41). Mental health professionals demonstrated significantly lower levels of stigma (M=20.37, SD=5.37) compared to other healthcare professionals (M=24.15, SD=4.71), including GPs (M=23.97, SD=5.03). Additionally, having a close friend or relative with mental illness seemed to be related with lower levels of stigma for the dimension attitudes towards social distance (M=6.93, SD=2.50), compared to not having one (M=7.60, SD=2.56). On the other hand, a personal history of mental illness indicated higher levels of stigma for the dimension disclosure and help-seeking (M=8.95, SD=3.07), compared to having no history of mental illness (M=8.16, SD=2.67).

Conclusion

This study indicates that Portuguese healthcare professionals have stigmatising attitudes towards mental illness, although at low to moderate levels. Training and frequent interaction with people with mental illness seem to be associated with lower levels of stigma. Personal experience of mental illness seems to follow the opposite path regarding disclosure and seeking help. Thus, further research is necessary to evaluate the effectiveness of anti-stigma measures and deepen the study of the concept of self-stigma in healthcare professionals.

Somatized or stigma? Causal attributions and emotional responses in shaping social distance towards people with mental illness, China

Background

Mental illness in China has traditionally been attributed to physical factors and somatization tendencies, which seldom result in stigma. How has this perception changed after decades of social change?

Methods

Based on the Chinese General Social Survey database in 2011, this study constructed a structural equation model to analyze the effects of causal attribution and emotional responses on social distance. The causal attributions include dangerousness, controllability, and responsibility. And the emotional responses encompass negative affect, traditional prejudice, treatment carryover, and exclusionary sentiments. In addition, higher scores indicating greater social distance, whereas a low score reflected stronger emotional responses or a greater degree of internal attribution.

Results

The results reported a high level of social distance towards people with mental illness. These findings indicated that emotional responses have a direct impact on social distance. Specifically, when negative affect, traditional prejudice, and exclusionary sentiments increase by one standard deviation, the social distance decreases by 0.497, 0.178, and 0.073 standard deviation, respectively. Conversely, as the level of treatment carryover rises, social distance increases by 0.087. Meanwhile, the causal attribution only exerts a significant indirect effect on social distance by the function of emotional causal responses.

Conclusion

The results indicated that the public attributes mental illnesses like depression primarily to psychological issues rather than somatic ones. It suggested widespread stereotypes and public stigma towards people with mental illness in China, as well as an arduous task in anti-stigma. In addition, a targeted way to address public stigma lies in changing the stereotype of people with mental illness.

The Associations Among Observers' Openness to Experience and Agreeableness With Social Distance: The Moderating Role of Disability Type

ABSTRACT

Despite abundant literature on personality and stigma, the role of disability type in this relationship has remained unaddressed. In the current study, we examined whether the relationship between observers' openness to experience and agreeableness on the one hand, and social distance on the other, was moderated by the target person's type of disability (psychiatric vs. physical). One hundred thirty-nine participants were randomly assigned to complete a social distance questionnaire referring to a vignette of a person in three conditions (physical disability, psychiatric disability, and control). A main effect of openness on social distance was found. Additionally, we found an interaction effect of agreeableness and the type of disability. Namely, the relationship between agreeableness and social distance was significant only in the physical disability condition but not in the other two conditions. To conclude, the current study emphasizes the role of personality traits in social distance toward individuals with disabilities.

The perspectives of hospital doctors about end-of-life care in people with mental illness: an observational pilot study

BACKGROUND

Negative attitudes towards people living with mental illness (PLWMI), defined here as mentalism, are a major contribution to health care inequity, which may extend into end-of-life care. There is a clear need for investigation of the attitudes of doctors towards PLWMI at the end of life as doctors may lead processes of care that contribute to this inequity.

AIMS

The aim of this pilot study is to examine the perspectives of hospital-based doctors regarding end-of-life care and medical decision-making in PLWMI.

METHODS

A survey was created to explore whether mentalism is present in the perspectives of hospital doctors regarding end-of-life care for PLWMI. The survey included demographic characteristics of participants and questions comprising statements and vignettes that required agree/disagree responses. Descriptive statistics were used to summarise responses, and chi-square tests examined associations with demographic variables.

RESULTS

The survey was commenced by 48 hospital-based doctors and completed by 45. Descriptive statistics indicated that mentalism is present in the attitudes of hospital doctors regarding end-of-life care of PWLMI, with 47 of 48 participants (98%) endorsing at least one mentalist response. One significant association found that psychiatrists and psychiatry trainees were less likely to endorse a stereotype response in one vignette.

CONCLUSIONS

This preliminary study addresses a gap within the literature on the potential contribution of mentalist attitudes in doctors to the poorer end-of-life care outcomes for PLWMI. The findings highlight the need for further study of this topic and suggest a role for targeted medical education in the pursuit of health care equality for PLWMI.

AUD in perspective

Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.

Representations of hallucinations and dissociation in young adult literature: using literature to challenge stigma about psychosis

This paper explores the role that sensitively portrayed literary representations of hallucinations and dissociation may have in counteracting stigma associated with these experiences. In it, we focus on narratives of young people experiencing hallucinatory and dissociative phenomena in two award-winning, young adult novels: How It Feels to Float by Helena Fox and A Monster Calls by Patrick Ness. We identify and discuss three literary devices in these two novels that promote empathy for the characters and their experiences. The narrative accounts in both novels challenge conceptions of hallucinations and dissociation as unknowable and unrelatable experiences with their empathic portrayals of relatable characters that create comprehensible accounts of adolescents grappling with their sense of reality. Importantly, they highlight the potential role that literature can play in stigma reduction by positively shaping young peoples' understandings of unfamiliar mental health experiences.

Behavioral Addiction from the Asian Americans Perspective: Exploration of Public and Help-Seeking Stigma

Asian Americans have been unlikely to seek mental health services despite their needs for treatment, particularly when experiencing significant gambling or Internet gaming problems. Stigma is often considered to be a barrier to seeking help. To understand how stigma impacts Asian Americans' willingness to seek mental health services, the present study used an online survey to investigate the public stigma associated with addictive behaviors and help-seeking stigma among Asian Americans. Participants (N = 431) who self-identified as Asian American, reside in the US. Using a between-groups vignette study design, it was found that the individual with a behavioral addiction received more stigma compared to the individual who experienced a financial crisis. In addition, participants were more likely to seek help if they experienced addictive behavioral problems rather than financial problems. Lastly, this study did not reveal a significant relation between public stigma attached to addictive behaviors and Asian Americans' willingness to seek help, but it found that participants' willingness to seek help was positively associated with public stigma of help seeking (β = 0.23) and negatively associated with self-stigma attached to help-seeking (β = - 0.09). Based on these findings, recommendations are provided to inform community outreach to reduce stigma and promote mental health service utilization among Asian Americans.

Inclusive social norms and nationals' positive intergroup orientations toward refugees: The moderating role of initial prejudice and intergroup contact

Research on the interplay between inclusive norms and intergroup contact on improving intergroup orientations has yielded conflicting results, suggesting either that an experience of personal contact is necessary to have a positive effect of inclusive norms or that such personal experience is not always necessary. To clarify this issue, across four studies (N = 835), we investigated the influence of inclusive norms on positive intergroup orientations as a function of personal experiences of intergroup contact. Study 1 demonstrated that inclusive norms are more strongly correlated with experiences of personal contact with outgroups with whom opportunities of contact are more (i.e., immigrants) than less (i.e., refugees) frequent. Study 2 provided experimental evidence for this finding showing that inclusive norms increase prejudiced nationals' willingness to engage in future contact with immigrants but not with refugees, suggesting that conformity to inclusive norms depends on varying contact opportunities with the outgroups. Studies 3 and 4 confirmed that prejudiced nationals conformed to inclusive norms specifically when experienced positive contact with a refugee (experimentally induced with the imagined contact paradigm), compared with no contact (Study 3) or negative contact (Study 4). We discuss the implications of these findings for research on intergroup contact, social influence, and intergroup relations.

Effects of an empathy enhancement program using patient stories on attitudes and stigma toward mental illness among nursing students

Objective

This study aims to explore the impact of an empathy intervention through patients' stories and investigate its impact on attitudes and stigma toward mental illness among nursing students prone to hold prejudices against this condition.

Methods

Using a quasi-experimental pretest-posttest design, this study focused on nursing students and examined the effects of an empathy enhancement program targeting individuals with mental illnesses on communication, social distance, and prejudice. Ninety third-year nursing students from S and C cities and H and C universities enrolled in psychiatric nursing courses participated in the study. The intervention lasted 4 weeks and used the patient's story to facilitate a participatory approach to understanding the patient's life and encouraging mutual growth and expansion of consciousness in the therapeutic relationship. Age was treated as a covariate and analyzed using a two-way repeated-measure analysis of covariance.

Results

The Empathy Enhancement Program Using Patient Stories (EEP-PS) group and the clinical practicum group showed no significant differences in communication, social distance, and empathy scores between the two groups or across different time points. However, variations were observed when examining specific subdomains within each group and across time points. Informative communication (F = 10.34, p = 0.002) and affiliative communication (F = 21.60, p < 0.001), which are subcategories of communication, increased significantly in the posttest compared to the pretest. Among social distances, interpersonal-physical distance decreased significantly in the posttest compared to the pretest (F = 31.02, p < 0.001). Prejudice of incompetence (F = 6.52, p = 0.012) and prejudice of risk (F = 14.37, p < 0.001) were significantly lower in the posttest than in the pretest.

Conclusion

Both the EEP-PS and clinical practicum groups experienced improvements in communication, social distance, and prejudice toward individuals with mental illness. This study suggests that direct patient interactions and the use of patient narratives as indirect methods are effective approaches for enhancing attitudes and reducing stigma toward mental illness among nursing students.

Knowledge, familiarity, and impact of the COVID-19 pandemic on barriers to seeking mental health services among older people: a cross-sectional study

AIM

The COVID-19 pandemic caused drastic changes in older people's daily activities with a negative impact on their mental health, yet older people are less likely to seek mental health services. This study aims to explore the relationship between knowledge of and familiarity with mental health services, along with the impact of the COVID-19 pandemic, and barriers to seeking mental health services among older people.

METHODS

A descriptive cross-sectional study was conducted with a convenience sample of 352 older people, recruited among community-dwelling adults who attended randomly selected postal offices and pension outlets. Three tools were used: a structured interview schedule for sociodemographic and clinical characteristics of older people, the revised version of the Knowledge and Familiarity of Mental Health Services Scale (KFFMHS-R), and the Barriers to Mental Health Services Scale Revised (BMHSS-R).

RESULTS

All participants reported experiencing mental health distress during the COVID-19 pandemic. Intrinsic barriers had a higher mean score than extrinsic barriers, and 27.4% of the variance of overall barriers to seeking mental health could be explained through regression analysis by familiarity, knowledge of mental health services, and age. Overall barriers explained 24.4% of the variance of older people's perceived distress as an impact of the COVID-19 pandemic (F = 22.160, P < 0.001).

CONCLUSIONS

Knowledge of mental health services was the most significant predictor of barriers to seeking mental health services during the COVID-19 pandemic. Higher barriers predicted higher distress as an impact of the COVID-19 pandemic. The results of the study suggest the need for a multidisciplinary mental health team for older people.

Narratives and Mental Illness: Understanding the Factors That Impact Stigmatizing Attitudes and Behavioral Intentions

Entertainment television has been explored to reduce stigmatizing attitudes toward mental illness by incorporating positive stories about characters with mental illness. Guided by mediated contact theory and the extended elaboration likelihood model, this study examines whether exposure and engagement with entertainment narratives, featuring characters with mental illnesses of varying levels of public stigma, impacts stigmatizing attitudes and intentions to interact with individuals with mental illness generally. Participants (n = 234) were randomized to one of the three conditions: (1) a more stigmatized mental illness (schizophrenia), (2) a less stigmatized mental illness (depression), or (3) a non-mental illness control (cancer). Participants in the more stigmatized condition reported significantly less identification with characters than those in the less stigmatized condition, and greater identification with the characters were associated with more positive attitudes and behavioral intentions. Narrative counterarguing was associated with less positive attitudes and intentions toward people with mental illness. Implications based on these findings include identifying ways to increase engagement with less familiar mental illnesses to optimize the positive outcomes associated with narrative engagement.

Mental illness stigma in Bangladesh: Findings from a cross-sectional survey

Background

Mental illness stigma is universally prevalent and a significant barrier to achieving global mental health goals. Mental illness stigma in Bangladesh has gained little attention despite its widespread impact on seeking mental health care in rural and urban areas. This study aimed to investigate mental illness stigma and the associated factors in rural and urban areas of Bangladesh.

Methods

The study areas were divided into several clusters from which 325 participants (≥18 years) were recruited with systematic random sampling. The Bangla version of the Days' Mental Illness Stigma Scale was used to collect data. Independent-samples t-test, ANOVA, and multiple regression were performed.

Results

Results suggest that gender, age, geographical location, socioeconomic status, and occupation significantly differed across subscales of stigma. Age, gender, seeking treatment of mental illness, having knowledge on mental health, and socioeconomic status were predictive factors of mental illness stigma. The results also showed a high treatment gap in both rural and urban areas.

Conclusion

This study supports that mental illness stigma is prevalent in Bangladesh, requiring coordinated efforts. Results can inform the development of contextually tailored mental health strategies to reduce stigma and contribute to the promotion of mental health of individuals and communities across Bangladesh.

Beyond recovery: toward rights-based mental health care - A cluster randomized wait-list controlled trial of a recovery and rights training for mental health professionals with or without first person accounts

Introduction

Mental health models grounded in Recovery and Rights are driving the advancement of transformative care systems through multifaceted actions, which encompass Continuing Professional Development. The objective of this work is to evaluate a training activity developed through a participatory process that included people with lived experience of psychosocial distress, their relatives, and mental health professionals.

Methods

The training focused on alternatives to diagnosis, recovery principles, rights-based care, and peer support. The evaluation followed a cluster randomized wait-list controlled design. Four hundred eighty-eight health professionals from eight care centers were randomized to three experimental conditions: a wait list control, which underwent a one-month interval between the baseline assessment and the training activity, and two experimental groups, with or without first-person accounts, which accessed the training immediately after completing the baseline assessment. The dependent variables measured at all follow-ups were beliefs and attitudes toward mental health service users' rights. One hundred ninety-two professionals completed at least one follow-up and were included in the analyses.

Results

We observed different evolutions of experimental and control groups with statistically significant differences for tolerance to coercion and total beliefs and attitudes scores. No differences were observed between the groups with or who attended training activities with or without first person accounts. Upon receiving the training activity, the control group had an evolution equivalent to the experimental groups.

Discussion

The results of this evaluation project provide compelling evidence for the need to expand recovery and rights training activities to reach a larger audience of mental health professionals These training activities hold the potential to positively influence the beliefs and attitudes of mental health professionals, ultimately contributing toward a better future for individuals with lived experience of psychosocial distress.

Mental health related stigma in Romania: systematic review and narrative synthesis

BACKGROUND

Stigma related to mental illness is increasingly and more effectively addressed. Although more research is being conducted, there is relatively little from low and middle-income countries, with former Soviet bloc countries identified as a particular contributor to this evidence gap. Romania struggles with mental health stigma at many levels. The aim of this review was to bring together all relevant data regarding stigma and discrimination related to mental illness as well as actions to address these problems in Romania in order to prioritise further stigma research and identify priority targets for stigma reduction.

METHODS

A systematic literature search was conducted in three online databases and grey literature. After the analysis of full manuscripts, four were excluded based on lack of relevance or incomplete data reporting. Quality assessment was performed for included studies using the Mixed Methods Appraisal Tool (MMAT) and the narrative was synthesized based on the research questions.

RESULTS

The review included fifteen studies, the majority having a cross-sectional design. Stigma related to mental illness in Romania, has an impact on help-seeking attitudes and behaviours, workplace environment and social relationships of people with mental health problems. Negative stereotypes are maintained and validated by mass media reports. Significant stigma in healthcare and mental care settings has also been observed. Self-stigma was less frequently reported than public stigma. Despite a few stigma reduction actions, no rigorous evaluation of content, delivery and effectiveness has been conducted and no empirical evidence has been published.

CONCLUSIONS

Based on this review, three lines of action are recommended in Romania. Increase research concerning stigma in healthcare and mental care settings and use behavioural outcomes. Develop and deliver evidence-based tailored interventions to reduce stigma in identified priority subgroups of the population and ensure rigorous evaluation and scientific dissemination. Elaborate guidelines for working with community stigma and advocate for structural changes.

The associations between public stigma and support for others' help-seeking for alcohol use disorder: a cross sectional study in the general Danish population

BACKGROUND

A minority of all individuals with alcohol use disorders (AUD) seek treatment, where stigma is one prominent barrier. Social support is important to facilitate health and increase treatment-seeking. Whether there is an association between stigma and attitudes towards others' help-seeking for AUD is unknown. The aim of this study was to investigate the associations between stigma and support towards others' help-seeking for AUD, also to explore possible gender differences.

METHOD

Cross-sectional study, n = 2895, including Danish adults aged 30-65 in the general population. Year 2020, an online questionnaire was administrated, which covered demographics, attitudes towards others' help-seeking for AUD, and stigma measured with the Difference, Disdain & Blame Scales. Analyses were performed with Restricted Cubic Spline models, and odds ratios were calculated.

RESULTS

Lower level of stigma was associated with a higher probability for endorsing an "active support strategy". Level of stigma was not associated with "not knowing what to say or do" or "sharing my concern with others". There were few gender differences: among men, higher level of stigma was associated with a higher probability of "avoidance". Among women, lower level of stigma was associated with a lower probability of "avoidance".

CONCLUSION

There is a clear association between stigma and attitudes towards supporting others' help-seeking for AUD. The results highlight the need to reduce stigma and promote engagement towards others' treatment-seeking.

How to measure mental illness stigma at work: development and validation of the workplace mental illness stigma scale

Introduction

The study objective was to design a new theoretically driven multidimensional scale for the use in the empirical measurement of stigmatizing attitudes towards persons with mental illness within the return-to-work process as this integral part of vocational reintegration has been widely neglected by scholars so far.

Methods

Therefore, we developed and validated a 21-item instrument to comprehensively measure the three-factorial structure of stigmatizing attitudes (affect, cognition, behavior) across two studies (overall N = 251).

Results

In both studies the new scale proved to be highly internally consistent, and its proposed three-factor structure was equally supported across the two studies. Convergent and discriminant validity were demonstrated by moderate and high correlations or zero correlations with pertinent measures. Furthermore, construct validity of the new scale was supported by significant positive associations with relevant personality characteristics within stigma research.

Discussion

The WMISS is the first instrument to measure mental health stigma specifically within the return-to-work-process and demonstrates strong psychometric properties. Inclusion of this scale in future research can help facilitate understanding of mental illness stigma within the occupational sector and assist with targeted intervention development.

A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India

In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.

Does explaining psychogenic nonepileptic seizures using either a biomedical or biopsychosocial framework affect young people's illness representations? An experimental vignette study

Lay representations of psychogenic nonepileptic seizures (PNES) are important both for understanding public stigma and anticipating patient responses to PNES diagnosis. The current study presents the first evidence of the general public's representations of PNES and the malleability of these understandings to different ways of explaining PNES. An online experimental study exposed participants (n = 193, aged 18-25 years) to a vignette describing a case of PNES in biomedical terms, PNES in biopsychosocial terms, or epilepsy. Subsequent questionnaires assessed participants' illness representations, causal attributions, and stigmatising attitudes regarding the case about which they read. Results suggest that compared with biomedical framings, biopsychosocial explanations increased perceptions of PNES as threatening. While epilepsy was attributed to significantly more biological and less social causes than either of the PNES vignettes, causal attributions did not differ between biomedically- vs. biopsychosocially-framed PNES. Neither were there any differences between the three conditions in stigmatising attitudes towards people who experience seizures. These findings are useful for clinicians delivering a PNES diagnosis and patients disclosing a PNES diagnosis, in helping anticipate responses to these communications. Further research is required to confirm the clinical and societal significance of the study's first insights into the dynamics of lay responses to PNES.

Studying Socioeconomic Status: Conceptual Problems and an Alternative Path Forward

Socioeconomic status (SES; or social class) is considered an important determinant of psychological and life outcomes. Despite this importance, how to appropriately conceive of and measure it remains unsettled. In this article, I argue that SES is, under conventional conceptions of the construct, an unmeasurable construct and present an alternative strategy for studying socioeconomic conditions. I make this argument using several lines of analysis. First, a literature review of 20 years of psychological research on SES reveals that psychologists rarely define SES theoretically (79.6% of articles did not) but call a great number of operationalizations measures of SES (147 in total). Second, current recommendations for studying SES permit contradictory predictions, rendering the recommendations unsatisfactory. Third, the appropriate measurement model for SES inhibits accumulation of results across studies, which makes studying the construct practically impossible. To rectify these issues, I reconceptualize SES as a set of socioeconomic conditions and develop a measurement strategy for studying these conditions. I conclude by considering implications for ongoing research on socioeconomic conditions and for interpreting past research on SES.

Public stigma and treatment preferences for alcohol use disorders

BACKGROUND

Alcohol use disorders (AUD) are among the most highly stigmatized medical conditions. Only a minority of individuals with AUD seek treatment, and stigma is one of the most prominent barriers to treatment-seeking. However, there is a lack of knowledge about the associations between stigma and preferences for help-seeking, and the associations between stigma and preferences for treatment seeking.

AIM

to investigate the associations between stigma and preferences for where to seek help and treatment for AUD. As sub-analyses, associations between stigma, level of alcohol use and preferences for help-seeking and treatment preferences will be analyzed.

METHOD

Cross-sectional design, including n = 3037 participants aged 30 - 65 years, living in Denmark.

DATA

In 2020, an online questionnaire was administered by a market research company. The questionnaire covered demographics, preferences for help-seeking and treatment for AUD, stigma measured with the Difference, Disdain & Blame Scales for Public Stigma, and alcohol use measured with the Alcohol Use Disorder Test (AUDIT).

ANALYSES

restricted cubic spline models were applied to model outcomes. Odds ratios were calculated.

RESULTS

A lower level of stigma was associated with a higher probability of preferring formal and informal help-seeking for AUD. Both high and low levels of stigma were associated with a higher probability of preferring to consult general practitioners. Stigma was not associated with other preferences for treatment-seeking, nor trying to change oneself or a passive strategy. The sub-analyses, grouped by level of alcohol use, showed similar results.

CONCLUSION

Stigma is associated with lower preferences for formal and informal help-seeking, however not type of treatment preferred. Future studies should address stigma in relation to other factors of the treatment-seeking process.

General and Case-Specific Approval of Coercion in Psychiatry in the Public Opinion

BACKGROUND

Psychiatric patients are subjected to considerable stigmatization, in particular, because they are considered aggressive, uncontrollable, and dangerous. This stigmatization might influence the approval of coercive measures in psychiatry by the public and healthcare professionals and might have an influence on the clinical practice of coercive measures. We examined whether the general approval of coercive measures for psychiatric patients with dangerous behaviors differs from case-specific approval.

METHOD

We conducted a representative survey of the general population (n = 2207) in the canton of Basel-Stadt, Switzerland. In total, 1107 participants assessed a case vignette depicting a fictitious character with a mental illness and indicated whether they would accept coercive measures (involuntary hospitalization, involuntary medication, and seclusion) for the person in the vignette. It was explicitly stated that within the last month, the fictitious character displayed no dangerous behavior (Vignette ND) or dangerous behavior (Vignette D). Another 1100 participants were asked whether they would approve coercive measures (involuntary hospitalization, involuntary medication, and seclusion) for psychiatric patients with dangerous behavior in general (General D), i.e., without having received or referring to a specific case vignette.

FINDINGS

The logistic regression model containing all variables explained 45% of the variance in approval of any type of coercive measures. Assessment of case vignettes without dangerous behavior (Vignette ND) was associated with significantly reduced approval of coercive measures compared to assessment of a case vignette with dangerousness (Vignette D), while approval for coercive measures in a person with mental health disorder with dangerous behavior in general (General D) was significantly higher than for the case vignette with dangerousness.

CONCLUSIONS

The general approval of coercive measures for people with mental disorders seems to differ depending on if the respondents are asked to give a general assessment or to examine a specific and detailed clinical case vignette, indicating an increased role of stigmatization when asking about generalized assessments. This may contribute to diverging findings on the acceptance of coercive measures in the literature and should be considered when designing future studies.

Effects of media representations of drug related deaths on public stigma and support for harm reduction

BACKGROUND

Drug related deaths (DRD) are at historically high levels in the United Kingdom (UK), but some approaches that have the potential to reduce risk of mortality remain controversial. Public support makes an important contribution to drug policy development but there are high levels of public stigma towards people who use drugs (PWUD), and this is partly shaped by media representations. We investigated whether depiction of the characteristics of decedents represented in news articles about DRD was associated with differences in stigmatising attitudes and support for harm reduction policy.

METHODS

We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample (UK). Participants (N = 1280) were randomly presented with one of eight simulated news stories that reported on a DRD that differed with respect to drug (ecstasy or heroin), and the gender (male or female) and age (younger or older) of the decedent. Data were analysed using MANOVA.

RESULTS

Data were obtained for 1248 participants (51.0% female; mean age 45.7±15.4). Stigma was higher towards depictions of male, older, and heroin deaths (all p < .001). Harm reduction support was higher in those participants seeing older compared to younger subjects (p = .035), and the older ecstasy decedent compared to younger decedent (p = .029).

CONCLUSION

Presentation of some types of DRD are associated with higher public stigma towards the decedent than others. Those groups developing agenda-setting activities designed to reduce stigma or foster public support for harm reduction policies should consider the different ways in which audiences may respond to the depiction and framing of DRD in news media.

Cross-race responses to mental illness cues

Much research suggests mental health diagnoses elicit stigmatization of individuals. The current study builds upon this literature at the intersection of same- and cross-race perceptions. Black and White participants viewed Black and White targets paired with either a mental health diagnosis (e.g., depression), a physical health diagnosis (e.g., high blood pressure), or no health information (control) while indicating each target's favorability and how much social distance they would want from them. Overall, people were more stigmatizing toward targets with a mental health diagnosis than a physical health diagnosis or no diagnosis. Black targets with a mental health diagnosis were stigmatized more than White targets with a mental health diagnosis and White participants displayed a greater aversion to Black targets with a mental health diagnosis than did Black participants. Results contribute to the mental health stigma literature and suggest it may be particularly problematic for White perceivers' attitudes toward Black individuals with mental health diagnoses. Findings may shed light on the racial differences in treatment-seeking amongst Black and White individuals.

The effectiveness of psychoeducation in improving attitudes towards psychological disorders and internalized stigma in the family members of bipolar patients: A quasi‐experimental study

Family members of bipolar patients experience stigma following being labeled by others, which can disrupt their routine lives and result in social isolation. This study aims to evaluate the effectiveness of psychoeducation in improving the attitudes of bipolar patients' family members towards psychological disorders and internalized stigma. The present study is a quasi-experimental study with a pre- and post-test follow-up design, in which 74 individuals were selected by convenience sampling among families who had a member with a bipolar disorder who was referred to the largest psychiatric hospital in Iran in 2021. The participants were randomly divided into the experimental and control groups (n = 37 per group). The members of the experimental group then underwent eight 90-min sessions of psychoeducation. The control group also received psychoeducation at the end of the study. The results of analysis of covariance showed that psychoeducation reduced internalized stigma in the family members of bipolar patients and increased their positive attitudes towards psychological disorders compared with the control group (p < .01). On this basis, psychoeducation can be useful to reduce the internalized stigma of family members of bipolar patients and to increase their positive attitudes towards psychological disorders.

Parasocial relationships on YouTube reduce prejudice towards mental health issues

Intergroup contact has long been established as a way to reduce prejudice among society, but in-person interventions can be resource intensive and limited in reach. Parasocial relationships (PSRs) might navigate these problems by reaching large audiences with minimal resources and have been shown to help reduce prejudice in an extended version of contact theory. However, previous studies have shown inconsistent success. We assessed whether parasocial interventions reduce prejudice towards people with mental health issues by first creating a new PSR with a YouTube creator disclosing their experiences with borderline personality disorder. Our intervention successfully reduced explicit prejudice and intergroup anxiety. We corroborated these effects through causal analyses, where lower prejudice levels were mediated by the strength of parasocial bond. Preliminary findings suggest that this lower prejudice is sustained over time. Our results support the parasocial contact hypothesis and provide an organic method to passively reduce prejudice on a large scale.

Investigation of a group of Iranian theater artists' mental health and attitude toward patients with mental disorders

Introduction

Stigmatizing attitude toward patients with severe mental disorders is one of the main obstacles of improving the mental health of societies. Media plays an important role in how the public views mental health issues. Thus, we have performed this study to investigate the Iranian theater artists' mental health status, and their view toward patients with severe mental disorders.

Methods

This cross-sectional study was performed via an online anonymous survey including the Social Distance Scale and the Dangerousness Scale measuring the attitude of participants toward patients with severe mental disorders, and the 28-item General Health Questionnaire (GHQ-28). It was disseminated to artists who had the experience of working in theater in the past year in Iran.

Results

Our survey was responded by 104 artists. Social Distance Scale scores' mean was 10.67 (scores can range from 0 to 21) and the Dangerousness Scale scores' mean was 28.87 (scores can range from 8 to 56); higher scores indicate worse discrimination. Our participants' strongest fears were to let someone with a severe mental disorder to take care of their children, and for these groups of patients to obtain a hunting license. Twenty-six (25%) participants were at risk of moderate to severe anxiety, and 18 (17.3%) participants were at risk of moderate to severe depression.

Conclusion

By and large, our participants did not have a positive attitude toward patients with severe mental disorders. Providing the knowledge of mental health issues can help the general public to be more tolerant of the mentally ill and specifically, theater can be employed to fight stigmatizing mental health issues by educating its audience.

Beliefs and Attitudes of Health Care Professionals Toward Mental Health Services Users’ Rights: A Cross-Sectional Study from the United Arab Emirates

Purpose

Patients and Methods

Results

Conclusion

Modeling the effects of Crisis Intervention Team (CIT) training for police officers: How knowledge, attitudes, and self-efficacy drive de-escalation skills and referral decisions

OBJECTIVE

Prior research on Crisis Intervention Team (CIT) training for police officers has demonstrated improvements in knowledge, attitudes, self-efficacy, and stigma, but how these factors work together to influence behavioral outcomes like de-escalation skills and referral decisions remains unstudied.

METHOD

251 CIT-trained and 335 non-CIT officers completed in-depth surveys measuring these six constructs. We used structural equation modeling to test fit of the data to our hypothesized model and made indicated changes to improve fit.

RESULTS

An alternate 8-path model (with three paths originally hypothesized being removed) fit reasonably well, and allowing path coefficients to differ for CIT and non-CIT groups resulted in models with similar fit statistics.

CONCLUSION

CIT training enhances knowledge and attitudes, both of which have beneficial effects on stigma. Though an important outcome itself, lower stigma does not have an effect on de-escalation skills and referral decisions, though self-efficacy clearly does.

Estigma dirigido a pessoas com transtornos mentais: uma proposta para a formação médica do século XXI

Uma visão estigmatizada das pessoas com transtornos mentais está presente em parcelas significativas da sociedade, incluindo os profissionais de saúde, o que pode contribuir para uma baixa qualidade assistencial e dificuldade de acesso à saúde por parte dessa população. Diante desse problema, o artigo apresenta o relato de experiência curricular de uma escola médica privada, situada em uma capital do Sudeste brasileiro, de metodologia ativa, cujo cenário de prática ocorre inteiramente em uma Rede de Saúde Mental Comunitária do Sistema Único de Saúde – SUS. A avaliação dessa experiência concluiu que um modelo proposto contribuiu para a redução do estigma direcionada a portadores de transtornos mentais, além de ter sido avaliada positivamente pelos alunos. Para tanto, foi necessário a inclusão de estratégias educacionais que promovessem o convívio direto dos alunos com os portadores de transtornos mentais e o início do curso indicou ser um momento oportuno para oferecer esse tipo de atividade. A experiência também aponta que a colaboração eficaz entre a Universidade e o SUS pode promover mudanças positivas na formação em saúde mental de futuros médicos brasileiros.

Prescribing stigma in mental disorders: A comparative study of Portuguese psychiatrists and general practitioners

BACKGROUND

Physicians, including psychiatrists and general practitioners (GPs), have been reported as essential sources of stigma towards people diagnosed with a mental disorder (PDMDs), which constitutes an important barrier to recovery and is associated with poorer clinical outcomes. Therefore, psychiatrists and GPs are key populations where it is crucial to examine stigma, improve attitudes and reduce discrimination towards psychiatric patients.

AIMS

This study is the first to explore mental health-related stigma among Portuguese psychiatrists and GPs, examining the differences between these two specialities and assessing whether sociodemographic and professional variables are associated with stigma.

METHOD

A cross-sectional study was performed between June 2018 and August 2019. A consecutive sample of 55 Psychiatrists and 67 GPs working in Porto (Portugal) filled a 25-item self-report questionnaire to assess their attitudes towards PDMDs in clinical practice. The instrument was designed by the authors, based on previous mental health-related stigma studies and validated scales. The questionnaire includes 12 stigma dimensions (Autonomy, Coercion, Incompetence, Dangerousness, Permanence, Pity, Responsibility, Segregation, Labelling, Diagnostic Overshadowing, Shame and Parental Incompetence), and its total score was used to measure Overall Stigma (OS). Sample characteristics were examined using descriptive statistics, and the factors affecting stigma were assessed through regression analysis.

RESULTS

GPs exhibit significantly higher OS levels than psychiatrists, and present higher scores in the dimensions of dangerousness, parental incompetence, diagnostic overshadowing and responsibility. Besides medical speciality, several other sociodemographic variables were associated with sigma, including age, gender, having a friend with a mental disorder, professional category, agreement that Psychiatry diverges from core medicine and physician's interest in mental health topics.

CONCLUSIONS

Our data suggest that both psychiatrists and GPs hold some degree of stigmatizing attitudes towards PDMDs. Overall, these results bring new light to stigma research, and provide information to tailor anti-stigma interventions to Portuguese psychiatrists and GPs.

Social exclusion in psychotic disorders: An interactional processing model

Psychotic disorders are among the most highly stigmatized mental disorders, and individuals with psychosis experience significant exclusion from the community. Stigma reduction programs have done little to reduce social exclusion of individuals with psychosis, and there are significant limitations to the traditional stigma model as it applies to social exclusion. Herein, we present the Interactional Processing Model (IPM) of social exclusion towards individuals with psychosis. The IPM considers social exclusion to be the result of two interacting pathways with additional consideration for a feedback loop through which social exclusion sets in motion natural behavioural responses of individuals with psychosis that inadvertently perpetuates exclusion. The IPM considers initial social exclusion to be the result of an interaction between these two pathways. The first path aligns with the traditional stigma model and consists of the community becoming aware that an individual is diagnosed with a psychotic disorder and then excluding the individual based on pre-existing, generalized knowledge about the disorder. The second path to exclusion involves the observation of atypical behaviours from the individual, and generation of an individualized exclusion response. We provide initial empirical support for the IPM of social exclusion, outline testable hypotheses stemming from the model, and discuss implications for novel ways to consider both societal stigma reduction and personalized intervention.

Can employment in a café change Clientele Attitude towards the staff when they are Persons with Mental Illness?

BACKGROUND

Clientele's attitude toward Persons with Mental Illness (PwMI) changes over a period of time. The aim of this study was to explore and understand how and whether perception about PwMI changes when they are seen working like persons without mental illness among those availing services of ROSes café at NIMHANS, Bengaluru.

METHODS

The descriptive research design was adopted with purposive sampling. Community Attitude toward Mentally Ill (CAMI) a self -administered questionnaire of was administered to measure the clientele attitude towards staff with mental illness in ROSes Café (Recovery Oriented Services). A total of 256 subjects availing services from the ROSes café recruited in the study. Chi-square and Mann-Whitney U test was computed to see the association and differences on selected variables.

RESULTS

The present study results showed that subjects had a positive attitude seen in health care professionals in the domains of benevolence (BE) (28.68 ± 3.00) and community mental health ideology (CMHI) (31.53 ± 3.19), whereas non-health care professionals had showed negative attitude in the domain of authoritarianism (AU) (30.54 ± 3.42) and social restrictiveness (SR) (30.18 ± 3.05). Education, employment, marital, income, and working status were significantly associated with CAMI domains.

CONCLUSION

PwMI also can work like people without mental illness when the opportunities are provided. The community needs to regard mental illness in the same manner as chronic physical illness diabetes mellitus and allow PwMI to live a life of dignity by creating and offering opportunities to earn livelihood which would help them recover with their illnesses.

Cultural Factors Influencing Mental Health Stigma: Perceptions of Mental Illness (POMI) in Pakistani Emerging Adults

Pakistan has a fast-growing, young, and highly religious population. Mental health literacy and care in Pakistan do not meet the population’s needs, and mental health stigma (MHS) is cited as the cause. Explanations for MHS across cultures include collectivism, and sociocultural-religious/spiritual beliefs and values surrounding mental illness and those who experience it. MHS interventions and campaigns that aim to improve help-seeking behaviors require insight into the emic perspectives of each target population. Although these perspectives have been elusive for Pakistanis, they are more available today due to growing interest in studying and improving Pakistani mental health. This cross-sectional study of 92 Pakistani emerging adults explored whether collectivism was associated with stigmatizing attitudes toward mental illness. This study also piloted the Perceptions of Mental Illness (POMI) questionnaire, a 44-item true/false survey customized to the Pakistani context, to assess how mental health knowledge, perceptions, exposure, and help-seeking preferences related to stigmatizing attitudes. Results indicated that the POMI provided unique insights into Pakistani beliefs and attitudes that relate to both stigmatizing attitudes and collectivism. With further development, the POMI may be used to guide the design of mental health awareness programs in Pakistan, ultimately helping to reduce MHS and increase help seeking when needed.

Mental Health Shame, Caregiver Identity, and Self-Compassion in UK Education Students

Although students in education have high rates of mental health problems, many of them do not ask for help, which can exacerbate their symptoms. One reason for their low help-seeking is shame associated with mental health problems. As education students aspire to provide care for children, they may feel ashamed to care for themselves, as the role identity theory suggests. Self-compassion is reported to reduce shame and mental health problems. This study explored the relationships between mental health problems, mental health shame, self-compassion, and caregiver identity among UK education students. One hundred and nine postgraduate students completed four self-report scales regarding those constructs. Correlation and regression analyses were performed. Mental health problems were positively associated with shame and identity, and negatively associated with self-compassion. Self-compassion was the only significant predictor of mental health problems. Findings will help educators and education students to develop effective approaches for their mental health problems.

Effects of Internet-based Storytelling Programs (Amazing Adventure Against Stigma) in Reducing Mental Illness Stigma with Mediation by Interactivity and Stigma Content: A Randomized Controlled Trial (Preprint)

Background

Mental illness stigma has been a global concern, owing to its adverse effects on the recovery of people with mental illness, and may delay help-seeking for mental health because of the concern of being stigmatized. With technological advancement, internet-based interventions for the reduction of mental illness stigma have been developed, and these effects have been promising.

Objective

This study aimed to examine the differential effects of internet-based storytelling programs, which varied in the levels of interactivity and stigma content, in reducing mental illness stigma.

Methods

Using an experimental design, this study compared the effects of 4 storytelling websites that varied in the levels of interactivity and stigma content. Specifically, the conditions included an interactive website with stigma-related content (combo condition), a noninteractive website with stigma-related content (stigma condition), an interactive website without stigma-related content (interact condition), and a noninteractive website without stigma-related content (control condition). Participants were recruited via mass emails to all students and staff of a public university and via social networking sites. Eligible participants were randomized into the following four conditions: combo (n=67), stigma (n=65), interact (n=64), or control (n=67). The participants of each group viewed the respective web pages at their own pace. Public stigma, microaggression, and social distance were measured on the web before the experiment, after the experiment, and at the 1-week follow-up. Perceived autonomy and immersiveness, as mediators, were assessed after the experiment.

Results

Both the combo (n=66) and stigma (n=65) conditions were effective in reducing public stigma and microaggression toward people with mental illness after the experiment and at the 1-week follow-up. However, none of the conditions had significant time×condition effects in reducing the social distance from people with mental illness. The interact condition (n=64) significantly reduced public stigma after the experiment (P=.02) but not at the 1-week follow-up (P=.22). The control condition (n=67) did not significantly reduce all outcomes associated with mental illness stigma. Perceived autonomy was found to mediate the effect of public stigma (P=.56), and immersiveness mediated the effect of microaggression (P=.99).

Conclusions

Internet-based storytelling programs with stigma-related content and interactivity elicited the largest effects in stigma reduction, including reductions in public stigma and microaggression, although only its difference with internet-based storytelling programs with stigma-related content was not statistically significant. In other words, although interactivity could strengthen the stigma reduction effect, stigma-related content was more critical than interactivity in reducing stigma. Future stigma reduction efforts should prioritize the production of effective stigma content on their web pages, followed by considering the value of incorporating interactivity in future internet-based storytelling programs.

Trial Registration

ClinicalTrials.gov NCT05333848; https://clinicaltrials.gov/ct2/show/NCT05333848

Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.

Social Status Influence on Stigma Towards Mental Illness and Substance Use Disorder in the United States

We describe the relationship between socio-demographic membership and stigma towards any mental illness (AMI) and substance use disorder (SUD) in the United States using a national survey (N = 2512). We hypothesize that participants from higher status socio-demographic groups may be more likely to report stigmatizing attitudes than participants from lower status socio-demographic groups. We find support for our hypothesis using multiple linear regression. Participants who were college-educated, male, or had household incomes above the national median were more likely to report stigmatizing attitudes toward both AMI and SUD in comparison to participants that were not college-educated, were female, or had household incomes below the national median. In contrast to our hypothesis, we find that participants who identified as Hispanic were more likely to report stigmatizing attitudes toward AMI than non-Hispanic whites. Younger and urban participants were more likely to report stigmatizing attitudes than their older and non-urban counterparts.

A national study of the mental health literacy of community pharmacists

BACKGROUND

Community pharmacists are in a prime position to communicate with and assist those with mental health needs. However, mental health literacy, which includes beliefs and knowledge of mental health conditions, can impact the provision of pharmacy services. The mental health literacy of community pharmacists in New Zealand is currently unknown.

OBJECTIVES

To assess the mental health literacy of community pharmacists in New Zealand.

METHODS

We employed a national cross-sectional online survey, evaluating attitudes towards mental illness, ability to recognise depression using a vignette and followed by questions related to the helpfulness of various interventions, and willingness to provide pharmacy services for people with mental illness in comparison to cardiovascular diseases. Additionally, opportunities for mental health training were explored. Participants were community pharmacists working in New Zealand contacted via mailing lists of professional bodies.

RESULTS

We received responses from 346 participants. The majority of participants showed positive attitudes towards mental illness and correctly identified depression in the vignette (87%). Participants rated counsellors (84%) and physical activity (92%) as the most helpful professionals and intervention respectively while only 43% considered antidepressants as helpful for depression. When compared to other people in the community, long-term functioning of the individual described in the vignette was rated poorly, especially in terms of increased likelihood to attempt suicide (85%) and reduced likelihood to be a productive worker (64%). Approximately 30% of participants reported reduced confidence/comfort while approximately half of participants reported greater interest in providing mental health-related care compared to cardiovascular disease. The participants also highlighted several areas for future mental health training they wished to undertake.

CONCLUSIONS

We have identified positive attitudes towards mental illness in our study. Participants correctly identified and supported evidence-based interventions for mild to moderate depression. However, we highlighted the need for ongoing mental health training to address knowledge gaps and enhance the confidence in providing mental health-related care.

Perceived Course of Illness on the Desire for Social Distance From People Suffering From Symptoms of Schizophrenia in India

BACKGROUND

Stigmatization of people with schizophrenia remains a highly relevant topic worldwide, particularly in low- and middle-income countries like India. It is crucial to identify the determinants of the desire for social distance as a proxy for discriminatory behavior in a socio-cultural context to indicate ways to reduce stigma. This study aims to explore whether the public perception of the perceived course of an illness concerning people with symptoms of schizophrenia has an impact on the desire for social distance.

SUBJECTS AND METHODS

Data collection took place in five cities in India. The sample (N = 447) was stratified for gender, age, and religion. Desire for social distance was sampled based on a self-reported questionnaire using unlabelled vignettes for schizophrenia. First, factor analysis was conducted to identify the main factors underlying the perception of the perceived course of the illness. Subsequently, a regression analysis was conducted to examine the impact of the perception of those prognostic factors on the desire for social distance.

RESULTS

Factor analysis revealed two independent factors of the perceived course of an illness: (1) life-long dependency on others and loss of social integration and functioning and (2) positive expectations toward treatment outcome. This second factor was significantly associated with a less desire for social distance toward persons with schizophrenia.

CONCLUSION

The desire for social distance toward people with schizophrenia reduces with the expectation of positive treatment outcomes which underlines the need to raise public mental health awareness and provide psychoeducation for affected people and their family members in India. Help-seeking behaviors can be promoted by directing those needing treatment toward locally available, affordable and credible community-based services rather than facility-based care. Strikingly, lifelong dependency and the inability to socially integrate do not increase the desire for social distance, reflecting the Indian nation's socio-relational values and insufficiency of public mental health services. This indicates the suitability of systemic therapy approaches in public mental healthcare services to support the family's involvement and family-based interventions in caregiving for mentally ill people across the lifespan.

Health care providers and people with mental illness: An integrative review on anti-stigma interventions

BACKGROUND

Health care providers are an important target group for anti-stigma interventions because they have the potential to convey stigmatizing attitudes towards people with mental illness. This can have a detrimental impact on the quality and effectiveness of care provided to those affected by mental illness.

AIMS AND METHODS

Whittemore & Knafl's integrative review method (2005) was used to analyze 16 studies investigating anti-stigma interventions targeting health care providers.

RESULTS

The interventions predominantly involved contact-based educational approaches which ranged from training on mental health (typically short-term), showing videos or films (indirect social contact) to involving people with lived experiences of mental illness (direct social contact). A few studies focused on interventions involving educational strategies without social contact, such as mental health training (courses/modules), distance learning via the Internet, lectures, discussion groups, and simulations. One study investigated an online anti-stigma awareness-raising campaign that aimed to reduce stigmatizing attitudes among health care providers.

CONCLUSION

Anti-stigma interventions that involve social contact between health care providers and people with mental illness, target specific mental illnesses and include long-term follow-up strategies seem to be the most promising at reducing stigma towards mental illness among health care providers.