Have there been any changes in the public's attitudes towards psychiatric treatment? Results from representative population surveys in Germany in the years 1990 and 2001

Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

Background: Coercion is routinely used in psychiatry. Its benefits and drawbacks are controversially debated. In addition, the majority of persons with mental health problems are exposed to stigmatization and are assumed to be dangerous. Stigmatization is associated with negative consequences for individuals with mental illness such as disapproval, social rejection, exclusion, and discrimination. Being subjected to coercive measures can increase the stigmatization of the affected persons, and stigmatization might lead to higher approval for coercion. Aims of the Study: This study aims to examine the approval for coercive measures in psychiatry by the general public, and to explore its relation with person- and situation-specific factors as well as with stigmatization. Method: We conducted a representative survey of the general population (N = 2,207) in the canton of Basel-Stadt, Switzerland. Participants were asked to read a vignette depicting psychopathological symptoms of a fictitious character and indicate whether they would accept coercive measures for the person in the vignette. Desire for social distance and perceived dangerousness were assessed as measures of stigmatization. Findings: The person in the case vignette exhibiting dangerous behavior, showing symptoms of a psychotic disorder, being perceived as dangerous, and treatment being understood as helpful increased approval of coercion in general, while familiarity of the respondents with mental illness decreased approval. Conclusions: The public attitude regarding the approval of coercion in psychiatry is highly differentiated and largely follows the current legal framework and medical treatment guidelines. Higher approval occurred in situations of self-harm or harm to others and when coercive measures were thought to have a beneficial effect for the affected persons. A considerable part of the approval for coercion is predicted by stigmatization. With the increasing severity of coercive measures, the influence of person- and situation-specific factors and of familiarity with mental illness decreased and generalizing and stigmatizing attitudes became stronger predictors for the approval of more severe measures.

Mental health literacy and attitude towards people with mental illness: A trend analysis based on population surveys in the eastern part of Germany

Background

There is growing evidence that mental health literacy has improved in western countries in recent years. The question arises as to whether this trend is paralleled by an improvement of attitudes towards people with mental illness.

Aim

To examine the development of mental health literacy and the desire for social distance towards people with schizophrenia and major depressive disorder in Eastern Germany over a time period of eight years.

Method

A trend analysis was carried out using data from two population surveys conducted in the eastern part of Germany in 1993 and 2001. By means of a fully structured interview psychiatric labelling, causal beliefs, help-seeking and treatment recommendations as well as the desire for social distance was assessed.

Results

While there was an increase in the mental health literacy of the public, the desire for social distance from people with major depression and schizophrenia remained unchanged or even increased.

Conclusions

The assumption underlying a number of anti-stigma campaigns, namely that educating people about mental disorders may automatically lead to the improvement of their attitudes towards the mentally ill, appears questionable.

Concepts of mental disorders in the United Kingdom: Similarities and differences between the lay public and psychiatrists

BACKGROUND

The lay public often conceptualise mental disorders in a different way to mental health professionals, and this can negatively impact on outcomes when in treatment.

AIMS

This study explored which disorders the lay public are familiar with, which theoretical models they understand, which they endorse and how they compared to a sample of psychiatrists.

METHODS

The Maudsley Attitude Questionnaire (MAQ), typically used to assess mental health professional's concepts of mental disorders, was adapted for use by a lay community sample (N = 160). The results were compared with a sample of psychiatrists (N = 76).

RESULTS

The MAQ appeared to be accessible to the lay public, providing some interesting preliminary findings: in order, the lay sample reported having the best understanding of depression followed by generalised anxiety, schizophrenia and finally antisocial personality disorder. They best understood spiritualist, nihilist and social realist theoretical models of these disorders, but were most likely to endorse biological, behavioural and cognitive models. The lay public were significantly more likely to endorse some models for certain disorders suggesting a nuanced understanding of the cause and likely cure, of various disorders. Ratings often differed significantly from the sample of psychiatrists who were relatively steadfast in their endorsement of the biological model.

CONCLUSION

The adapted MAQ appeared accessible to the lay sample. Results suggest that the lay public are generally aligned with evidence-driven concepts of common disorders, but may not always understand or agree with how mental health professionals conceptualise them. The possible causes of these differences, future avenues for research and the implications for more collaborative, patient-clinician conceptualisations are discussed.

Evaluation of Antistigma Interventions With Sixth-Grade Students: A School-Based Field Experiment

OBJECTIVE

School-based interventions for preadolescents provide the opportunity, in a ubiquitous institutional setting, to attack stigmatizing attitudes before they are firmly entrenched, and thus they may reduce mental illness stigma in the overall population. This study evaluated the effectiveness of classroom-based interventions in reducing stigma and increasing understanding of mental illness and positive attitudes toward treatment seeking among sixth-grade students.

METHODS

In an ethnically and racially diverse sample (N=721), 40% of participants were Latino, 26% were white, and 24% were African American; the mean age was 11.5. In a fully crossed design, classrooms from a school district in Texas were randomly assigned to receive all three, two, one, or none of the following interventions: a PowerPoint- and discussion-based curriculum, contact with two college students who described their experiences with mental illness, and exposure to antistigma printed materials. Standard and vignette-based quantitative measures of mental health knowledge and attitudes, social distance, and help-seeking attitudes were assessed pre- and postintervention.

RESULTS

Printed materials had no significant effects on outcomes and were grouped with the control condition for analysis. For eight of 13 outcomes, the curriculum-only group reported significantly more positive outcomes than the control group; the largest between-group differences were for stigma awareness and action, recognition of mental illness in the vignettes, and positive orientation to treatment. The contact-alone group reported significantly more positive outcomes on three vignette-based measures.

CONCLUSIONS

Results were most promising for a classroom-based curriculum that can be relatively easily disseminated to and delivered by teachers, offering the potential for broad application in the population.

Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys

Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.

Approval of psychotherapy and medication for the treatment of mental disorders over the lifespan. An age period cohort analysis

AIMS

Previous cross-sectional studies revealed inconsistent results regarding mental health treatment preferences among the general population. In particular, it is unclear to what extent specific age groups approve psychotherapy or psychotropic medication for the treatment of mental disorders. We explore whether treatment recommendations of either psychotherapy or psychiatric medication change over the lifespan which includes age-related effects due to increasing age of a person, cohort effects that reflect specific opinions during the time a person was born and period effects that reflect societal changes.

METHODS

Using data from three identical population surveys in Germany from 1990, 2001 and 2011 (combined n = 9046), we performed age-period-cohort analyses to determine the pure age, birth cohort and time period effects associated with the specific treatment recommendations for a person with either depression or schizophrenia, using logistic Partial Least-Squares regression models.

RESULTS

For both disorders, approval of both psychotherapy and medication for a person with mental illness increases with age. At the same time, younger cohorts showed stronger recommendations particularly for psychotherapy (OR around 1.07 per decade). The strongest effects could be observed for time period with an increase in recommendation between 1990 and 2001 with odds ratio of 2.36 in depression and 2.97 in schizophrenia, respectively. In general, the treatment option that showed the strongest increase in recommendation was medication for schizophrenia and psychotherapy for depression.

CONCLUSION

Underutilisation of psychotherapy in old age seems not to reflect treatment preferences of older persons. Thus, special treatment approaches need to be offered for this group that seems to be willing for psychotherapy but do not yet use it. Cohort patterns suggest that approval of psychotherapy among older persons will likely further increase in the coming years as these people get older. Finally, strong period effects underpin the importance of changing attitudes in the society. These could reflect reporting changes about psychiatric topics in the media or a general increase in the perception of treatment options. Nevertheless, more treatment offers especially for older people are needed.

Understanding of Psychiatry & Psychiatrists in England and China

This descriptive study aimed to test the findings of Williams, Cheyne, and Macdonald (2001) on the accuracy of people's knowledge of psychiatry and psychiatrists and extends the findings to another culture, namely, the People's Republic of China. The questions asked by Williams et al. were repeated with people on the streets in England and China and also with groups of students who had been educated in mental health issues. The results showed that there were some shared misperceptions about psychiatry in both countries. For example, a lack of awareness about psychiatrists’ medical qualifications. There were also some cultural differences, which reflected the different social systems involved. Education was found to increase awareness of problems treated and treatments used, to improve the image of psychiatrists, and to emphasise the role of the criminal justice system in dealing with the mentally ill.

Young people's difficulty in talking to others about mental health problems: An analysis of time trends in Switzerland

The article aimed to analyse time trends regarding young people's willingness to talk about mental health problems. Data on 16,774 participants (16-20-year olds) of the 'Swiss Multicentre Adolescent Survey on Health' (SMASH) were analysed. The survey was conducted in 1992/93 and in 2002. Logistic regression analyses were conducted to identify predictors associated with the self-reported willingness of youth to talk about mental health problems with adults (other than parents), friends or no one. Socio-demographic characteristics were used as covariates. These analyses were first carried out for the total sample and, in a second step, stratified by suicidality of the participants. The percentage of participants who would talk about mental health problems with adults or friends increased between 1992/93 and 2002, while the percentage of those who would not talk about such problems decreased. This pattern was confirmed in the stratified analyses (i.e., for suicidal and non-suicidal individuals). Hence, Swiss youth seem to have less difficulty in talking with others about mental health problems than previous cohorts. This trend towards increased disclosure may have implications for claims that the prevalence of mental health problems has increased in recent decades.

Exploring attitudes toward eating disorders among elite athlete support personnel

To date, little is known about the beliefs, attitudes, and experiences of athlete support personnel (ASP) working in elite sport toward disordered eating (DE) and eating disorders (EDs). This study seeks to explore this area of mental health, employing an attribution model of stigma as a conceptual lens. Interviews were undertaken with 14 service providers (seven males and seven females) working in high-performance sport in Ireland. In contrast to previous research in the general population, findings revealed that sport-based personnel, in the main, did not hold the individual responsible for the development of their eating disorder. The predominant emotional response of those who had worked with an athlete with a known or suspected eating disorder was anxiety and worry. In line with the findings of previous studies with other health professionals, negative views on the prognosis of those with EDs were expressed by the ASP. Furthermore, confidentiality was found to be a significant barrier to bringing athletes' disclosure of problematic eating or exercise behavior to the fore. The findings of this study add to the limited research exploring attitudes toward EDs in sport and highlights the importance of greater education and openness toward this particular mental health problem.

[Reality of treatment in psychotherapy: Results of a survey of German psychiatric hospitals]

OBJECTIVES

Since the introduction of the qualification as specialist for psychiatry and psychotherapy, in addition to psychopharmacotherapy psychotherapy is an integral component of the treatment of mentally ill people. A survey was carried out to evaluate the reality of clinical routine use of psychotherapy in German psychiatric hospitals.

METHODS

Between October 2011 and March 2012 German hospitals of psychiatry and psychotherapy were contacted by the head organization, the conference of national directors (Bundesdirektorenkonferenz), to participate in a survey regarding the application of psychotherapy in the real clinical world of daily treatment. With an anonymous questionnaire, data were requested as either a printed form or online version.

RESULTS

Data from 25 psychiatric hospitals in the year 2010 could be analysed (average number of beds 300 of which 53 were for psychosomatic/psychotherapeutic patients) and a total of 87,000 inpatients were treated whereby 34 % were diagnosed as F1 addictive disorders and 24 % as F3 affective disorders. More than 80 % of the hospitals applied group therapies of relaxation, cognitive behavior therapy, social competence training and specific techniques, such as dialectic-behavior therapy. As individual treatment methods, patients with depressive disorders were treated with cognitive behavior therapy, interpersonal psychotherapy or psychodynamic therapy in more than 50 % of the cases. Relaxation techniques were offered in most cases by the nursing staff, behavior therapy by psychologists and physicians and psychodynamic therapy mainly by psychiatrists.

EPA guidance on how to improve the image of psychiatry and of the psychiatrist

Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.

Neurotic disorders of general medical outpatients in Xi'an, China: knowledge, attitudes, and help-seeking preferences

OBJECTIVE

This study assessed knowledge of neurotic disorders, and attitudes and preferences toward professional help and treatment for them, among general medical outpatients in general hospitals in Xi'an, China.

METHODS

General medical outpatients (N=372) from general hospitals in China were recruited by using a stratified cluster sampling method between June and September 2010. In face-to-face interviews, participants age 16 years or older were assessed for their knowledge, attitudes, and help-seeking preferences in regard to neurotic disorders (obsessive-compulsive disorder, social phobia, and panic disorder). Demographic data were also collected.

RESULTS

Lack of insight into neurotic disorders was common among medical outpatients in general hospitals of Xi'an, China. Twenty-four percent to 58% of the outpatients had some knowledge of the symptoms and treatment of neurotic disorders. Only 11% of the outpatients would reveal to others that they or a family member suffered from neurotic disorders. When faced with the problem of neurotic disorders, the preference of the respondents was to visit a psychiatrist in a general hospital (44%), and only 17% would visit a physician in a psychiatric hospital. Major ways for the outpatients to obtain knowledge regarding neurotic disorders were via radio and television (36%), and only 18%-23% of outpatients obtained knowledge about neurotic disorders through printed public health materials and by attending lectures.

CONCLUSIONS

Study results underscore the need for information campaigns aimed at improving the mental health literacy of general medical outpatients. Such campaigns must consider culturally relevant beliefs to facilitate the development of specific educational programs.

Does psychoeducation influence carers' attitudes to treatment of schizophrenia?

Objective: To measure the impact of a six-week Carer Psychoeducation Program (CPP) on factors that influence attitudes towards treatment among carers and relatives of people suffering from schizophrenia. We also examined which specific attitudes to treatment the CPP had the most effect on.

Method: Between 2002 and 2004, all patients and their relatives continued standard care. During this period, we conducted a historically-controlled open trial, in which 64 relatives completed a 17-item adapted version of the Drug Attitudes Inventory (DAI) before and after the CPP.

Results: Attitudes to treatment improved significantly overall (p < 0.001), an improvement most marked in terms of attitudes to health and illness, attitudes towards the physician and attitudes towards the potentially harmful effects of treatment. No statistically significant improvement was found, however, in attitudes to locus of control or the preventative role of treatment.

Conclusion: A CPP specifically improves family attitudes towards treatment. This finding is clinically important because such attitudes influence adherence which, in turn, influences outcome. The fact that certain attitudes are influenced by the CPP, while others are not, may help to explain the mechanism through which patient outcomes improve.

Beliefs about mental disorder treatment and prognosis: comparison of health professionals with the Australian public

OBJECTIVE

In the 1990s, large differences in beliefs about the helpfulness of treatments for mental disorders were observed between the Australian public and health professionals. This study evaluates whether gaps in public and professional beliefs remain by comparing beliefs of the public and health professionals on the helpfulness of interventions and likely prognosis for six mental health problems: depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia, and post-traumatic stress disorder.

METHODS

Mental health literacy surveys based around a vignette of a person with a mental disorder were carried out in a nationally representative sample of the Australian public (n=6019) in 2011 and samples of Australian general practitioners, psychiatrists, and psychologists (n=1536) in 2012. Respondents were asked to rate the helpfulness of a range of interventions and the likely outcome with or without appropriate professional treatment. Differences between groups were examined with chi-square tests.

RESULTS

There were many significant differences in treatment beliefs, but most of these were small in size. Medium-sized differences tended to be consistent across vignettes and relate to the greater belief by the public in the helpfulness of close family or friends, a counsellor, vitamins and minerals, a special diet or avoiding certain foods, and having an occasional alcohol drink to relax. In contrast, professionals showed a greater belief in psychotherapy and cognitive behaviour therapy for depression and anxiety, and antipsychotics for schizophrenia. Findings on prognosis showed mostly small differences in beliefs.

CONCLUSIONS

Overall, the results indicate that the views of the public and professionals are more aligned than in the 1990s. There are now few large gaps in treatment beliefs, but there remain some areas that could be improved.

Health literacy and the pharmacological treatment of anxiety disorders: a systematic review

OBJECTIVE

Anxiety disorders are treatable conditions, but many affected individuals neither seek professional help nor adhere to recommended pharmacological treatments. Increasing the health literacy of people with (or at risk of) anxiety disorders may encourage treatment-seeking and adherence to recommended interventions. Aims of this study were to review the literature relating to health literacy in the treatment of anxiety disorders, focusing on results on public opinion on psychotropic medications and its effectiveness in improving access to psychiatric health care and the actual use of medications.

METHODS

A computerized literature search of the published literature on mental health literacy was undertaken, focusing on the question of whether increased mental health literacy led to increased treatment-seeking and pharmacotherapy adherence in individuals with anxiety disorders.

RESULTS

Twelve relevant articles were identified. All reported that improving mental health literacy leads to raised awareness, and in 10 out of 12 studies, increased help-seeking. However, there is currently no unequivocal evidence to show that increasing health literacy leads to increased use of medication in any psychiatric disorder, including anxiety disorders. Two studies show that knowledge of presumed biological mechanisms can predict use of psychotropic medication, including antidepressants, in psychiatric disorders, however, not specifically in anxiety disorders.

CONCLUSION

There have been few investigations of health literacy focused on psychotropic medications. Given the prevalence, burden and sub-optimal recognition, and treatment of anxiety disorders, further work is needed to determine whether increased mental health literacy is associated with treatment-seeking and medication adherence in patients with these disorders. Copyright © 2014 John Wiley & Sons, Ltd.

Willingness to disclose a mental disorder and knowledge of disorders in others: changes in Australia over 16 years

OBJECTIVE

To assess whether willingness to disclose experience of a mental disorder and treatment, and awareness of others' experiences have changed over a 16-year period.

METHODS

In 2011, telephone interviews were carried out with 6019 Australians aged 15+. The survey interview used the same questions as those of the 1995 and 2003/4 national mental health literacy surveys, in which participants were presented with a case vignette describing either depression, depression with suicidal thoughts (2003/4 only), early schizophrenia or chronic schizophrenia (2003/4 only). Participants were asked whether they had a close friend or family member who had experienced a problem similar to that described in the vignette and whether the person received professional help. They were also asked whether they had experienced such a problem and whether they received professional help.

RESULTS

The numbers of those disclosing experiences of depression and early schizophrenia, and of having received professional help for depression, have increased since 1995. Awareness of a family member or close friend with experiences of depression and early schizophrenia also increased between these years, as did awareness that the person received professional help.

CONCLUSIONS

The numbers of those disclosing experiences of and treatment for mental disorders has increased in the last 16 years. This is likely to be due to increased willingness to disclose rather than increased prevalence of disorders or increased rates of help-seeking.

The public's knowledge and beliefs about obsessive compulsive disorder

BACKGROUND

Obsessive compulsive disorder (OCD) is a disabling condition associated with significant personal and societal burdens. Despite the availability of efficacious treatments, in most cases, the disorder remains unrecognized and untreated. Lack of knowledge (i.e. poor mental health literacy, MHL) regarding OCD may be an impediment to seeking treatment. Therefore, the current study assessed public knowledge and beliefs about OCD and examined factors influencing MHL.

METHODS

Five hundred seventy-seven US adults participated in a telephone survey. After hearing a vignette describing someone with OCD, participants' MHL for OCD was assessed across three domains as follows: recognition of OCD, knowledge and beliefs about available help, and concerns about being negatively evaluated for reporting symptoms.

RESULTS

The majority of participants (90.9%) reported that the symptoms were a cause for concern and that the person in the vignette should seek professional help (89.5%). However, only one-third of respondents correctly labeled the disorder as OCD. More respondents were optimistic about the likely success of psychotherapy than medication, but primary care physicians were the most frequently reported source of professional help. Finally, less education, lower income, and being in an older cohort were associated with poorer recognition of OCD.

CONCLUSIONS

When presented with brief vignettes describing a person with OCD, most community members can recognize the benefits of seeking professional help. However, recognition of the disorder and knowledge of treatment options can be improved.

The Australian public's beliefs about the harmfulness of antipsychotics: associated factors and change over 16 years

Negative views of psychiatric medications are common in many countries. Relatively little is known about beliefs about antipsychotic medications. A 2011 national survey of 2024 Australian adults assessed beliefs about their helpfulness or harmfulness for a person with either early or chronic schizophrenia and the associations with sociodemographic characteristics, exposure to schizophrenia, recognition of schizophrenia, and beliefs about other interventions, long-term outcomes, causes, and stigmatising attitudes. Changes since previous surveys (conducted in 1995 and 2003/4) were also assessed. Results showed that 19% of Australian adults believe that antipsychotics would be harmful for a person with early schizophrenia and 14% for chronic schizophrenia. This group was more likely to be male, born overseas, have less exposure to schizophrenia, show poorer schizophrenia recognition, have less positive views about other standard interventions, be less pessimistic about long-term outcomes and have greater stigmatising attitudes. Comparison with previous surveys showed that overall belief in the harmfulness of antipsychotics for schizophrenia decreased between 1995 and 2003/4 and between 1995 and 2011. The higher proportions of males and those from non-English speaking backgrounds believing in harmfulness suggest that education about the role of antipsychotics in the treatment of schizophrenia should focus on these groups.

What to do about depression? Self-help recommendations of the public

BACKGROUND

While help-seeking and treatment preferences for depression have been assessed in a number of population studies, little is known about the public's self-help beliefs.

AIMS

To explore public beliefs about self-help actions to be taken in case of depression.

METHODS

In spring 2009, a population-based survey was conducted by telephone in the city of Vienna. A fully structured interview was carried out, which began with the presentation of a vignette describing a case of depression. Subsequently, respondents were asked to indicate to what extent they would recommend various self-help actions.

RESULTS

Among the self-help options proposed, confiding in a close friend or someone in the family were most frequently recommended. Apart from that, a variety of interpersonal actions (socializing with others, joining a self-help group), psychological methods (thinking positively), lifestyle changes (engaging in sport, listening to music, going on vacation, reading a good book) and dietary methods (eating healthy food) were endorsed by over half of respondents. While women were more ready to recommend self-help actions, the better educated were less enthusiastic about them.

CONCLUSIONS

As only some of the self-help measures endorsed by the public are evidence based, more research is needed before promulgating their use.

Evolution of public attitudes about mental illness: a systematic review and meta-analysis

OBJECTIVE

To explore whether the increase in knowledge about the biological correlates of mental disorders over the last decades has translated into improved public understanding of mental illness, increased readiness to seek mental health care and more tolerant attitudes towards mentally ill persons.

METHOD

A systematic review of all studies on mental illness-related beliefs and attitudes in the general population published before 31 March 2011, examining the time trends of attitudes with a follow-up interval of at least 2 years and using national representative population samples. A subsample of methodologically homogeneous studies was further included in a meta-regression analysis of time trends.

RESULTS

Thirty-three reports on 16 studies on national time trends met our inclusion criteria, six of which were eligible for a meta-regression analysis. Two major trends emerged: there was a coherent trend to greater mental health literacy, in particular towards a biological model of mental illness, and greater acceptance of professional help for mental health problems. In contrast, however, no changes or even changes to the worse were observed regarding the attitudes towards people with mental illness.

CONCLUSION

Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness.

Stigmatising attitudes towards people with mental disorders: changes in Australia over 8 years

The aim of the study was to investigate whether Australians' stigmatising attitudes towards people with mental disorders have changed over an 8-year period. In 2011, telephone interviews were carried out with 6019 Australians aged 15 or over. The survey interview used the same questions as those of the 2003/4 national mental health literacy survey, in which participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. Questions were asked about stigmatising attitudes, including personal and perceived stigma and social distance. Results showed decreases in social distance scores for all vignettes other than chronic schizophrenia and increases in beliefs about dangerousness and unpredictability. Campaigns to improve mental health literacy and reduce stigmatising attitudes may have had beneficial effects in reducing the desire for social distance from those with mental disorders. However, increase in beliefs about the dangerousness and unpredictability of those with these disorders is of concern and points to the need for public education to address these aspects of stigma.

Public recognition of mental disorders and beliefs about treatment: changes in Australia over 16 years

BACKGROUND

A 1995 Australian national survey of mental health literacy showed poor recognition of disorders and beliefs about treatment that differed from those of health professionals. A similar survey carried out in 2003/4 showed some improvements over 8 years.

AIMS

To investigate whether recognition of mental disorders and beliefs about treatment have changed over a 16-year period.

METHOD

A national survey of 6019 adults was carried out in 2011 using the same questions as the 1995 and 2003/4 surveys.

RESULTS

Results showed improved recognition of depression and more positive ratings for a range of interventions, including help from mental health professionals and antidepressants.

CONCLUSIONS

Although beliefs about effective medications and interventions have moved closer to those of health professionals since the previous surveys, there is still potential for mental health literacy gains in the areas of recognition and treatment beliefs for mental disorders. This is particularly the case for schizophrenia.

Biogenetic explanations and public acceptance of mental illness: systematic review of population studies

BACKGROUND

Biological or genetic models of mental illness are commonly expected to increase tolerance towards people with mental illness, by reducing notions of responsibility and blame.

AIMS

To investigate whether biogenetic causal attributions of mental illness among the general public are associated with more tolerant attitudes, whether such attributions are related to lower perceptions of guilt and responsibility, to what extent notions of responsibility are associated with rejection of people who are mentally ill, and how prevalent notions of responsibility are among the general public with regard to different mental disorders.

METHOD

A systematic review was conducted of representative population studies examining attitudes towards people with mental illness and beliefs about such disorders.

RESULTS

We identified 33 studies relevant to this review. Generally, biogenetic causal attributions were not associated with more tolerant attitudes; they were related to stronger rejection in most studies examining schizophrenia. No published study reported on associations of biogenetic causal attributions and perceived responsibility. The stereotype of self-responsibility was unrelated to rejection in most studies. Public images of mental disorder are generally dominated by the stereotypes of unpredictability and dangerousness, whereas responsibility is less relevant.

CONCLUSIONS

Biogenetic causal models are an inappropriate means of reducing rejection of people with mental illness.

Psychoeducational methods for patients suffering from depression: the knowledge seeking instrument (KSI)

OBJECTIVE

To develop and psychometrically assess a short instrument that can be easily used in clinical practice to measure knowledge-seeking behavior in patients suffering from depression.

METHOD

We developed the knowledge seeking instrument (KSI), a self-report scale of three items to assess the number of hours spent in knowledge seeking behavior such as reading written materials, surfing the internet, or watching audio-visual tools. Experts in mood disorders (n=12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to outpatients who were attending psychiatry clinic (n=63). All patients also completed a multiple choice question instrument to measure knowledge of depression, a Likert self report questionnaire to assess attitudes towards depression and its treatment, and an adherence to antidepressants scale.

RESULTS

In addition to the empirical evidence for validity, there was 68% agreement among experts that the items were highly relevant in measuring behavior of knowledge seeking, providing evidence for content validity. There were significant correlations (p<0.05) between knowledge of psychological and biological treatments of depression and knowledge seeking reading scores. The internal consistency reliability (Cronbach's alpha) was 0.67 for the instrument.

CONCLUSION AND SIGNIFICANCE

The KSI takes 2 min to complete. There is evidence for reliability, content, and criterion based concurrent validities. The KSI can be utilized to assess knowledge seeking behavior in patients with depression.

What to do about depression? Help-seeking and treatment recommendations of the public

AIMS

Several population studies on beliefs about depression carried out in western countries during the 1990s have shown that the public clearly favors psychotherapy over antidepressant medication. The present study examines whether this phenomenon still exists at the end of the first decade of the twenty-first century.

MATERIALS AND METHODS

In 2009, a telephone survey was conducted among the population of Vienna aged 16 years and older (n = 1205). A fully structured interview was administered which began with the presentation of a vignette depicting a case of depression fulfilling the diagnostic criteria of DSM-IV for a moderate depressive episode.

RESULTS

Psychotherapists were most frequently endorsed as source of professional help. Antidepressant medication still was more frequently advised against than recommended. Respondents familiar with the treatment of depression tended to be more ready to recommend to seek help from mental health professionals and to endorse various treatment options, particularly medication.

CONCLUSION

At the end of the first decade of this century, there still exists a large gap between the public's beliefs and what mental health professionals consider appropriate for the treatment of depression. Therefore, further effort to improve the public's mental health literacy seems necessary.

Emotional reactions to people with mental illness

Aims– Based on findings from population surveys, we provide an overview of the public's emotional reactions to people with mental illness.Methods– A literature search for populations studies using measures of emotional response to people with mental illness was carried out. In addition, data on the public's emotional reactions, originating from representative surveys conducted in Germany in the years 1990, 1993 and 2001, were analysed.Results– Positive emotional reactions to people with mental illness are most prevalent, followed by fear and anger. This pattern appears relatively stable across different cultures. In recent years, the emotional response of the public remained unchanged or even deteriorated. The public seems to react quite differently to people with different mental disorders. Emotional reactions have a substantial effect on the desire for social distance. The association between familiarity with mental disorder and the desire for social distance is to a considerable extent mediated through emotions.Conclusions– The public's emotional reactions to people with mental disorder are relatively under-researched. More research may help better understand the complexities of the stigma surrounding mental illness. Interventions aimed at reducing the stigma of mental illness may benefit from paying more attention to emotions.

The loss of sadness: the public's view

OBJECTIVE

With the exception of bereavement, the diagnosis of major depressive disorder in the DSM-IV does not take into account the context in which the symptoms occur. Recent criticism has maintained that common sense suggests making a distinction between depression as mental disorder and sorrow as 'normal' reaction to social stress. This study sets out to investigate whether the public does in fact make this distinction.

METHOD

In spring 2009, a population-based survey was conducted by phone in the city of Vienna (n = 1205). A fully structured interview was carried out which began with the presentation of a vignette describing a diagnostically unlabeled case of depression, with or without provision of information about preceding stressful life events.

RESULTS

Respondents presented with vignettes containing information on loss events were less likely to define depressive symptoms as indication of mental illness. They were also not as willing to recommend professional help. And if they were, they tended to less frequently recommend seeking help from someone with a medical background.

CONCLUSION

In contrast to the conceptualization in the DSM-IV, the public tends to perceive depressive symptoms differently depending on the context in which they occur.

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force's findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.

Actions that young people can take to prevent depression, anxiety and psychosis: beliefs of health professionals and young people

BACKGROUND

Members of the public know about actions they can take to prevent major physical diseases, but there has been less attention to the public's capacity to take action to prevent mental disorders. Since mental disorders often have first onset during youth, young people's beliefs about prevention are of particular relevance.

METHODS

Young people's prevention beliefs were assessed by a national telephone survey of 3746 Australian youth aged 12-25 years. To allow a comparison with professional beliefs, postal surveys were carried out with 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses. Respondents were asked to rate the helpfulness of 9 potential strategies in relation to the prevention of four disorders: depression, depression with alcohol misuse, social phobia and psychosis.

RESULTS

Both young people and professionals believed that mental disorders could be prevented by physical activity, keeping contact with family and friends, avoiding use of substances, and making time for relaxing activities. However, professionals disagreed with young people about the benefits of avoiding stressful situations, particularly for social phobia. Professionals were also less optimistic about the prevention of psychosis than depression and anxiety.

LIMITATIONS

The surveys assessed beliefs, but not actual use of preventive strategies.

CONCLUSIONS

Given the beliefs of young people and professionals that prevention is possible, there is fertile ground for health promotion in this area. However, young people need to be aware that avoiding stressful situations may not be helpful for anxiety.

The development and psychometric assessment of an instrument to measure attitudes towards depression and its treatments in patients suffering from non-psychotic depression

OBJECTIVE

To develop and psychometrically assess an instrument to measure patients' attitudes towards depression, to its treatments, and aspects of professional help in patients suffering from depression.

METHOD

A 27 item Likert type instrument was developed and written based on an evidence from a literature review and in consultation with experts in depression. Psychiatrists (n=12) participated in a validation process of the instrument before it was administered to outpatients (n=63) suffering from non-psychotic depression.

RESULTS

Internal consistency reliability for the instrument was 0.79 (Cronbach's alpha) and there was 88% overall agreement between experts about the relevance of the instruments' items to test patients' attitudes to depression and its treatments, providing evidence for content validity. Factor analysis resulted in five cohesive and theoretically meaningful factors: 1) Acceptance of treatment, 2) Perceived stigma and shame, 3) Negative attitude towards antidepressants, 4) Self stigma, and 5) Preference for psychotherapy.

CONCLUSION

The developed instrument is a reliable, valid and empirical measure to assess attitudes towards depression and its treatments. Future research should be designed to replicate and extend the present findings with larger and more heterogeneous samples.

Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders

OBJECTIVE

To investigate the prevailing attitudes towards mental health help-seeking in Europe, their correlates, and whether these attitudes are associated with actual service use for mental health problems.

METHOD

Data were derived from the European Study of Epidemiology of Mental Disorders, a survey representative of the adult population of six countries: Belgium, France, Germany, Italy, the Netherlands and Spain (n = 8,796). The World Mental Health Composite International Diagnostic Interview was used to assess attitudes and DSM-IV diagnoses. The attitudes referred to beliefs that the respondents would seek professional help when faced with a serious emotional problem, would feel comfortable talking about personal problems with a professional, would not be embarrassed if friends knew about the professional help, and respondents' perceived effectiveness of mental health care.

RESULTS

Almost a third of the respondents held the view that professional care was worse than or equal to no help when faced with serious emotional problems. Female gender, being younger than 65 years of age, high income, living in Spain or Italy, presence of mood disorder and previous service use were associated with at least two of the four assessed attitudes towards mental health help-seeking. All four attitudes were significantly associated with mental health care use, also after adjustment for previous service use.

CONCLUSION

The low perceived effectiveness of professional care calls for serious action aiming to improve the visibility and credibility of the mental health care sector.

Unmet need for mental health care in schizophrenia: an overview of literature and new data from a first-admission study

We present an overview of the literature on the patterns of mental health service use and the unmet need for care in individuals with schizophrenia with a focus on studies in the United States. We also present new data on the longitudinal course of treatments from a study of first-admission patients with schizophrenia. In epidemiological surveys, approximately 40% of the respondents with schizophrenia report that they have not received any mental health treatments in the preceding 6-12 months. Clinical epidemiological studies also find that many patients virtually drop out of treatment after their index contact with services and receive little mental health care in subsequent years. Clinical studies of patients in routine treatment settings indicate that the treatment patterns of these patients often fall short of the benchmarks set by evidence-based practice guidelines, while at least half of these patients continue to experience significant symptoms. The divergence from the guidelines is more pronounced with regard to psychosocial than medication treatments and in outpatient than in inpatient settings. The expansion of managed care has led to further reduction in the use of psychosocial treatments and, in some settings, continuity of care. In conclusion, we found a substantial level of unmet need for care among individuals with schizophrenia both at community level and in treatment settings. More than half of the individuals with this often chronic and disabling condition receive either no treatment or suboptimal treatment. Recovery in this patient population cannot be fully achieved without enhancing access to services and improving the quality of available services. The recent expansion of managed care has made this goal more difficult to achieve.

Social comparison of distress and mental health help-seeking in the US general population

The role of social comparison of distress in the mental health help-seeking process remains largely unexplored. The aim of this study was to examine the association of socially compared distress with mental health help-seeking and perceived need for mental health care in a population sample. In 36,679 adult participants of the 2003 US National Survey on Drug Use and Health, data on 12-month help-seeking and perceived unmet need for care were compared between participants who described themselves as more worried, nervous or anxious than others vs. participants who described themselves as no more worried, nervous or anxious than others. Compared to participants who described themselves as no more worried, nervous or anxious, than others, those who described themselves as more worried, nervous or anxious were significantly more likely to seek professional help (adjusted odds ratio=1.84) or to perceive an unmet need for such help (adjusted odds ratio=1.44). It is concluded that social comparison of distress is a significant correlate of mental health help-seeking and perceived unmet need for such help. Individual variations in social comparison of distress may partly explain the discrepancy between need-as measured by non-compared distress-and help-seeking in the general population.

Stigma and its impact on help-seeking for mental disorders: what do we know?

AIMS

Many people suffering from serious mental illness do not seek appropriate medical help. The stigma of mental illness has often been considered a potential cause for reluctance in seeking help. We review recent evidence on this topic.

METHODS

Narrative review of the recent literature on stigma and help-seeking for psychiatric disorders.

RESULTS

There is proof of a particular stigma attached to seeking help for a mental problem. Anticipated individual discrimination and discrimination qua self-stigmatisation are associated with a reduced readiness to seek professional help for mental disorders. Intervention studies show that destigmatisation may lead to increased readiness to seek professional help, but other aspects like knowledge about mental diseases seem to be at least as important. The belief that seeking help for a mental health problem is actually helpful has been shown to be at the core of help-seeking intentions and thus offers a promising target for information programmes. Population based time-trend studies show that public attitudes towards help-seeking have improved over the last decade.

DISCUSSION

The relationship between help-seeking intentions and actual help-seeking needs further exploration. While many studies have been able to relate attitudes to intentions, predicting actual help-seeking has proved more difficult.

Part-time hospitalisation and stigma experiences: a study in contemporary psychiatric hospitals

Background

Because numerous studies have revealed the negative consequences of stigmatisation, this study explores the determinants of stigma experiences. In particular, it examines whether or not part-time hospitalisation in contemporary psychiatric hospitals is associated with less stigma experiences than full-time hospitalisation.

Methods

Survey data on 378 clients of 42 wards from 8 psychiatric hospitals are used to compare full-time clients, part-time clients and clients receiving part-time care as aftercare on three dimensions of stigma experiences, while controlling for symptoms, diagnosis and clients' background characteristics.

Results

The results reveal that part-time clients without previous full-time hospitalisation report less social rejection than clients who receive full-time hospitalisation. In contrast, clients receiving part-time treatment as aftercare do not differ significantly from full-time clients concerning social rejection. No significant results for the other stigma dimensions were found.

Conclusion

Concerning social rejection, immediate part-time hospitalisation could be recommended as a means of destigmatisation for clients of contemporary psychiatric hospitals.

Impact of shared mental health care in the general population on subjects' perceptions of mental health care and on mental health status

OBJECTIVE

A community survey evaluated whether the development of a shared mental health care intervention had an impact on health care perceptions and mental health status of subjects with common mental health problems (MHP).

METHODS

Adults <70 years old with common MHP (DSM-IV/CIDI-SF major depressive disorder, generalized anxiety or MHI-SF 36 psychic distress diagnoses), were randomly drawn from the general population in the intervention area (IA, n = 349) and in a control area (CA, n = 360), and evaluated twice at an interval of 18 months (percentage of follow-up: IA = 69.3%, CA = 71.9%, P = .44). CA and IA groups did not differ for the criteria of interest at baseline.

RESULTS

At 18 months, compared to CA, IA reported significantly different help-seeking attitudes or behaviours (P = .02 for all subjects and .006 for subjects with current MHP) and greater general satisfaction with care (P = .03 for both). Remission rates and daily life functioning did not differ.

CONCLUSIONS

After 4 years of development of a mental health network based on a consultation-liaison model, Shared Mental Health Care was associated with greater satisfaction and access with care among subjects with common MHP. The association was not found with mental health status, but the study lacked power to adequately address the issues.

Attitudes toward psychiatric drug treatment: the experience of being treated

BACKGROUND

Effectiveness and tolerability of psychiatric medications are not only determined by the drug's pharmacological profile but through the interaction of different factors, including patients' attitudes toward their prescribed medications. Increased knowledge about those attitudes may help prescribers to improve patient concordance and thereby the effectiveness of the pharmacological therapy.

OBJECTIVE

The goal of this study was to assess stable psychiatric outpatients' attitudes toward psychiatric drug treatment and to what extent patients and public opinions on this subject diverge as a consequence of being on this type of medication.

METHODS

Two anonymous self-reported questionnaires [Drug Attitude Inventory (DAI)-10 and an abridge version of Beliefs about Medicines Questionnaire (BMQ)] were administered to 270 stable psychiatric outpatients under treatment and 292 citizens naïve to psychotropic medication.

RESULTS

Psychiatric patients showed a more positive attitude toward medication (DAI score 3.6 vs. -0.7; range -10 to +10; negative to positive). Up to 77% of patients showed positive scores compared with only 36% in the general population. Multiple regression analysis showed that none of the variables in the analysis have a predictive value with regard to the attitude toward psychiatric drugs used.

CONCLUSION

The continuous use of psychotropic medication shapes the opinion of the users toward a more beneficial perception of medications, but the opinion on the general population, where stigmatizing attitudes are born, is more negative toward them. For psychiatrists and their patients, trying to achieve a better understanding of each other's expectations and reaching concordance is mandatory.

What makes people decide who to turn to when faced with a mental health problem? Results from a French survey

BACKGROUND

The unequal use of mental health care is a great issue, even in countries with universal health coverage. Better knowledge of the factors that have an impact on the pathway to mental health care may be a great help for designing education campaigns and for best organizing health care delivery. The objective of this study is to explore the determinants of help-seeking intentions for mental health problems and which factors influence treatment opinions and the reliance on and compliance with health professionals' advice.

METHODS

441 adults aged 18 to 70 were randomly selected from the general population of two suburban districts near Paris and agreed to participate in the study (response rate = 60.4%). The 412 respondents with no mental health problems based on the CIDI-SF and the CAGE, who had not consulted for a mental health problem in the previous year, were asked in detail about their intentions to seek help in case of a psychological disorder and about their opinion of mental health treatments. The links between the respondents' characteristics and intentions and opinions were explored.

RESULTS

More than half of the sample (57.8%) would see their general practitioner (GP) first and 46.6% would continue with their GP for follow-up. Mental health professionals were mentioned far less than GPs. People who would choose their GP first were older and less educated, whereas those who would favor mental health specialists had lower social support. For psychotherapy, respondents were split equally between seeing a GP, a psychiatrist or a psychologist. People were reluctant to take psychotropic drugs, but looked favorably on psychotherapy.

CONCLUSION

GPs are often the point of entry into the mental health care system and need to be supported. Public information campaigns about mental health care options and treatments are needed to educate the public, eliminate the stigma of mental illness and eliminate prejudices.