Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences

Treatment stigma mediates relationships between morally injurious events and depression, PTSD and anxiety symptoms

Background: Morally injurious events (MIEs), encompassing personal transgressions, witnessing others commit transgressions, or experiencing betrayal by leaders, can conflict with one's moral/ethical principles, evoking outrage and profound mistrust. Although MIEs are associated with depression, PTSD, and anxiety, the mechanisms linking MIEs to psychiatric symptomatology remain unclear, especially among civilians in times of collective trauma.Objective: This study explored one potential mechanism: stigma toward mental-health treatment, which can deter help-seeking and exacerbate guilt, shame, and mistrust.Method: We focused on civilians (N = 1,052) exposed to MIEs in conflict zones in southern and northern Israel following the 7 October 2023 attack. Participants were recruited using an online platform and assessed for depression, PTSD, and anxiety symptoms. We hypothesised that stigma toward treatment would mediate relationships between MIE exposure levels and depression, PTSD, and anxiety symptoms.Results: Results showed high MIE exposure levels and symptomatology among civilians in conflict zones. Moreover, we found significant indirect effects of stigma toward treatment on all three symptom types.Conclusions: Our findings suggest that while MIEs directly link to symptoms, stigma toward treatment plays a significant role in understanding this link. These findings emphasise the importance of addressing stigma toward treatment for individuals experiencing MIEs and underscore the need for targeted interventions in conflict zones.

Worldwide changes in self-stigma among people with mental illness from 2005 to 2023: A cross-temporal meta-analysis and systematic review

BACKGROUND

Self-stigma in mental illness constitutes a growing public health imperative, with limited longitudinal data available to characterize its evolution over time. Here, we employed cross-temporal meta-analysis to systematically assess whether self-stigma levels have escalated, leveraging standardized measurement tools to quantify potential changes.

METHODS

We searched six databases (inception to July 2024) for studies measuring self-stigma using the Internalized Stigma of Mental Illness Inventory (ISMI). Two researchers independently screened studies and extracted data. SPSS 25.0 and R 4.4.2 were used for correlation, regression, and quantification of self-stigma differences.

RESULTS

179 articles involving 33,046 people were identified. Self-stigma levels increased across all ISMI dimensions from 2005 to 2023 (β = 0.086-0.283), corresponding to small-to-large effect size (d = 0.30-0.89). Notably, stigma resilience increased significantly (d = 0.89), which is a noteworthy observation, suggesting a positive shift in their ability to cope with stigmatizing experiences. Subgroup analyses further revealed that people with mild mental illnesses experienced more severe and frequent self-stigma (d = 1.07-2.80) than those with severe mental illnesses (d = 0.13-1.02). Geographically, self-stigma increased in Asian regions (d > 0), while trends in other regions were mixed (d > 0 or < 0). Importantly, statistically significant differences (Pa <0.05 in ISMI and its dimensions) across illness severities and continents mental illness located further validated these subgroup findings.

CONCLUSIONS

Self-stigma within the studied age group has indeed increased from 2005 to 2023, underscoring an immediate need for intervention. Consequentially, continuous data is essential to monitor its persistence. Moreover, exploring self-stigma's social determinants to provide effective intervention strategies is necessary.

A pilot short-term study of feasibility, acceptability and preliminary efficacy of 3-stage 8-session 4-week group therapy-based narrative intervention in 17 improved hospitalized female schizophrenia patients in southern China

Self-stigma has been consistently cited as a major obstacle to recovery-related outcomes among patients with schizophrenia. To examine the feasibility, acceptability, and preliminary efficacy of the group-based narrative intervention for improving self-stigma, self-esteem and psychological capital in hospitalized patients with schizophrenia, a case-series study was conducted from March to May 2023 in a closed psychiatric ward of a specialized hospital in mainland China. Feasibility was assessed by examining rates of recruitment, retention, and protocol adherence. Acceptability was assessed through the therapist's and patients' feedback about the intervention. Changes in the levels of self-stigma, self-esteem, and psychological capital perceived by patients were measured before and after 4 weeks of intervention. Rates of enrolment (85%) and completion of intervention sessions and study procedures (100%) were excellent, demonstrating high rates of feasibility among these patients in the local setting. The feedback from participants and the therapist about satisfaction, helpfulness, and difficulty of the intervention was largely positive, demonstrating high rates of acceptability. And the results indicated significant improvements in patients' self-reported self-stigma, self-esteem, and psychological capital (change in T = 3.872, p = 0.001; T = -6.308, p < 0.001; T = -2.895, p = 0.011, respectively). The study provided a structured intervention program for clinical care to reduce self-stigma and promote positive recovery outcomes for inpatients with schizophrenia.

Stigmatisation of survivors of political persecution in the GDR: attitudes of healthcare professionals

Introduction

People with mental disorders face various barriers on the road to treatment. People who have experienced injustice of the state apparatus of the German Democratic Republic (GDR) in the form of various reprisals are a group that has received insufficient attention in research. Some of them still show long-term psychological and physical consequences that occur more frequently than in the general population, resulting in an increased need for treatment. There are currently no studies on how those affected are perceived by practitioners due to their history and whether they are exposed to stigmatizing attitudes.

Method

A vignette-based survey was carried out to identify possible stigmatising attitudes. An independent opinion and survey institute conducted the study in three phases in December 2022, April 2023 and May to August 2024 using an online survey. A total of N=1357 practitioners from the German healthcare system were presented one of four case vignettes. The two vignettes described a person with mental health difficulties who had either experienced an unremarkable socialization in the GDR (A) or had suffered injustice in the GDR (B). In addition to socio-demographic variables, stereotypes, emotional reactions and desire for social distance towards the person described were recorded.

Results

Age and sex as well as subjective knowledge about the GDR, the occupational group and the working environment influence the intensity of emotional reactions as well as the desire for social distance and the extent of negative stereotypical attitudes. The presentation of a case vignette that deals with an experience of SED injustice favours a decrease in positive and an increase in negative stereotypes. The explanatory power of the regression models is predominantly in the medium range (from 9.7 till 35.3%).

Conclusions

Even more than three decades after the reunification of Germany, people with mental health problems and an experience of SED injustice in the GDR still experience stigmatizing attitudes on the part of those treating them. Stigmatizing attitudes can affect treatment and care.

Self-stigma among people with epilepsy: Comparison between Germany and Japan

OBJECTIVE

Epilepsy is a neurological disorder characterized by recurrent seizures, with prevalence and treatment availability varying across countries. Stigma associated with epilepsy significantly impacts the quality of life (QOL) of people with epilepsy (PWE). This study aimed to compare self-stigma, depressive symptoms, anxiety, and QOL in PWE treated at tertiary epilepsy centers in Germany and Japan. It also explored cultural differences influencing these experiences.

METHODS

Participants were recruited from the Bethel Epilepsy Center in Germany and the Comprehensive Epilepsy Centers at Saitama Medical University in Japan. Eligible participants were PWE aged 18 and above, receiving treatment at these facilities, meeting language requirements, and capable of providing informed consent. Data collection occurred from May 2022 to April 2023 using questionnaires assessing self-stigma (Epilepsy Self-Stigma Scale, ESSS), self-esteem, depressive symptoms, anxiety, knowledge, and QOL. Comparisons between Japanese and German samples and associations among variables were analyzed using t-tests, chi-square tests, and regression analyses.

RESULTS

PWE in Japan reported higher levels of self-stigma, depressive symptoms, and anxiety compared to those in Germany. Conversely, they demonstrated lower epilepsy knowledge, self-esteem, and overall health. Significant correlations emerged among variables; however, differences in ESSS scores remained significant in a multiple regression model, highlighting persistent cultural variances.

SIGNIFICANCE

The findings reveal marked differences in self-stigma and psychosocial factors between Japanese and German PWE. Japanese participants experienced higher self-stigma and psychological distress, potentially due to disparities in healthcare delivery systems, institutional frameworks, and social support structures. Healthcare providers should address these contextual factors in epilepsy care. Future studies should explore systemic influences on self-stigma through long-term, multi-center research in diverse healthcare settings to improve support for PWE globally.

PLAIN LANGUAGE SUMMARY

This study compared how people with epilepsy treated in two tertiary epilepsy centers in Japan and Germany feel about their condition and themselves. The research found that Japanese patients felt more stigma (negative self-judgment) about having epilepsy and reported more feelings of depression and anxiety than German patients. They also knew less about epilepsy and felt less confident about themselves. These findings suggest that differences in healthcare systems and social attitudes between the two countries may affect how people cope with epilepsy, highlighting the need for better support systems in Japan.

Prevalence and correlates of positive and negative psychological effects of bereavement due to COVID-19: A systematic review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic was associated with an increase in mortality rates globally. Given the high numbers of deaths and the potentially traumatic characteristics of COVID-19 deaths, it was expected that grief-related distress would be higher in COVID-19 bereaved (compared to non-COVID-19 bereaved) people. This systematic review investigates the empirical evidence regarding this claim. More specifically, this review summarizes studies up to December 2024, evaluating the prevalence and correlates of positive and negative psychological effects of COVID-19 bereavement.

METHODS

Systematic searches were conducted in PsychInfo, Web of Science, and Medline by two independent reviewers. Eligible studies included quantitative research in peer-reviewed articles reporting on positive and/or negative psychological outcomes, using validated measures, in COVID-19 bereaved adults. The primary outcome was prolonged grief symptoms (PG).

RESULTS

We identified 9918 articles, whereof 28 studies met the inclusion criteria. Rates of psychological outcomes were primarily reported in terms of (early) PG, depression, posttraumatic stress, anxiety, and pandemic grief, and varied widely between studies (e.g., PG rates ranged between 30 % and 87 %). No studies reported on positive psychological outcomes. Closer kinship to the deceased, death unexpectedness, and COVID-19 stressors were identified as correlates of increased psychopathology.

CONCLUSIONS

Due to the small number and heterogeneity of studies, knowledge about psychological effects of COVID-19 bereavement is limited. This review offers a synthesis of research evidence to inform clinicians, policy makers, public health professionals, and future research concerned with psychological effects of COVID-19 bereavement.

Self-compassion as an antidote to self-stigma and shame in autistic adults

Autistic individuals are frequently exposed to stigmatizing attitudes and discrimination. Through the lived experience of stigmatizing attitudes, autistic people can internalize the negative stereotypes associated with autism. This phenomenon is known as self-stigma. In non-autistic populations, self-stigma is associated with shame and negative mental health outcomes. In this study, we aim to better understand the mental health outcomes associated with self-stigma in autism and to investigate whether and how self-compassion compared to camouflaging may protect from self-stigma in autistic individuals. For this purpose, 689 adults who reported a diagnosis of autism were recruited online and completed self-reported questionnaires for self-stigma (Internalized Stigma of Mental Illness Scale-9 items), self-compassion (Self-Compassion Scale-short form), depression (Depression, Anxiety and Stress Scale-21) and camouflaging (Camouflaging Autistic Traits Questionnaire). We conducted mediation analysis and moderated mediation analysis. Our results indicate that self-stigma is highly prevalent in autistic adults (45.5%), correlated to depression (ρ (687) = 0.437, p < 0.001) and that internalized shame mediates the relationship between self-stigma and depressive symptoms (b = 1.48, 95% confidence interval = (1.11, 1.94)). Self-compassion moderates this mediation (Indirect Effect, IE = -0.305, 95% confidence interval = (0.601, 0.014), β = 0.183, z = 2.012, p = 0.044), whereas camouflaging does not (IE = 0.003, 95% confidence interval = (0.009, 0.015), β = 0.0531, z = 0.514, p = 0.607). These results highlight the protective effect of self-compassion on the negative impacts of self-stigma in autistic individuals. Future research should explore how to adapt existing compassion-focused interventions and evaluate their feasibility and efficacy to reduce self-stigma and shame in autistic populations.Lay abstractWhat is already known about the topic?Autistic individuals are frequently exposed to stigmatizing attitudes and discrimination. Negative stereotypes about autism, such as dangerousness or inability to work, are very frequent in our societies. Through exposure to these stigmatizing ideas, autistic people can internalize these ideas and begin to believe them to be true about themselves. This is self-stigma. Past research conducted with non-autistic individuals indicate that self-stigma can lead people to feel ashamed of who they are and deteriorate their mental health.What this paper adds?In this paper, we found that self-stigma in autistic people increases depressive symptoms through feelings of shame. We then showed that relating to self with compassion - that is, to be friendly towards oneself (kindness), be aware of one's feelings and thoughts (mindful awareness) and realize that everyone feels pain and makes mistakes (common humanity) - helps reducing the negatives consequences of self-stigma on mental health. We also demonstrated that camouflaging does not modify the impact of self-stigma on mental health.Implications for practice, research or policy?Because self-compassion can protect from the negative effects of self-stigma, future research should explore how to adapt existing compassion-focused interventions and evaluate their feasibility and efficacy to reduce self-stigma and shame in autistic people.

Community-based recovery interventions for improving mental health in schizophrenia patients: a scoping review in Southeast Asia

BACKGROUND

Schizophrenia is a complex mental health condition that affects an individual's thoughts, perceptions, emotions, and behavior. Recovery from schizophrenia is not solely defined by symptom reduction, but also by the ability to lead a meaningful and fulfilling life within the community. Recovery-oriented approaches emphasize hope, empowerment, social inclusion, and the rebuilding of identity. In Southeast Asia, community-based interventions play a crucial role in supporting individuals diagnosed with schizophrenia through culturally relevant, accessible, and holistic care.

AIM

This scoping review aims to explore the types and characteristics of community-based recovery interventions implemented for individuals diagnosed with schizophrenia in Southeast Asia, specifically in Indonesia, Malaysia, and Thailand.

METHODS

A scoping review was conducted following Arksey and O'Malley's framework. Literature searches were performed in five databases: Scopus, PubMed, CINAHL, Web of Science, and Google Scholar. Keywords included "recovery", "intervention", "community-based", "schizophrenia", "psychiatric", and "psychosis". Inclusion criteria were: (1) studies involving individuals diagnosed with schizophrenia (2), studies conducted in Indonesia, Malaysia, or Thailand (3), articles published in English or Indonesian between 2014 and 2024, and (4) studies focusing on recovery-related outcomes. A qualitative descriptive analysis was used to synthesize findings.

RESULTS

A total of 10 eligible articles were included. The studies explored a variety of community-based recovery interventions, such as psychoeducation programs, empowerment and self-management training, forgiveness therapy, horticultural therapy, web-based cognitive training, and psychosocial interventions including relaxation techniques and mindfulness-based self-awareness. These interventions were found to enhance patients' knowledge, coping skills, social functioning, and overall quality of life.

CONCLUSION

Community-based recovery interventions in Southeast Asia show promise in supporting individuals with schizophrenia in their recovery journey. These approaches address not only clinical symptoms but also social and psychological well-being. Further research is needed to evaluate the long-term effectiveness, cultural adaptability, and sustainability of such interventions in diverse community settings.

Applying the Health Stigma and Discrimination Framework to psychosis stigma in Malawi

Psychotic disorders are highly stigmatized across the globe, negatively impacting people with psychosis and their families. However, little is known about stigma faced by people with psychosis in sub-Saharan Africa. We developed semi-structured qualitative guides based in a constructivist epistemology and formative research methodologies and conducted 36 in-depth interviews (IDIs) and two focus-group discussions (FGDs) with 12 people with lived experience (PWLE) with psychosis; 12 caregivers of PWLE; six traditional healers; six medical providers; six community leaders (1 FGD); and six religious leaders (1 FGD) in Blantyre, Malawi. We drew from the Health Stigma and Discrimination Framework to delineate the stigmatization process. Participants described key drivers of stigma as lack of awareness, prejudice, stereotypes, and fear. Manifestations included experienced, anticipated, witnessed, perceived, internalized and secondary stigma in the form of insults, gossip, abuse, physical violence, restraints, social exclusion, and employment-based discrimination from family and community. With respect to negative outcomes and health and social impacts, stigma impacted quality of care, resilience, mental health, morbidity, social inclusion and quality of life. In Malawi, stigma is pervasive challenge for PWLE, with severe implication for their health and social wellbeing. In partnership with PWLE, investment into the integration of evidence-based stigma reduction activities into existing psychosis management programs is warranted.

Exploring the Relationship Needs of Service Users During Crisis Interventions: A Qualitative Study

People in crisis sometimes seek professional support, and the relationship between service users and professionals is crucial in overcoming the crisis. To understand the relationship needs of people in crisis, 29 semi-structured interviews with service users were conducted and analyzed using a grounded-theory approach. The findings reveal that people in crisis seek a professional who is there for them, recognizes the crisis as an emergency and a solvable situation, treats them with respect, and offers individual support. Furthermore, there needs to be a general fit between professionals, the support services, and service users for a supportive relationship to be established. However, two main aspects were discovered where service users differ depending on the resources they can access during the crisis: While people with access to many resources seek a rather distant and egalitarian relationship, those with access to fewer resources prefer more intimate and hierarchical relationships with professionals.

The Chinese version of the stigma of loneliness scale in people with chronic diseases: an assessment of psychometric characteristics

BACKGROUND

Loneliness is prevalent in patients with chronic diseases and can threaten their health status, treatment process and quality of life. The stigma of loneliness stems from a derogatory and stigmatizing label that individuals possess towards loneliness with the possibility of being socially disadvantaged, which exacerbates the negative impact of loneliness on patients with chronic diseases and jeopardizes social support. However, few studies focused on this theme in patients with chronic diseases. This study aimed to assess the psychometric characteristics of the Chinese version of the Stigma of Loneliness Scale (SLS) among patients with chronic diseases, to provide a validated tool for related research.

METHODS

The current study consisted of a two-phase questionnaire survey of 704 patients with chronic diseases. Sample 1 comprised 318 patients (Age:40.87 ± 18.55) with chronic diseases, and the data obtained were used for item analysis and exploratory factor analysis. Sample 2 included 386 patients (Age:40.65 ± 17.08) with chronic diseases, and the resulting data were of use for confirmatory factor analysis, criterion validity, incremental validity, and Cronbach's α coefficient test. Moreover, in Sample 2, the equivalence of SLS in male and female cohorts and in outpatient and inpatient groups was further examined.

RESULTS

In the exploratory factor analysis, two dimensions were extracted: Self-Stigma of Loneliness (SSL) and Public Stigma of Loneliness (PSL). The confirmatory factor analysis revealed that the first-order two-factor model demonstrated good fit indices (χ2/df = 2.754, RMSEA = 0.067, SRMR = 0.023, CFI = 0.988, IFI = 0.989, TLI = 0.983, PNFI = 0.677, PCFI = 0.681), and it was superior to both the one-factor model and the two-factor orthogonal model. The criterion validity test indicated that the SLS scores were significantly positively correlated with the scores of UCLA Loneliness Scale, Brief Illness Perception Questionnaire, Self-Concealment Scale, Social Interaction Anxiety Scale, Social Phobia Scale, Acceptance and Action Questionnaire-Second Edition, Kessler Psychological Distress Scale-6 scores. The Cronbach's α coefficient values for the SLS, SSL, and PSL were 0.961, 0.949, and 0.960, respectively. The results of the incremental validity tests indicated that stigma of loneliness and loneliness differ in psychological construct. In addition, the SLS showed measurement equivalence in populations of patients with chronic diseases of different genders, as well as ways of seeking medical care.

CONCLUSIONS

The Chinese version of the SLS showed favorable reliability and validity in patients with chronic disease populations, which can provide instrumental endorsement for recognition and intervention studies of stigma of loneliness.

The internalized stigma, self-efficacy, occupational competence and employment outcome among persons with severe mental illness under one-to-one peer support services in Taiwan

BACKGROUND

In non-Western countries, the provision of services by peer support workers (PSWs) for individuals with severe mental illness (SMI) has increased in recent years. However, the psychological and employment outcomes for both PSWs and service users remain underexplored.

METHODS

In 2018 and 2019, a 28-hour PSW training curriculum was conducted at a community rehabilitation center in eastern Taiwan. Following the training, PSWs provided one-on-one support services to service users for 1 to 1.5 h per week over eight internship sessions, with a case-load ratio of 1:2 to 1:3. Internalized stigma, self-efficacy, and occupational competence were assessed using the Internalized Stigma of Mental Illness Scale-Chinese (ISMI-C), General Self-Efficacy Scale-Chinese (GSS-C), and Traditional Chinese-Occupational Self-Assessment Scale (TC-OSA). Employment and work training data were also collected.

RESULTS

A total of 11 PSWs and 31 service users participated in the program, with a mean age of 48.9 ± 8.8 years. More than half were female (n = 18, 58.1%), the majority lived in halfway houses (n = 27, 87.1%), and most were diagnosed with schizophrenia (n = 29, 93.1%). By the end of the program, PSWs showed a significant improvement in the TC-OSA my environment subscale score (89.1 ± 16.0 vs. 92.2 ± 13.7, df = 28, t = 1.25, p = 0.22). Among the 29 service users who completed the program, weekly income significantly increased (USD 25.7 ± 32.7 vs. USD 47.9 ± 42.6, df = 28, Z = 3.02, p < 0.01). However, no significant changes were observed in other measured outcomes for either PSWs or service users.

CONCLUSIONS

Participation in the program enhanced PSWs' ability to manage environmental challenges, while service users experienced an improvement in income following one-on-one peer support services. Future large-scale studies are needed to validate these findings. Training programs for PSWs in Taiwan could emphasize sharing experiences of overcoming stigma to enhance self-competence in community life.

CLINICAL TRIAL REGISTRATION

Not applicable.

Longitudinal impact of stigma resistance on mental health among individuals with mental disorders

PURPOSE

This study evaluated a conceptual model regarding the longitudinal impact of stigma resistance on the mental health of individuals with mental disorders. Specifically, it examined whether stigma resistance is longitudinally associated with reduced psychological distress, improved personal recovery, and enhanced life satisfaction, and tested whether these associations are mediated by increased identity affirmation and heightened valued living.

METHODS

A total of 235 individuals with mental disorders completed questionnaire measures of stigma resistance, identity affirmation, valued living, psychological distress, personal recovery, and life satisfaction at baseline (Month 0; M0) and 12 months later (Month 12; M12). The relations among these variables were examined using path analyses and bootstrap analyses.

RESULTS

Path analyses revealed that stigma resistance at M0 was associated with increased identity affirmation and heightened valued living at M12, which, in turn, were associated with reduced psychological distress, improved personal recovery, and enhanced life satisfaction at M12. Bootstrap analyses further demonstrated that stigma resistance at M0 had indirect effects on psychological distress, personal recovery, and life satisfaction at M12 through identity affirmation and valued living at M12.

CONCLUSIONS

Theoretically, our findings elucidate how stigma resistance can help individuals with mental disorders improve their mental health by fostering a positive identity and aligning their lives with personal values. Practically, these findings underscore the importance of developing interventions aimed at promoting stigma resistance in these individuals, enabling them to lead more fulfilling and flourishing lives.

Mental health stigma in Ukraine over time: A cross-sectional study

This study examined changes in public knowledge, behaviours and attitudes towards individuals with mental health disorders in Ukraine. A nationwide survey was used to gather data from Ukrainian adults; this data was then compared with data gathered by Quirke et al. (2021, Cambridge Prisms Global Mental Health, 8) to form a comparison study. In congruence with the original study, the Mental Health Knowledge Schedule, the Community Attitudes towards Mental Illness Scale and the Reported Intended Behaviour scales were used. Measures of knowledge and attitudes towards individuals with mental disorders reflected a small reduction of knowledge (r = 0.13, p < .001) and a large reduction in benevolent attitudes (r = 0.96, p < .001). Conversely, there was a large decrease in authoritarian attitudes (r = -0.50, p < .001). Measures of behaviour reflected a medium positive increase in past and present behaviour (r = 0.33, p < .001) and a small positive increase in intended future behaviour towards individuals with mental illness (r = 0.24, p < .001). These findings provide a snapshot of changes in stigma towards those with mental health disorders in Ukraine and highlighted the growing need for evidence-based anti-stigma interventions and the monitoring of their impact.

Construal of self as a mental health inpatient: a systematic review and narrative synthesis of repertory grid studies

Introduction

Mental health is influenced by how we perceive ourselves and others. A person's conceptual structure and how he/she understands and makes sense of the world can be explored using the repertory grid technique (RGT), an assessment tool derived from personal construct theory. This review aimed to a) draw together relevant literature that had implemented the RGT to explore the conceptual system of a person diagnosed with a mental health condition necessitating psychiatric admission, b) synthesise research findings related to the structure and content of the conceptual system, and c) provide insights into how inpatient service users construed themselves and others to inform therapeutic practice.

Methods

A systematic search of five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science) and thesis databases (EThOS and ProQuest), alongside manual searches in relevant articles and Google Scholar, was conducted. Included studies were appraised for methodological quality using the Quality Assessment Tool for Studies with Diverse Designs.

Results

Twenty-one studies were identified and analysed using narrative synthesis. Of these 21 studies, 12 intentionally used a comparison group and compared the conceptual systems of people with different mental health diagnoses or compared conceptual systems of people with and without a diagnosed mental health condition. Findings from comparison group studies suggested that the self-esteem of a person diagnosed with a mental health condition was lower, compared to a person with no identified mental health diagnoses. Other people were typically idealised by people experiencing mental ill health; however, this finding was not observed in the experience of depression. Cognitive complexity, conceptual structure, and construing were variable across mental health conditions. Conceptual structures that were "simple" and characterised by "tight" construing were consistent with the profile of people with a mental health diagnosis, except for people with schizophrenia spectrum and psychotic disorders.

Conclusions

The structure of a conceptual system differed in people with and without a mental health condition and across mental health diagnoses. Considerations for how the review findings could inform psychological therapy and suggestions for future research are offered.

Mediators of functioning and quality of life among people living with schizophrenia participating in the culturally adapted family psychoeducation (KUPAA) trial in Tanzania

PURPOSE

KUPAA is a culturally adapted version of Family Psychoeducation (FPE) that has shown to be beneficial to people living with schizophrenia-spectrum disorders (PLWS), who may experience limitations across multiple functional domains. Family Psychoeducation can lead to improvement in functional outcomes that align with recovery goals; however, the mechanisms of action are unclear. The current study objective is to identify mechanisms by which the KUPAA intervention reduces disability and improves quality of life among care-seeking PLWS in Tanzania.

METHODS

This clinical trial was conducted at Muhimbili National Hospital and Mbeya Zonal Referral Hospital and included a total of 66 dyads composed of PLWS ages 18-50 years and their caregivers. A causal mediation framework employing the g-formula was used to estimate the indirect effects of the KUPAA intervention on disability and quality of life, through the mediated pathways of hopefulness, self-stigma and generalized self-efficacy.

RESULT

A greater decrease in mean disability score and increase in quality of life score was observed among KUPAA participants, compared to controls. We found that generalized self-efficacy mediates 33% of the effect of KUPAA on quality of life and generalized self-efficacy and hope each mediate 36% of the effect of KUPAA on disability.

CONCLUSION

Results provide preliminary support for the hypothesis that KUPAA can reduce disability and improve quality life by reducing stigma, increasing hope and strengthening self-efficacy. Future psychosocial programs for PLWS should consider tailoring their interventions to focus on reducing stigma, increasing hope and fostering self-efficacy.

The Mediating Role of Internalized Stigma and Illness Knowledge in the Relationship Between Psychological Flexibility and Symptom Severity in Schizophrenia

Schizophrenia is a chronic mental illness that affects daily functioning and quality of life. Many patients experience internalized stigma, which worsens symptoms and quality of life. Psychological flexibility may help reduce stigma's negative effects. This study explores how psychological flexibility, internalized stigma, and illness knowledge relate to symptom severity in schizophrenia. We hypothesized that internalized stigma mediates the link between psychological flexibility and symptoms, and that greater illness knowledge leads to lower stigma and better outcomes. This cross-sectional study included patients diagnosed with schizophrenia at a Community Mental Health Center (CMHC) in Turkey. 253 participants completed standardized scales of psychological flexibility(AAQ-II), internalized stigma(ISMI), knowledge about schizophrenia(KASQ), and symptom severity(PANSS). Mediation analysis was performed using the PROCESS macro for SPSS to assess the indirect effects of stigma and illness knowledge on symptom severity. Psychological flexibility was significantly associated with lower levels of internalized stigma (β = -1.046, p < 0.001). Internalized stigma mediated the relationship between psychological flexibility and symptom severity(β = 0.506, p < 0.001), whereas illness knowledge had a protective effect on symptom severity(β = -1.582, p < 0.001). However, illness knowledge did not significantly mediate the relationship between psychological flexibility and stigma. The findings highlight the critical role of psychological flexibility in mitigating the negative impact of internalized stigma, suggesting that interventions aimed at enhancing flexibility could improve clinical outcomes. Psychoeducation programs may further reduce symtom severity by increasing ilness knowledge. Future research should explore longitudinal interventions targeting stigma reduction and psychological flexibility to enhance functional recovery in schizophrenia.

Addressing social determinants of health in individuals with mental disorders in clinical practice: review and recommendations

Social determinants of health have been shown to have a greater impact on overall health than traditionally considered medical risk factors, especially in people with mental disorders. It is the primary responsibility of healthcare providers to ensure that persons with psychiatric disorders are actively helped in reducing the adverse effects of SDoMH on their health and healthcare. Yet, the current clinical psychiatric practice in the U.S. does not have any standardized guidelines for evaluating or addressing these critical factors even among individuals who are receiving psychiatric and other medical treatment. Although there are several barriers to implementing such interventions, there are also practical approaches to address selected social determinants of mental health and improve the well-being of our patients. In this article, we review the literature on the assessment of relevant social factors and pragmatic psychosocial strategies at the individual, family, and community levels to help reduce their adverse impact. We offer guidelines for psychiatric clinicians and case managers to improve the health and quality of life of persons with mental disorders, using sustained inter-professional collaborative efforts.

Association of insight with stigma and its moderating factors among patients with stable schizophrenia

Stigma is prevalent among patients with schizophrenia, and its impact can be profound. Improving insight is a critical aspect of treating schizophrenia, but it is often accompanied by increased stigma. This study aims to explore how trait mindfulness and perceived social support moderate the relationship between insight and stigma in patients with stable schizophrenia. A cross-sectional study was conducted in Shanghai's Changning and Huangpu Districts from August to December 2023, recruiting patients through convenience sampling from local mental health centers. A total of 350 patients were included in the study, with their demographic information, insight, trait mindfulness, perceived social support, and stigma being measured. The study found that patients with higher BMI, unemployment or retirement status, and lower income levels experienced significantly higher stigma. The correlation analysis revealed that insight was positively correlated with stigma, while trait mindfulness and perceived social support were negatively correlated with stigma. Regression analysis showed that insight increased stigma, whereas trait mindfulness and perceived social support reduced it. Moderation analysis indicated that higher levels of both trait mindfulness and perceived social support significantly reduced the negative impact of increased insight on stigma in patients with schizophrenia. These findings highlight the importance of enhancing patients' trait mindfulness and perceived social support while improving insight in the treatment of schizophrenia.

Virtual Service Delivery in Mental Health and Substance Use Care: A Systematic Review of Preference Elicitation Studies

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care ('service', 'treatment', 'clinician' and 'additional supports'). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.

Adaptation and Implementation of a Multi-Family Group Psychoeducational Intervention for Parents of Children with Autism: A Pilot Study

Background/Objectives: A relatively small number of studies have evaluated the effectiveness of interventions designed to ameliorate family burden and to improve family functioning for families with a child with ASD. This study aims to investigate whether a long-term multi-family group psychoeducational intervention, originally developed for families including a member with a psychiatric disorder, can assist the parents of children with ASD to improve family functioning, support family rituals, and ease family burden; to understand the etiology, the characteristics, and treatment options for ASD; and to manage social and self-stigmatization. Method: We compared an intervention group (N = 3 couples-6 parents) with a waitlist control group (N = 3 couples-6 parents) by administering psychometric scales to evaluate the effectiveness of the intervention on (a) family functioning, (b) family rituals, and (c) family burden. Qualitative analysis of pre- and post-intervention semi-structured interviews assessed (a) the participants' understanding of the nature, causes, and treatments for ASD and (b) the management of social and self-stigmatization in families with a child with ASD. Results: Quantitative pre- and post-test group comparisons, as well as qualitative thematic analysis, revealed significant decreases in all parameters under study for the treatment group. Conclusions: Our findings provide pilot evidence that long-term group psychoeducation, originally designed for families including a member with a psychiatric disorder, may provide an efficacious treatment choice toward improving the general functioning of families with a child with ASD. Systematic replications of this psychoeducational intervention merit attention.

Predictors of the Fear of COVID-19 in Individuals with Schizophrenia: a Prospective Study

Purpose: The fear of COVID-19 can result in psychological distress and mental health problems. Individuals with schizophrenia (IWSs) are especially vulnerable to contracting COVID-19. This study with a 1-year follow-up examined whether individual characteristics (sociodemographic characteristics, schizophrenia symptoms, depression, and self-esteem) or factors related to individual-environmental interaction (self-stigma, loneliness, and perceived social support) predicted the level of fear of COVID-19 (FC) among IWSs. Patients and methods: In total, 257 IWSs (out of an initial pool of 300 IWSs) were enrolled, and their baseline data were collected. FC was assessed using the Fear of COVID-19 Scale at 1 year after the onset of the study. The associations of baseline factors with FC 1 year later were analyzed using bivariable and multiple linear regression analysis. Results: Bivariable linear regression results demonstrated that being a woman (p < 0.05), being unemployed (p < 0.05), having depression (p < 0.001), having low self-esteem (p < 0.05), experiencing loneliness (p < 0.01), and having feelings of self-stigma (p < 0.001) significantly predicted FC 1 year later. A multiple linear regression model further indicated that having feelings of self-stigma significantly predicted FC 1 year later (p < 0.01). Conclusion: Clinicians and policymakers should consider the predictors identified in this study when designing interventions to reduce FC among IWSs.

Predictors of internalised stigma among people with mental illness attending a psychiatry outpatient clinic in Ethiopia: Institution based cross sectional study

BACKGROUND

Despite initiatives to increase access to mental health care and improve the quality of life for individuals living with mental illness, there is limited information on internalized stigma and its impact on these individuals. This study aimed to determine the prevalence of internalised stigma and identify associated factors (sociodemographic, clinical, and substance use) among people with mental illness attending an outpatient clinic in Ethiopia.

METHOD

Institution-based cross-sectional study was conducted with patients with mental illness at the University of Gondar Hospital clinic. We recruited 638 participants from the clinic using systematic random sampling with an interval of three applied. Internalised stigma was measured using the nine-item (ISMI-9) Internalised stigma of Mental Illness Scale. Variables were coded and entered into SPSS-28 software for further analysis. To analyze the data, we used descriptive and multivariate logistic regression analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value less than 0.05 were considered significant.

RESULTS

Prevalence of internalised stigma among study participants was 49.1% (95% CI: 45, 52). The following attributes were associated with a greater likelihood of high internalised stigma, participants with no formal education (AOR=2.19, 95% CI:1.33, 3.61); patients with fair self-reported health (AOR=3.12, 95% CI:1.28, 7.59), patients with poor self-reported health (AOR= 9.11, 95% CI: 2.89, 28.73), patients with suicidal ideation (AOR=1.95, 95% CI:1.37, 2.79), alcohol users (AOR= 1.89, 95% CI:1.24,2.91), patient with low self-esteem (AOR=1.55, 95% CI:1.09, 2.21), patient with poor drug adherence (AOR=2.2, 95% CI:1.30,3.71), patients with family history of substance use (AOR= 2.46, 95% CI:1.54,3.93).

CONCLUSIONS

The prevalence of high internalised stigma among patients with mental illness in was high. Therefore, anti-stigma activities, early outpatient support, drug adherence information, and reduction of suicidal behaviors are all necessary to reduce stigma in patients with mental illnesses.

Usefulness in rehabilitation of the paper Multiple Errands Test to assess executive functions in patients with schizophrenia, bipolar or autism disorders. Results from the REHABase cohort study

OBJECTIVE

Neuropsychological tests measuring executive functions are useful for identifying specific cognitive disorders, but they have limits for characterizing executive dysfunction in everyday activities. This study aims to investigate the socio-demographic, clinical, and psychosocial features associated with executive functions in patients with schizophrenia, bipolar, and autism spectrum disorders using a Paper Multiple Errands Test.

PATIENTS OR MATERIALS AND METHODS

A total of 1071 adults with schizophrenia spectrum disorder, 329 with bipolar spectrum disorder, and 254 with autism spectrum disorder were recruited from the French National Centers of Reference for Psychiatric Rehabilitation (REHABase) cohort between January 2016 and October 2022. Executive function severity was assessed by the multiple errands test. Socio-demographic and clinical data were extracted as well as results from standardized scales for self-stigma, quality of life, well-being, and self-esteem. Data were analyzed using bivariate and Quasi-Poisson regression model.

RESULTS

The mean number of errors measured by the paper multiple errands test was 3.1±1.9 in patients with schizophrenia spectrum disorder (n=1071), 2.4±1.8 in bipolar disorder (n=329), and 2.6±1.9 in autism disorder (n=254). Factors significantly associated with the number of errors were (1) age, illness duration, number of hospitalizations, education level, working memory, and insight in patients with schizophrenia; (2) age, illness duration, number of hospitalizations, education level, and working memory in patients with bipolar disorder; and (3) education level and working memory in patients with autism disorder. The number of errors was associated with lower quality of life, well-being and self-esteem, but not self-stigma, in all three disorders.

CONCLUSION

The predictors of executive dysfunction observed with the paper multiple errands test were similar to those found with other tests of executive function. The paper multiple errands test is associated with essential psychosocial determinants in rehabilitation, particularly quality of life and well-being, and provides a wide range of information about functioning in community living.

Narrative enhancement and cognitive therapy for self-stigma among youth with bipolar disorder or multiple mental health conditions: protocol for a pilot randomised basket trial

INTRODUCTION

Self-stigma occurs when individuals internalise negative stereotypes about their mental health conditions. Self-stigma is common among those with serious mental illnesses, including youth, and is considered a major barrier to recovery through its impact on hope, self-esteem and self-identity. This patient-oriented protocol aims to assess the feasibility of conducting a future full-scale randomised controlled trial (RCT) of a youth-oriented adaptation of narrative enhancement and cognitive therapy for self-stigma among youth (NECT-Y).

METHODS AND ANALYSIS

This is a two-site, two-arm pilot basket RCT with 1:1 randomisation to NECT-Y or treatment as usual (TAU). Participants are youth, ages 16-29 diagnosed with bipolar disorder, any subtype (Basket 1) or with any two or more mental health conditions (Basket 2). After informed consent, we will conduct baseline assessments and randomisation, then either a 14-week NECT-Y group intervention or TAU. Diagnostic interviews will be used to confirm diagnosis at baseline. A range of self-report questionnaires will be administered at baseline, post-treatment and 3 month follow-up. The primary outcome is feasibility as indicated by the achievement of recruitment goals, retention and adherence, intervention fidelity and the absence of serious adverse events. Secondary outcomes include acceptability and the intervention's impact on self-stigma, wellness, symptomatology, treatment-seeking attitudes and other related constructs. A youth advisory group is informing all stages of the study process.

ETHICS AND DISSEMINATION

The Research Ethics Board for Centre for Addiction and Mental Health (#062/2024) has approved this study protocol. Ethics is also approved at London Health Sciences Centre (Western Health Sciences Research Ethics Board (HSREB) #125812). Results will be published in international peer-reviewed journals and presented at relevant conferences. Summaries will be provided to the funders of the study, as well as to lay audiences, including study participants.

TRIAL REGISTRATION NUMBER

NCT06672562.

Stigma Toward Severe Mental Illness Among Healthcare Students: A Qualitative Study

BACKGROUND

Individuals diagnosed with Severe Mental Illness (SMI) often perceive negative attitudes from health professionals, acting as a barrier to effective treatment. The present study explores healthcare students' attitudes toward SMI to identify potential areas of stigma.

METHODS

A descriptive analytical qualitative approach was employed. Twenty-seven students from six different healthcare programs at the University of Malaga participated in semi-structured interviews, which were subsequently analyzed using thematic content analysis with the assistance of NVivo 12 software.

RESULTS

Three main themes emerged from the data: ideals, experiences with SMI, and views on hospitalization and coercive measures. Students acknowledge the importance of empathy but often feel unprepared due to limited knowledge, leading to avoidance and negative interactions. Although stigmatizing beliefs regarding dangerousness and inabilities persist, students generally reject segregation and advocate for equal rights. Positive contact experiences with mental illness can modify negative attitudes and enhance empathy, particularly among individuals with their own personal experiences. Participants generally oppose coercive measures, except for safety concerns and lack of illness awareness, advocating for alternatives to preserve autonomy.

CONCLUSIONS

The study highlights that insecurity and feeling unprepared could be linked to stigmatizing and negative experiences with individuals with SMI. Therefore, we underline the need for the anti-stigma education of healthcare students focusing on contact experiences and promoting confidence in their knowledge and skills.

User Personas for eHealth Regarding the Self-Management of Depressive Symptoms in People Living With HIV: Mixed Methods Study

BACKGROUND

eHealth has enormous potential to support the self-management of depressive symptoms in people living with HIV. However, a lack of personalization is an important barrier to user engagement with eHealth. According to goal-directed design, personalized eHealth requires the identification of user personas before concrete design to understand the goals and needs of different users.

OBJECTIVE

This study aimed to identify user personas for eHealth regarding the self-management of depressive symptoms in people living with HIV and explore the goals and needs of different user personas for future eHealth.

METHODS

We used an explanatory sequential mixed methods design at the First Hospital of Changsha City, Hunan Province, China, from April to October 2022. In the quantitative phase, 572 people living with HIV completed validated questionnaires with questions related to demographics, self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Latent profile analysis was performed to identify different user personas. In the qualitative phase, 43 one-to-one semistructured interviews across different user personas were conducted, transcribed verbatim, and analyzed using conventional content analysis. The findings from both phases were integrated during the interpretation phase.

RESULTS

Three types of user personas could be identified, including "high-level self-managers" (254/572, 44.4%), "medium-level self-managers" (283/572, 49.5%), and "low-level self-managers" (35/572, 6.1%). High-level self-managers had relatively high levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. High-level self-managers had a positive attitude toward using eHealth for the self-management of depressive symptoms and desired access to self-management support for depressive symptoms from eHealth with high usability. Medium-level self-managers had relatively medium levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Medium-level self-managers felt burdened by using eHealth for the self-management of depressive symptoms and preferred to access self-management support for HIV from eHealth with privacy. Low-level self-managers had relatively low levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Low-level self-managers had an acceptable attitude toward using eHealth for the self-management of depressive symptoms and desired access to professional guidance from eHealth with privacy and no cost ("free of charge").

CONCLUSIONS

The 3 user personas shed light on the possibility of personalized eHealth to support the self-management of depressive symptoms in different people living with HIV. Further research is needed to examine the generalizability of the user personas across study sites.

Experienced and anticipated discrimination among people living with schizophrenia in China: a cross-sectional study

PURPOSE

Understanding the experienced and anticipated discrimination of people living with schizophrenia (PLS) in China is the cornerstone of culturally informed intervention. This study aims to describe the pattern of experienced and anticipated discrimination against PLS in China and investigate which social and illness characteristics are associated with discrimination.

METHODS

PLS dwelling in community were randomly recruited from four cities across China and completed measures of experienced and anticipated discrimination by discrimination and stigma scale (version 12; DISC-12). Multivariable regression was used to analyses the correlates of experienced and anticipated discrimination.

RESULTS

A total of 787 participants (54.0% were female) were included in the analysis. 38% of participants reported experienced discrimination and 71.4% reported anticipated discrimination. The most common experienced discrimination for PLS in China were from neighborhood, making/keeping friends, finding/keeping a job, and family. 59.3% of participants had concealed their mental illness. Living in rural areas, household poverty, longer illness duration, severer symptoms and higher level of disability were associated with more experienced discrimination. Younger ages, unemployment, higher level of disability and experienced discrimination were associated with more anticipated discrimination.

CONCLUSION

More than a third of PLS in China have experienced discrimination in their lives. Economically disadvantage PLS and PLS living in rural setting may experience more discrimination in China. New and culturally informed intervention approaches are needed to prevent and reduce discrimination of schizophrenia.

Mood Disorder Public Stigma in Jewish Communities in the United States

This study employed an experimental vignette design in Jewish communities in the United States (n = 243) to investigate whether public stigma toward target individuals with major depressive disorder or bipolar disorder presenting with either mania or depression was associated with their gender and symptomatology. The Mental Illness Stigma Scale (Day et al., in J Appl Soc Psychol 37(10):2191-2219, 2007) was used to measure the following dimensions of public stigma: (a) anxiety; (b) relationship disruption; (c) hygiene; (d) visibility; (e) treatability; (f) professional efficacy; and (g) recovery. The influence of characteristics of survey respondents on public stigma was also examined. In Jewish communities in the United States, mood disorder symptomatology was associated with the stigma dimensions of recovery, relationship disruption, and hygiene. Among respondents, younger and middle-aged males reported increased treatment efficacy stigma. Research implications include designing stigma reduction interventions tailored to specific diagnostic (e.g., bipolar disorder) and demographic (e.g., younger males) groups within the Jewish community.

Antipsychotics and Identity: The Adverse Effect No One is Talking About

People who take antipsychotics, and people who are prescribed antipsychotics without taking them, experience effects which are not frequently discussed: effects on their identity and sense of self. Qualitative research indicates the relationship between taking APs and identity is multilayered, and changeable. Taking APs can restore people to their earlier, pre-symptom sense of self. Being prescribed and taking APs can also, on the other hand, be experienced as damaging, erasing and dulling people's sense of who they are. This complexity deserves exploration in clinical practice, which we believe is currently not done routinely. More work is needed to understand whether, and how, the relationship between identity and APs is being addressed. We outline the importance of having discussions in a clinical space around identity, and a sense of agency, on the grounds that true recovery-oriented care, which enacts shared decision-making principles, demands it. Further, we argue that it will allow for better therapeutic alliance and trust to be forged between clinician and client, ultimately leading to better care.

Factors Associated with Stigma and Beliefs About Psychotropics Among the Japanese Ancestry Population Diagnosed with Depression in Brazil

To analyze stigma related to depression, beliefs about psychotropics, and associated factors in a population of Japanese ancestry in Brazil. This cross-sectional study was conducted between March and June, 2022. Beliefs about psychotropics (BMQ-specific) and depression-related stigma (The Stigma Scale) were collected through an online questionnaire. Multiple linear regression analysis was performed to identify the factors associated with these dependent variables. Ninety-three respondents of Japanese ancestry completed the questionnaire. Participants were more focused on the necessity of the prescribed psychotropics than on possible adverse effects. Married individuals (β=-4.68 [95%CI -8.74, -0.63]; p = 0.024) were less concerned with their psychotropics than single individuals, while those undergoing treatment for longer years (β = 6.23 [95%CI 1.35, 11.11]; p = 0.013) perceive a greater necessity for treatment than those who started it recently. In addition, older individuals perceived less necessity for treatment (β=-5.83 [95%CI -10.76, -0.90]; p = 0.021) than younger individuals. Unemployed people (β = 12.09 [95%CI 0.47, 23.70]; p = 0.042) perceived more depression-related stigma than those employed. Aspects of Japanese cultural heritage related to depression and its treatment are still prevalent among people of Japanese ancestry in Brazil. Factors such as age, treatment duration, and marital status affects the perception of beliefs about psychotropics, whereas occupation affects the perception of stigma.

Assessing the effectiveness and the feasibility of a group-based treatment for self-stigma in people with mental disorders in routine mental health services in North-East Italy: study protocol for a pragmatic multisite randomized controlled trial

BACKGROUND

Self-stigma refers to the process whereby individuals with mental disorders internalize negative societal attitudes and misconceptions about mental health conditions, potentially affecting their sense of self-worth and identity. This internalization can significantly impact various aspects of life, including treatment engagement, personal relationships, and overall well-being. Narrative Enhancement and Cognitive Therapy (NECT) was developed in the United States to counteract self-stigma and has been supported by multiple randomized controlled trials. However, NECT has not yet been implemented in Italy or within a public mental health system grounded in community psychiatry. This study aims to evaluate the efficacy and feasibility of the Italian version of the NECT within the public mental health sector in a large part of North-East Italy.

METHODS AND ANALYSIS

This pragmatic, multisite, superiority, randomized, wait-list controlled trial with two parallel arms will recruit over four hundred patients with severe mental disorders from 26 public community-based mental health centers in North-East Italy. The experimental intervention, NECT, consists of 20 group-based sessions to reduce self-stigma. The study will assess NECT's impact on several psychological dimensions, including self-stigma levels (primary outcome), self-esteem, hope, empowerment, recovery perception, mental well-being, and stigma stress (secondary outcomes). Feasibility will be evaluated by collecting data on participant adherence and treatment implementation, including eligibility screening, participation rates, intervention completion, exposure levels, and reasons for dropout.

DISCUSSION

The findings of this research are expected to contribute to the understanding of effective treatments for patients with mental disorders, particularly those burdened by high levels of self-stigma, and to improve their recovery outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov; Identifier: NCT06567145.

How does stigma impact acts of compassion among people with borderline personality disorder

Borderline personality disorder (BPD) is a highly stigmatised mental disorder. A variety of research exists highlighting the stigma experienced by individuals with BPD and the impacts of such prejudices on their lives. Similarly, much research exists on the benefits of engaging in compassionate acts, including improved mental health recovery. However, there is a notable gap in understanding how stigma experienced by people with BPD acts as a barrier to compassion and by extension recovery. This paper synthesises these perspectives, examining common barriers to compassionate acts, the impact of stigma on people with BPD, and how these barriers are exacerbated for individuals with BPD due to the stigma they face. The synthesis of perspectives in the article highlights the critical role of compassion in supporting the recovery of individuals with BPD, while also revealing the significant barriers posed by stigma. Addressing these challenges requires a comprehensive understanding of the intersection between compassion and stigma, informing the development of targeted interventions to promote well-being and recovery for individuals with BPD.

Examining the relationships between self-stigma, loneliness, depressive symptoms, and suicidal ideation among people with bipolar disorder

People diagnosed with bipolar disorder (BD) commonly experience self-stigma, which negatively affects various health outcomes. The aim of the present study was to elucidate the mechanisms through which self-stigma may contribute to suicidality among bipolar patients by investigating the mediating roles of loneliness and depressive symptoms. A total of 140 patients with BD were cross-sectionally assessed with self-report scales measuring self-stigma, loneliness, depressive symptoms and suicidal ideation, and with a clinician-rated scale evaluating overall psychopathology. Path analysis was used to analyze the data. Self-stigma was directly related to more severe loneliness, depressive symptoms and suicidal thoughts. There were also significant direct effects of loneliness on depressive symptoms and depressive symptoms on suicidal ideation. The direct effect of loneliness on suicidality was non-significant. The following indirect effects on suicidal ideation were found: from self-stigma via depressive symptoms, from loneliness via depressive symptoms and a sequential effect from self-stigma through loneliness and depressive symptoms. Our findings clearly indicate that interventions aiming to reduce the risk of suicide among people with BD should be comprehensive and take into account not only psychiatric symptoms, but also social context and the psychological aspects of living with this diagnosis.

Mental health professionals' perspectives and suggestions on religious and superstitious activities engagement of patients with serious mental illness: A national survey in Thailand

BACKGROUND

Patients with serious mental illness (SMI) often engage in religious and superstitious activities. The implications of such engagements remain unclear, with no established guidelines for mental health professionals.

AIMS

This study aimed to survey perspectives and gather suggestions from various disciplines within mental healthcare regarding the engagement in religious/superstitious activities of SMI patients: schizophrenia spectrum disorders, bipolar disorder, major depressive disorder.

METHOD

This cross-sectional study was conducted between November and December 2023 among Thai mental health professionals. Participants used 10-point Likert scales to rate their agreement levels for engaging each activity. Additional suggestions were obtained through textual responses, which were subsequently summarised and synthesised.

RESULTS

Of the 403 professionals participated, the majority were female (73.2%), Buddhist (87.6%) and psychiatrists (42.2%), with a median age of 34.0 years. Among patients with active symptoms, patients with major depressive disorder tended to receive the highest mean agreement scores for engagement, while patients with schizophrenia consistently scored the lowest across most activities. Similar trends were observed among patients in remission. From textual responses, two key themes were synthesised: (1) environmental factors and (2) impacts on natural courses.

CONCLUSIONS

Patients with active schizophrenia received the lowest levels of agreement while patients with major depressive disorder tended to receive the highest mean agreement scores on engaging religious/superstitious activities.

Brief video intervention to increase treatment-seeking among individuals living in a conflict zone: A randomized controlled trial

BACKGROUND

On October 7, 2023, a large-scale attack in Southern Israel and the ensuing war led to widespread casualties and the displacement of hundreds of thousands in Southern and Northern Israel. The conflict has exacerbated mental health issues. This randomized controlled trial assessed a brief social-contact-based video intervention on a large sample of individuals living in conflict zones, aiming to examine its effects on increasing treatment-seeking intentions. As a secondary aim, we tested changes in treatment-seeking behavior.

METHODS

Participants (N = 1,052), civilians in conflict zones in Israel, were randomized into either a brief video-based or a psychoeducational control intervention. The 2.5-minute video featured the personal story of a terrorist attack survivor sharing his traumatic experiences and subsequent mental health struggles. Treatment-seeking intentions were assessed at baseline, immediately post-intervention, and at a 30-day follow-up. Treatment-seeking behavior was assessed at the 30- and 90-day follow-ups.

RESULTS

The brief video intervention elicited an immediate increase in treatment-seeking intentions. A significant group-by-time interaction emerged (χ²=10.5, df=2, p=.005; Cohen's d = 0.36), particularly among male viewers (p<.001; d = 0.47). However, these effects were not sustained 30 days after the initial viewing. We found no effect on treatment-seeking behavior.

CONCLUSIONS

This trial confirms the efficacy of a single brief social-contact-based video intervention in increasing treatment-seeking intentions, among those in conflict-affected areas. Although the impact was brief, this accessible intervention underscores its potential as a strategy to facilitate treatment-seeking intentions.

Women with Schizophrenia: Beyond Psychosis

Although women with schizophrenia face significant lifelong challenges due to their diagnosis and sex-related issues, those challenges are seldom taken into consideration in their medical treatment and general care. In order to report the needs and desires of a group of women with schizophrenia, we conducted a series of semistructured interviews with nine women diagnosed with schizophrenia and attending outpatient clinics at the Hospital Del Salvador in Valparaíso. Our qualitative study followed a phenomenological design. Using ATLAS.ti software, we performed a content analysis of the interview transcripts, developed a coding frame for each major topic addressed in the interviews, and triangulated the results. Despite presenting with psychotic symptoms, some women received different diagnoses. Although acknowledging the benefits of medication, women also reported concerns about weight gain and body image. All women reported experiences with stigma and self-stigma related to the diagnosis of schizophrenia, and most had experienced childhood trauma, including sexual abuse, parental violence, and/or bullying. Young women with schizophrenia also feared that if they become mothers, then their children might also have schizophrenia and/or that they would be unable to adequately care for them. Women with schizophrenia have different experiences and play different roles in society beyond their psychoses, an understanding that should integrated into more personalized treatments for schizophrenia that consider individual characteristics and needs.

Perceptions of Lesotho nurse-midwives regarding post-partum depression management

BACKGROUND

 Effective post-partum maternal care is essential for the overall well-being of both the mother and the child. Postpartum depression (PPD) is a pervasive issue with profound implications for maternal health. However, a significant research gap exists concerning the perspectives of nurse-midwives on PPD within the context of Lesotho.

OBJECTIVES

 This study aimed to explore perceptions of nurse-midwives about PPD management at a tertiary care facility in Lesotho.

METHOD

 The study site was the Quthing Hospital, a government-funded healthcare facility situated in Lesotho's southernmost district, Quthing. Employing a constructivist paradigm, the research adopted a qualitative, exploratory, descriptive and contextual design. Using purposive sampling, nine nurse-midwives participated in individual interviews.

RESULTS

 Thematic analysis of the data resulted in three themes emerging namely: a lack of nurse midwifery empowerment, inadequate human and material resources and stigma on mental health issues.

CONCLUSION

 Nurse-midwives at a large tertiary care facility perceive PPD management through a multifaceted lens. Insights underscored the complexity of PPD and its ramifications for maternal care.Contribution: This study provides invaluable perspectives from nurse-midwives within a specific Lesotho context, laying the foundation for strategies to enhance PPD management and maternal mental healthcare.

Parsing stigma's relationship with the psychosocial functioning of youth identified as at clinical high risk for psychosis: evaluating whether symptom stigma or labelling stigma is stronger

BACKGROUND

The clinical high risk for psychosis (CHR-p) syndrome enables early identification of individuals at risk of schizophrenia and related disorders. We differentiate between the stigma associated with the at-risk identification itself ('labelling-related' stigma) versus stigma attributed to experiencing mental health symptoms ('symptom-related' stigma) and examine their relationships with key psychosocial variables.

AIMS

We compare labelling- and symptom-related stigma in rates of endorsement and associations with self-esteem, social support loss and quality of life.

METHOD

We assessed stigma domains of shame-related emotions, secrecy and experienced discrimination for both types of stigma. Individuals at CHR-p were recruited across three sites (N = 150); primary analyses included those who endorsed awareness of psychosis risk (n = 113). Paired-sample t-tests examined differences in labelling- versus symptom-related stigma; regressions examined associations with psychosocial variables, controlling for covariates, including CHR-p symptoms.

RESULTS

Respondents reported greater symptom-related shame, but more labelling-related secrecy. Of the nine significant associations between stigma and psychosocial variables, eight were attributable to symptom-related stigma, even after adjusting for CHR-p symptoms.

CONCLUSIONS

Stigma attributed to symptoms had a stronger negative association with psychosocial variables than did labelling-related stigma among individuals recently identified as CHR-p. That secrecy related to the CHR-p designation was greater than its symptom-related counterpart suggests that labelling-related stigma may still be problematic for some CHR-p participants. To optimise this pivotal early intervention effort, interventions should address the holistic 'stigmatising experience' of having symptoms, namely any harmful reactions received as well as participants' socially influenced concerns about what their experiences mean, in addition to the symptoms themselves.

A multicultural comparative study of self-stigma in epilepsy: Differences across four cultures

OBJECTIVE

Epilepsy is a neurological disorder characterized by recurrent seizures, exhibiting variance in prevalence and treatment availability across diverse geopolitical contexts and cultural milieus. The stigma associated with epilepsy is a significant global issue affecting the quality of life (QOL) of people with epilepsy (PWE). This study aims to examine the relationship between self-stigma and depressive symptoms in PWE, with a particular emphasis on understanding the manifestations of these across different cultural contexts. We aim to enhance the provision of customized care to diverse cultural settings, fostering the adoption of healthier lifestyles for PWE.

METHODS

We recruited PWE who received treatment at specialized medical facilities for epilepsy in Japan, Malaysia (Chinese, Malay), and Turkey from February to October 2023. The Epilepsy Self-Stigma Scales (ESSS), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Generalized Anxiety Disorder 7 (GAD-7) in local languages were used to assess self-stigma, depressive symptoms, and anxiety.

RESULTS

The ESSS total scores were significantly higher among the Turkish and Japanese cohorts (F [3, 406] = 6.57, p < 0.001, η2 = 0.05). In addition, the self-stigma observed moderate positive correlations for depressive symptoms (rs = 0.41-0.50, Ps < 0.001) and anxiety (rs = 0.42-0.44, Ps < 0.001). The ANCOVA findings suggested that the notable variations in self-stigma, as found in the one-way ANOVA conducted across four cultures, were reduced when taking into consideration depressed symptoms. Our finding highlights the potential influence of mental health factors over cultural factors concerning self-stigma.

SIGNIFICANCE

The manifestation of self-stigmatization within epilepsy exhibits distinctions across diverse cultural cohorts, regardless of the demographic and clinical variation, yet demonstrates a significant correlation with psychological factors. In subsequent research endeavors, we should comprehensively investigate these subtle differences, their potential impact on patient care, and the development of supportive approaches.

PLAIN LANGUAGE SUMMARY

This cross-cultural study reveals significant variations in self-stigma among people with epilepsy across different cultural contexts, with Turkish and Japanese cohorts showing higher levels. Self-stigma demonstrated moderate positive correlations with depressive symptoms and anxiety across all cultures. Notably, differences in self-stigma were reduced when accounting for depressive symptoms, suggesting that mental health factors may have a stronger influence than cultural factors. These findings underscore the importance of considering both cultural and psychological aspects in developing targeted interventions to address self-stigma in epilepsy care.

Discrimination and Social Exclusion of People Experiencing Mental Disorders in Burkina Faso: A Socio-anthropological Study

Stigma has been pointed out as a barrier to mental healthcare in sub-Saharan Africa. Among the manifestations of stigma, the use of physical restraints is condemned as a form of violation of basic human rights. Research on this phenomenon is limited in West Africa and more particularly in Burkina Faso. This study explores the phenomenon of stigma of individuals experiencing mental disorders in Bobo-Dioulasso (Burkina Faso). As part of 8 months of socio-anthropological fieldwork, we interviewed 94 informants (7 focus groups and 25 individual interviews) to document exclusionary practices, their perceptions, and justifications. Exclusionary practices can be divided in five subgroups: ignoring, physically and sexually abusing, abandoning, banning, and restraining. Some practices were linked to a lack of financial and material resources, while others were justified by an inferior moral status. We observed differences in the type of exclusion experienced between men and women. Restrictive, abusive, and exclusionary measures are common in Bobo-Dioulasso. These practices can either be understood as part of families' adaptative strategies when dealing with chronic conditions, as part of security measures in the case of patients with aggressive behaviors, or as part of punitive measures when transgressions are committed. We conclude the article by addressing the tensions between local and global meanings of stigma.

Psychiatric and functional correlates of stigma associated with cognitive impairment in schizophrenia

Schizophrenia is the most strongly stigmatized psychiatric diagnosis, with negative stereotypes including assumptions of incompetence and inability to recover. Individuals with cognitive impairment associated with schizophrenia (CIAS) have reported stigma experiences, suggesting that CIAS carries stigma in addition to the stigma associated with schizophrenia as a diagnostic label. While research has established that mental illness stigma more generally is linked with poor psychiatric and functional outcomes, no research has explored correlates of CIAS stigma. This study evaluated cognitive, psychiatric, and functional correlates of CIAS stigma among 54 individuals with schizophrenia spectrum disorders participating in a cognitive remediation trial. Participants with greater estimated cognitive decline reported higher levels of CIAS stigma experiences. Participants who reported higher levels of CIAS stigma also scored higher on a measure of depressive symptom severity. No significant associations were found between CIAS stigma and positive and negative psychosis symptoms or general psychopathology ratings. CIAS stigma was not associated with performance-based functional capacity or ratings of community functioning. Findings suggest that CIAS stigma is linked with the degree of cognitive decline and depressive symptom severity among individuals with schizophrenia spectrum disorders. Additional research is needed to elucidate directionality and the relationship between CIAS stigma and functioning outcomes.

The survey of the status of self-stigma of depression and its relationship with demographic factors in Gonabad, Iran

Introduction

Depression is a common mental illness. Depression stigma can reduce individuals' desire to seek mental health services. No study has investigated depression self-stigma and its relationship with demographic factors in the general population of Gonabad city in Iran. Therefore, this study was aimed at determining the relationship between depression self-stigma and demographic factors.

Methods

This cross-sectional study was conducted among 1,075 Iranians living in Gonabad city in 2024. Proportionate stratified sampling was used to select participants. Data collection tools included demographic data and the self-stigma of depression scale (SSDS). Higher SSDS scores indicate greater depression self-stigma. Data were analyzed using SPSS 24 with the independent samples t-test, one-way analysis of variance, and Pearson correlation.

Results

The mean (± SD) of self-stigma of depression (SSD) was 42.51 (9.31). Only 16.1% of the participants mentioned that they had a mental disorder, and 17.2% reported that they had been referred to a psychologist. Based on the results, males had more SSD (p = 0.028), help-seeking inhibition (p < 0.001), and shame (p = 0.002) than females. There were no significant relationships between education level, economic status, age group, occupation, and marital status with SSD (p > 0.05). Individuals with a history of mental disorder had higher SSD (p = 0.011) and help-seeking inhibition (p = 0.004). People who did not obtain information related to mental illness had more help-seeking inhibition (p = 0.001). Based on the Pearson correlation results, a positive and significant correlation coefficient was observed between the subscales of SSDS (P < 0.001).

Conclusion

The results of the study showed that SSD level was 42.51 ± 9.31 from 70. SSD is one of the main obstacles to help-seeking and treatment, so providing knowledge and awareness in this area is essential to the community.

Homicides by offenders with psychotic illness in Italy and Turkiye: A comparison of offender and crime-scene profiles

OBJECTIVE

The primary aim of this study was to conduct a comparative analysis of homicide cases and their perpetrators with psychotic illnesses in Italy and Turkiye, identifying the extent to which country-specific factors influence offender profiles and crime-scene characteristics.

METHOD

This cross-national chart review study recruited individuals with psychotic illnesses from forensic psychiatric centers in Italy and Turkiye who were referred for criminal responsibility assessments. Data were collected on the offenders' background characteristics, psychiatric history, victim profiles, and crime-scene details.

RESULTS

Compared to the Italian sample, a higher prevalence of hospitalizations, contact with mental health services, and past offending history prior to the index homicide in the Turkish sample highlight inadequate community mental health care and monitoring systems, as well as insufficient supervision by the criminal justice system in Turkiye. Turkish offenders were less likely to exhibit organized crime scenes and post-crime behavior, with fewer stressors preceding the offense, suggesting a greater role of positive psychotic symptoms in their homicidal acts.

CONCLUSION

Despite certain similarities, the differences between the two samples highlight the impact of sociocultural, healthcare, and legal systems on offender profiles and crime-scene characteristics. These findings emphasize the need for tailored mental health services, forensic psychiatric assessments and legal supervision that take into account country-specific factors.

How to combat stigma surrounding mental health disorders: a scoping review of the experiences of different stakeholders

BACKGROUND

The stigma associated with mental health disorders (MHDs) results in delayed help-seeking, limited access to health services, suboptimal treatment, poor treatment outcomes, and an increased risk of human rights violations. This scoping review summarizes qualitative research on the lived experiences of different stakeholders regarding strategies and interventions to combat stigma for people with MHDs.

METHODS

This study was a six-step scoping review using the Arksey and O'Malley framework. A comprehensive search of the following electronic databases was conducted to identify relevant records: PubMed, Scopus, Web of Science (WoS) and Google Scholar, as well as a manual search of the reference lists. All steps, including screening of eligible studies, data extraction, and analysis, were performed independently by multiple reviewers, with disagreements resolved by discussion. The data were synthesized based on the for-content synthesis guidelines.

RESULTS

A total of 25 studies were included in this review of the 32,976 initial identified citations. The included studies were from all countries (low, middle, and high income), stigmatized disorders (e.g., schizophrenia, bipolar disorder, etc.) and target populations (e.g., people with MHDs and their families, health care providers, the general community, and students and school members). The thematic synthesis revealed six types of interventions and strategies and 17 themes related to reducing stigma in patients on MHDs. Strategies and interventions were classified by patient (self-stigma), family (family stigma), healthcare professionals' stigma, workplace stigma, public/societal stigma, and structural type of stigma (institutional stigma).

CONCLUSIONS

This review contributes new evidence that should be considered in future interventions and policies to reduce stigma against MHDs. Multilevel and multistakeholder strategies and interventions are needed to reduce the stigmatization of MHDs.

Prevalence of depressive symptoms among young adults in Brazil: Results of the 2013 and 2019 editions of the National Health Survey

OBJECTIVE

To estimate the prevalence of depressive symptoms in the population aged 18 to 24, according to socioeconomic and demographic aspects in Brazil, comparing its evolution between 2013 and 2019.

METHODS

Cross-sectional study carried out with secondary data obtained from National Health Survey 2013 and 2019. It were included 7,823 young adulthood (aged 18 to 24) from 2013 and 8,047 from 2019. The instrument used to assess depression was the Patient Health Questionnaire-9 (PHQ-9). All estimates included population weights and complex sampling.

RESULTS

The prevalence of depression almost doubled: 10.9% (95%CI 9.6-12.2) in 2019, compared to 5.6% (95%CI 4.8-6.4) in 2013, an absolute difference of 5.3% (4.5-6.0) greater. Women were the most affected in both surveys, with an increase between 2013 (8.3%; 95%CI 6.9-9.6) and 2019 (15.6%; 95%CI 13.5-17.6) higher than that of men (2013: 2.9%; 95%CI 2.0-3.8 and 2019: 6.2%; 95%CI 4.7-7.7). In both sexes, the pattern of increase was greater for the groups aged 18 to 20, not participating in religious activities, who were at the lowest levels of education and income, who lived with two or three or more people, who lived in the Northeast, Southeast, capitals and metropolitan areas of the country.

CONCLUSION

There was a significant increase in the prevalence of depressive symptoms over the six years between the two surveys. However, this increase did not occur homogeneously among the characteristics analyzed, indicating population groups and locations in Brazil where the presence of these symptoms increased most in the period.

Evaluation of male-specific psychoeducation for major depressive disorder compared to cognitive behavioral therapy psychoeducation: A randomized controlled investigation in mentally distressed men

Background: Research suggests that male-specific psychotherapy approaches for major depressive disorder (MDD) that consider traditional masculinity ideologies (TMI) may achieve improved treatment efficacy and reduced therapy dropout. However, studies examining male-specific psychotherapy for MDD or specific therapy aspects remain lacking. Methods: An anonymous online study on men's mental health examined 152 self-reporting mentally distressed cisgender men (Mage = 25.5 ± 9.1) from German-speaking countries of Europe. After completing baseline assessments (T1) of state self-esteem, state shame, positive/negative affect, depressive symptoms, and TMI, men were randomly assigned to read either a male-specific (MSP) or a cognitive behavioral therapy-oriented (CBT) psychoeducation text for MDD. Immediately afterwards, participants rated its usefulness and completed follow-up assessments (T2). Results: Men in the MSP condition showed a stronger decrease in shame and negative affect as compared to men in the CBT-psychoeducation condition. Furthermore, in the MSP condition, prototypical depression symptoms tended to increase as compared to the CBT-psychoeducation, whereas male-typical externalizing depression symptoms tended to decrease. Conclusion: MSP for MDD may help depressed men feel less ashamed about their MDD and experience less negative affect about their condition than CBT-psychoeducation. Furthermore, MSP for MDD may elicit a shift from male-typical externalizing depression symptoms to prototypical depression symptoms.

Evaluation of the Psychometric Properties of the 18-Items Dysfunctional Attitudes Scale (Form B) in a Portuguese Sample of People Aged 60 and Over

The aim of the study is to assess the psychometric properties of the Portuguese version of the 18-items Dysfunctional Attitudes Scale (Form B) in a Portuguese sample of people aged 60 and over. Background: The 18-item Dysfunctional Attitudes Scale (Form B) is an instrument for assessing dysfunctional attitudes and can be useful as a predictor of depression for both initial episodes and relapses Methods: This was a one-stage cross-sectional survey of Portuguese-speaking people aged 60 years and over, able to read and write, functionally autonomous, and living in the community in their usual residences. The instrument was evaluated for its psychometric properties. Convergent validity with the Beck Depression Inventory-II was assessed. Results: The Portuguese version of the 18-item Dysfunctional Attitudes Scale (Form B) was structured into three factors, which explained a total of 58.95% of the total variance of the instrument. The exploratory factor analysis resulted in a modified model in which three factors were obtained with an eigenvalue greater than one (Kaiser's criterion). Three factors were obtained instead of two as in the original study. It showed an internal consistency (Cronbach's alpha = 0.770) and an interclass correlation coefficient ranging from 0.166 to 0.449, and the overall convergent validity with the Beck Depression Inventory-II was considered good; Conclusions: The Portuguese version of the Dysfunctional Attitudes Scale (DAS-18B) of people aged 60 and over demonstrated good psychometric properties.

The community health worker experience and perception toward mental illness: A multi-settings cross-sectional study in Indonesia

BACKGROUND

The experiences and perceptions of Community Health Workers toward mental illness are vital for tailoring interventions, reducing stigma, improving access to services, and fostering community engagement in mental health initiatives.

AIMS

This study investigates the experiences of community health worker and their perception of mental illness.

METHODS

A multi-settings cross-sectional study was conducted among 487 Community Health Workers. Their experience and perception toward mental illness were studied with questionnaires, which examined their general perception, religious-related perception, cause, treatment, and expectation for mental treatment.

RESULTS

Most participants concurred that serving as a community health worker enhances their communication abilities (90.4%), strengthens connections with community health center staff (84.8%), boosts self-confidence (84.6%), and refines their capacity to identify signs of mental disorders (77%). Most notably, they consider their fellow community health workers essential to their extended family. Furthermore, a notable proportion associates' mental illness with religious elements, with 19.5% believing it can result from a lack of religious worship and a minority attributing it to witchcraft or black magic (3.5%). In terms of treatment, 14.2% think Ruqyah can cure mental illness, 6.4% believe in treatment by religious scholars, and a similar percentage (6.4%) think no medication or treatment is necessary for mental problems.

CONCLUSION

Participants overwhelmingly recognize the positive impact of serving as community health workers, citing improvements in communication, relationships with health center staff, self-confidence, and mental disorder identification. The strong bond among community health workers, likened to an extended family, emphasizes their collective importance. Additionally, the majority advocates for compassionate treatment of individuals with mental illness. These findings underscore the complex interplay of professional, communal, and cultural elements in addressing community mental health.