Knowledge about schizophrenia and attitudes towards people with schizophrenia in Greece

Social Stigma Toward Individuals with Schizophrenia in a Lebanese Population

Background

Schizophrenia has been recognized as the most stigmatized mental disorder, imposing a substantial burden on affected individuals. However, no prior studies have investigated social stigma toward individuals with schizophrenia in Lebanon.

Purpose

We aimed to examine three components of social stigma including knowledge, attitude, and behavior toward individuals with schizophrenia in a Lebanese population and to explore associated factors with the level of social stigma.

Patients and Methods

A cross-sectional online survey was administered, and data from 469 participants were gathered from January 31, 2023, to February 18, 2023. We used previously validated questionnaires to assess the knowledge, attitude (Social Distance Scale), and behavior (Reported and Intended Behavior Scale) of participants toward individuals with schizophrenia. The score for each section was calculated and used to explore the associations between sociodemographic factors and the levels of stigma in each domain.

Results

The study participants had a moderate understanding of schizophrenia. However, a substantial proportion showed negative attitudes and unfavorable behaviors toward individuals with schizophrenia. We identified several sociodemographic factors associated with the knowledge, attitude, and behavior scores. Notably, a higher knowledge score and more positive attitudes were positively correlated with improved intended behaviors.

Conclusion

This study highlights the pervasive stigma encompassing issues in knowledge, attitudes, and behavior surrounding schizophrenia in a Lebanese population. Our study suggests a pressing need for targeted interventions to increase public awareness and decrease the social stigma of schizophrenia in Lebanon.

Social distance towards schizophrenia in health professionals

OBJECTIVE

The stigma and prejudice of the public regarding psychiatric disorders are a long-standing social problem. However, health professionals are more likely to have negative attitudes and label people with mental health conditions. This study aimed to investigate how self-rated familiarity and literacy about schizophrenia are related to social distancing towards schizophrenia patients among health professionals in Taiwan.

METHOD

This study used a cross-sectional questionnaire survey and invited respondents to complete the survey either electronically or in a pencil/paper format. Respondents included health professionals in different disciplines and students under medical placements. The survey instrument consists of three parts: sociodemographic information, the 18-item Social Distance Scale for schizophrenia, and the 19-item Schizophrenia Experience and Knowledge Questionnaires. Data were analyzed using linear regression models to explore sociodemographic factors, self-rated familiarity, and literacy total scores about social distance, attitude, and opinions towards schizophrenia.

RESULT

In total, 420 health professionals completed the questionnaire, of which 24.5% were physicians, 36.0% nurses, 6.7% pharmacists, and 28.6% interns. The majority of respondents (n = 360, 85.7%) had contact experience with schizophrenia patients, and approximately 60% rated their experience as a positive impression. Although 62.9% of respondents had received psychiatric education or training, 86% believed that such education/training was insufficient. Moreover, over half of the respondents did not have confidence in their knowledge of schizophrenia. Older age, being married, and having more working experience were associated with high social distance, a negative attitude, and high prejudice. More familiarity with schizophrenia was associated with low social distance, a positive attitude, and less prejudice. A high literacy score was associated with a positive attitude and less prejudice, but no significant correlation was observed with social distance (β ± SE = -0.26 ± 0.14, p = .057). Among respondents who rated their past contact experiences as negative, neither familiarity nor literacy was associated with social distance.

CONCLUSION

High levels of self-rated familiarity and high literacy about schizophrenia were associated with low social distance, a positive attitude, and less prejudice towards schizophrenia among health professionals. Therefore, sufficient education and training are imperative to increase familiarity and knowledge of schizophrenia. Appropriate education could be implemented from different perspectives, including communication skills, resources of social support, and topics to reduce stigma and prejudice.

Stigma towards schizophrenia in Cyprus: Does studying a mental health related programme make a difference?

BACKGROUND AND AIMS

Students from mental health related programmes may display stigmatising attitudes towards people of schizophrenia, however there are no data available on this population in Cyprus. The purpose of the present study was (a) to examine the levels of contact and stigma towards schizophrenia in Cypriot students of programmes related to mental health and students of other programmes and (b) to examine whether the successful recognition of a person with schizophrenia through a vignette and the estimation of severity levels was related to stigmatising attitudes.

METHODS

The participants were undergraduate students purposively selected across Cypriot universities (N = 152). A vignette depicting a person with schizophrenia, followed by the OMI to examine stigma and the BAE to examine contact with mental illness were used to collect the data.

RESULTS

The results showed that studying a mental health related programme and being a man was associated with more positive views related to social integration. No further stigma dimensions were predicted by the included variables. Similarly, level of contact and being able to identify the mental condition and estimate its severity was not related to stigma.

CONCLUSION

The results emphasise the need to develop educational interventions to tackle stigma across students independently of their study programme and enhance mental health related programmes with opportunities for structured contact with patients with mental illness.

Cultural Variations in Public Beliefs about Mental Disorders: A Comparison between Tunisia and Germany

Background

In recent years there is a growing interest in public beliefs about mental disorders. Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa.

Objective

To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences.

Methods

Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression.

Results

In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany.

Conclusion

Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for.

Mental Health Professionals' Attitudes to Severe Mental Illness and Its Correlates in Psychiatric Hospitals of Attica: The Role of Workers' Empathy

To describe mental health workers' attitudes to severe mental illness and to explore its socio-demographic and professional correlates, including the influence of empathy. A total of 127 mental health staff working on the psychiatric hospitals of Attica participated in the study. Stigma was assessed with the Attitudes to Severe Mental Illness scale (ASMI) and the Greek Social Distance scale; whilst Empathy with the Interpersonal Reactivity Index. Participants' unfavourable attitudes to severe mental illness were limited to pessimism about recovery, difficulty in viewing people with mental illness as similar to other people and desire to keep distance in intimate encounters. Professional group and personal experience with mental illness were found to predict stigma. Only perspective taking was associated with both stigma measures; while Fantasy was positively correlated with social distance. Anti-stigma interventions in mental healthcare should prioritize nurses and psychiatrists and aim at enhancing perspective taking.

Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison

Purpose: The detrimental impact of stigma on the utilization of mental health services is a well-established finding. Nevertheless, most studies consider only the personal or interactional dimensions of stigma. This contribution makes a distinction between the dominant beliefs about stigma within a culture and the personal beliefs of individuals with regard to stigma. We hypothesize that both have an impact on professional-care seeking within the field of mental health. Methods: A multi-level research design is used to estimate the effects of both types of stigma beliefs on the likelihood of consulting general and specialized health professionals about mental health problems in 28 European countries (N of individuals = 24,881, Eurobarometer 248, 2005-2006). Results: In countries where stigmatizing beliefs are dominant, the likelihood of seeking help from specialized mental health professionals is constrained, and individuals refrain from contacting general practitioners when in need of formal support, regardless of their own personal stigma beliefs. Conclusion: The present study signals the importance of stigma beliefs as shared cultural phenomena, and of personal stigma beliefs to the likelihood of seeking professional care for mental health problems. We therefore propose that most studies on stigma and formal-care seeking underestimate the pervasive effects of stigma beliefs, due to methodological individualism.

Evidence for the Influence of Social Dominance Orientation and Intergroup Relations on the Stigma of Schizophrenia

Abstract. The stigma of schizophrenia is an intergroup phenomenon associated with issues of social power. We consider that the concept of stigma power should be extended to include intergroup relations that go beyond the aspect of the relation between “schizophrenic” and “normal.” With the present study, we intend to demonstrate that perceivers hold more stigmatizing attitudes toward a person with schizophrenia belonging to the outgroup and that especially when the perceiver has a higher Social Dominance Orientation (SDO). One hundred and sixty-one participants from the general population participated in our study (50.3% male, Mage = 39.14, SD = 16.36), which was based on a 2 (Sex of Target: male vs. female) × 2 (Sex of Participant: male vs. female) × SDO between-subjects design. The participants read a standardized vignette used in previous research, depicting a person presenting the symptoms of schizophrenia, and were then asked to complete questionnaires about SDO and intention to discriminate against the depicted individual. Our analysis showed the main effect of SDO on discriminating intentions. Simple slope analysis revealed that SDO predicts male participants’ discriminating intentions when the target is a woman, while this relation is not significant when the target is a man. The exact reverse pattern was observed among female participants. Our results suggest intergroup relations and ideological motivations underpin the stigma of schizophrenia. We conclude that different group belongings of individuals with schizophrenia as well as the public’s ideological motivations should be further considered by future research and anti-stigma efforts.

Perceptions about pasung (physical restraint and confinement) of schizophrenia patients: a qualitative study among family members and other key stakeholders in Bogor Regency, West Java Province, Indonesia 2017

Background

The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung.

Objective

To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017.

Methods

This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation.

Results

Family members and society in general perceived that pasung is necessary for security reasons due to the patient’s aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient’s request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community.

Conclusion

Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.

Attitudes toward mentally ill patients: a comparison between Romanian and international medical students

Background

Stigmatizing attitudes to mental illness, and especially schizophrenia, are not limited to the general population but are also common among health professionals. Health professionals are in a position to model health related attitudes both in the general public and patients. Medical students are an interesting group to focus upon, since they are future health professionals and correcting stigmatizing attitudes is still possible during their educational curriculum.

Methods

This study investigated the attitude toward mental illness in medical students at the Iuliu Hatieganu University of Medicine and Pharmacy. We surveyed first year students, since they have not yet received specific classes or internships in psychiatry; 322 students from the Romanian and English sections participated, representing a response rate of 94.7%. The questionnaire consisted of the Romanian and English versions of Link’s Social Distance Scale towards people with mental illness scale.

Results

Overall, medical students had a relatively negative attitude towards people with mental illness, with moderate social distance and stereotypical attitudes. The level of personal contact with people with mental illness was correlated with positive attitudes. International students had scored lower then Romanian students on social distance toward mentally ill patients.

Conclusions

Medical education can play an important role in the attitudes of students toward mental illness. Medical students have stigmatizing attitudes about mentally ill patients. Personal contact with people suffering from mental illness might contribute to a positive attitude from the medical students toward mentally ill patients.

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.

Mental Illness Related Internalized Stigma: Psychometric Properties of the Brief ISMI Scale in Greece

Aims

Since evaluation regarding the impact of mental illness related internalized stigma is scarce, there is a great need for psychometric instruments which could contribute to understanding its adverse effects among Greek patients with severe mental illness. The Brief Internalized Stigma of Mental Illness (ISMI) scale is one of the most widely used measures designed to assess the subjective experience of stigma related to mental illness. The present study aimed to investigate the psychometric properties of the Greek version of the Brief ISMI scale. In addition to presenting psychometric findings, we explored the relationship of the Greek version of the Brief ISMI subscales with indicators of self-esteem and quality of life.

Methods

272 outpatients (108 males, 164 females) meeting the DSM-IV TR criteria for severe mental disorder (schizophrenia, bipolar disorder, major depression) completed the Brief ISMI, the RSES and the WHOQOL-BREF scales. Patients reported age and educational level. A retest was conducted with 124 patients.

Results

The Chronbach's alpha coefficient was 0 0.83. The test-retest reliability coefficients varied from 0.81 to 0.91, indicating substantial agreement. The ICC was for the total score 0.83 and for the two factors, 0.69 and 0.77 respectively. Factor analysis provided strong evidence for a two factor model. Factors 1 and 2 were named respectively "how others view me" and "how I view myself". They were negatively correlated with both RSES and WHOQOL-BREF scales, as well as with educational level. Factor 2 was significantly associated with the type of diagnosis.

Conclusions

The Greek version of the Brief ISMI scale can be used as a reliable and valid tool for assessing mental illness related internalized stigma among Greek patients with severe mental illness.

Public perception of the lifetime morbid risk of mental disorders in the United States and associations with public stigma

PURPOSE

This study examined the relationship between estimates of the prevalence of mental disorders and mental health stigma. It also examined whether stigma might be more greatly associated with the terms "mental illness," "mental disorder," or "mental health condition."

METHODS

Respondents (N = 302) on Amazon's Mechanical Turk completed an online survey designed to measure social distance, which is one variant of stigma. Half of the respondents were informed at the beginning of the survey that the lifetime morbid risk (LMR) of meeting criteria for at least one mental disorder at some point in life was 70-80 %, while the others were asked to provide their own LMR estimates. All respondents were also randomly assigned to view the survey with either the term "mental illness," "mental disorder," or "mental health condition."

RESULTS

Higher LMR estimates (B = -0.030; β = -0.154), having a mental disorder (B = -2.002; β = -0.200), and a history of contact with an individual with a mental disorder (B = -2.812; β = -0.298), each significantly predicted lower desire for social distance. Respondents in the "mental disorder" group endorsed greater desire for social distance. Participants who were informed about LMR at the start of the survey did not score lower on social distance.

CONCLUSIONS

Estimates for LMR were more than half as predictive of social distance scores as contact with individuals with mental disorders. But anti-stigma interventions may need to do more than inform individuals about the high prevalence of mental disorders in order to be effective.

Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area

BACKGROUND

The financial crisis has yielded adverse effects on the population worldwide, as evidenced by elevated rates of major depression. International recommendations for offsetting the mental health impact of the recession highlight the need for effective treatment, including reduction in the stigma attached to the disorder.

AIMS

This study endeavoured to explore lay attitudes to depression and psychiatric medication during a period of financial crisis and to identify their correlates. Furthermore, it investigated their link to help-seeking intentions.

METHOD

A random and representative sample of 621 respondents from Athens area participated in the study (Response Rate = 81.7%). The telephone interview schedule consisted of the Personal Stigma Scale, a self-constructed scale tapping attitudes to psychiatric medication and one question addressing help-seeking intentions.

RESULTS

The preponderant stigmatising belief about depression pertains to perceiving the disorder as a sign of personal weakness. In addition, stereotypes of unpredictability and dangerousness were popular among the sample. Nonetheless, stigmatising beliefs are much stronger with regard to psychiatric medication; perceived as addictive, capable of altering one's personality, less effective than homeopathic remedies and doing more harm than good. Help-seeking intentions were predicted by education, unemployment and attitudes to psychiatric medication solely.

CONCLUSION

Research on the mental health effects of the global recession should encompass studies investigating the stigma attached to mental disorders and its implications.

Systematic review of the prevalence of mental illness stigma within the Greek culture

BACKGROUND

A number of primary studies have now assessed mental illness stigma within the Greek culture. A synthesis and appraisal of all available evidence is now required and will contribute to our growing understanding of the relationship between the cultural context and the formation of stigmatising attitudes.

AIM

To systematically review the prevalence of mental illness public stigma within the Greek and Greek Cypriot culture.

METHOD

Empirical articles with primary data pertaining to the prevalence of mental illness public stigma among Greek and/or Greek Cypriot populations were retrieved. Included studies were assessed for quality and extracted data were narratively synthesised.

RESULTS

A total of 18 studies met the inclusion criteria. Methodological quality was highly variable; only 1 study was adequately statistically powered, 10 studies employed at least some element of probability sampling and obtained response rates of at least 70%, while 10 and 13 studies employed reliable and validated prevalence tools, respectively. Studies sampled the general population (n = 11), students (n = 4), healthcare professionals (n = 2), police officers, employers and family members (all n = 1). Stigma was consistently identified in moderate and high proportions across all of these groups, particularly in terms of social discrimination and restrictiveness, social distance and authoritarianism. However, some evidence of benevolence and positivity towards high-quality social care was also identified.

CONCLUSION

The review highlights the wide-scale prevalence of mental illness stigma within the Greek culture and the need for further rigorous research including culturally tailored stigma interventions.

What do the general population know, believe and feel about individuals with autism and schizophrenia: Results from a comparative survey in Denmark

Few studies investigate what members of the general population know about individuals with autism. Only one study has previously investigated how beliefs about autism differ from those about other psychiatric disorders. This study surveyed a convenience sample of the general adult population, within the Northern Region of Denmark, about their knowledge, attitudes and beliefs about individuals with autism and schizophrenia. The respondents (N = 440) possessed basic knowledge and were able to differentiate between the two disorders. Schizophrenia was associated with perceived danger (32.8%), while autism was associated with high intelligence (40.1%) and creativity (27.3%). Respondents were more positive towards interacting with individuals with autism (p < 0.001), but desire for social distancing was pronounced for both disorders in more intimate relationships. Significantly, more respondents reported that they would find it difficult and feel ashamed with regard to being diagnosed with schizophrenia (p < 0.001). Conversely, respondents significantly reported being more likely to elaborate on their diagnosis of autism to their colleagues (p < 0.001). Perceived dangerousness decreased the willingness for social interactions, while knowing someone with autism or schizophrenia increased the willingness to socially interact. Misconceptions and stigma must be addressed in order to minimize the social stigma and rejection associated with these disorders and ultimately improve the quality of life and psychological well-being of affected individuals and their families.

Mental health stigma and attitudes to psychiatry among Bangladeshi medical students

BACKGROUND

The shortage of specialized human resources in mental health in Bangladesh requires active recruitment of psychiatric residents. In addition, the involvement of positively inclined health personnel, for example, medical doctors, emerges as an immediate priority.

AIM

To explore stigma among medical students toward persons with mental disorders (PMDs) and their attitudes toward psychiatry.

METHOD

A cross-sectional study was conducted at Faridpur Medical College in Bangladesh before (First year) and following psychiatric rotation (Fifth year). Students (N = 200) filled anonymous questionnaires measuring stigma toward PMDs and attitudes to psychiatry.

RESULTS

Upper medical school year (p = .028), older age (p = .005), mother's lower academic level (p = .043), upper and lower socioeconomic level affiliation (p = .008) and self-consultation for mental or neurological complaints (p = .032) were associated with increased stigma toward PMDs. More favorable attitudes toward psychiatry were found in upper medical school year (p = .073) and were significantly associated with female gender (p = .018) and middle socioeconomic level affiliation (p = .013).

CONCLUSION

The relative improvement in attitudes toward psychiatry in the upper medical school year is overshadowed by the increased stigma toward PMDs. Specific anti-stigma program in the curriculum and strategies to improve the attitudes are required.

Public stigma towards mental illness in the Greek culture

Mental illness stigma negatively affects the lives of individuals with mental health disorders. Studies have indicated that the type and degree of stigma significantly varies across cultures. This study aimed to add to this body of knowledge by examining the prevalence and the type of mental illness stigma among individuals who identified themselves as Greek. It also examined the influence of a range of potential within-culture stigma moderating factors, including levels of previous experience with mental illness and mental illness knowledge. A cross-sectional quantitative design was employed, and 111 participants living in England and Greece were sampled through the snowball sampling technique. Stigma prevalence was measured using the 'Community Attitudes to Mental Illness' questionnaire. The findings revealed that participants showed a high degree of sympathy for people with mental illness but also considered them to be inferior and of a lower social class, and needing strict societal control. Higher stigma was significantly associated with being educated in England (instead of Greece), higher religiosity, lower knowledge levels and lower levels personal experience of mental illness. Targeted antistigma campaigns specifically tailored for the Greek culture are required in order to help reduce stigmatizing attitudes.

Putting television's portrayal of schizophrenia into reverse: an evaluation of the impact on public opinion

AIM

We examined whether it is possible to use a television programme to improve mental health literacy about schizophrenia by investigating the impact of the introduction of a realistic portrayal of schizophrenia into a popular television soap opera.

METHOD

A population level omnibus survey method was used. A market research company conducted face-to-face interviews with a representative sample of the Irish population (n = 993). A specifically developed questionnaire was used which included a question on the extent to which the relevant television programme was watched. A grouping variable 'viewers/non-viewers' was then created. Groups were subsequently compared for differences in demographic characteristics, mental health literacy and attitudes towards schizophrenia.

RESULTS

Of the sample, 370 were regarded as viewers. When compared, viewers and non-viewers did not differ on demographic characteristics but there were significant differences between the groups in both knowledge and attitudes regarding schizophrenia. Viewers were better informed on where to go for help and were more optimistic regarding the likelihood of recovery. However, on a question regarding willingness to have an intimate relationship with someone with a previous history of mental illness, viewers had greater concerns than non-viewers.

CONCLUSION

It is possible to use television dramas to educate the public about mental illnesses. Piloting of the educational material may offer an opportunity to refine the storyline so that the relevant messages are clearly communicated.

The influence of an anti-stigma intervention on adolescents' attitudes to schizophrenia: a mixed methodology approach

BACKGROUND

This study aimed at exploring adolescents' attitudes to schizophrenia and the impact of an educational intervention on improving them, by employing a mixed methodology.

METHOD

A total of 1081 secondary-school students were randomly allocated to a control and intervention condition. Stigma endorsement was assessed by a free association card and a questionnaire, before and 2 weeks after the intervention.

RESULTS

The intervention yielded substantial changes in students' beliefs, attitudes and social distance levels as well as in their associations with the term 'severe mental illness'.

CONCLUSIONS

Educational interventions can contribute substantially to preventing consolidation of unfavourable attitudes towards mental illness.

Estimated prevalence of mental disorders and the desire for social distance--results from population surveys in two large German cities

The study is focused on two research questions: What are the public's estimates of the prevalence of depression, schizophrenia, bulimia nervosa and anorexia nervosa? What is the relationship between the estimated prevalence of the mental disorders and the public's desire for social distance? Analyses are based on a telephone survey in two large German cities (Hamburg and Munich, N=2014, response rate 51%). Vignettes with typical signs and symptoms suggestive of a depression, schizophrenia, bulimia nervosa and anorexia nervosa were presented. Respondents were asked about the lifetime prevalence of the mental disorders and their desire for social distance. Across all four disorders under study the respondents markedly overestimate the rates of lifetime prevalence. Increasing prevalence estimation is associated with a significant decrease in the desire for social distance in case of schizophrenia. As for depression, anorexia nervosa and bulimia nervosa there are no significant associations. Many campaigns aimed at reducing stigma emphasize the high prevalence of mental disorders. The assumption of these campaigns is that reduction of the perceived distinction leads to a decrease of the desire for social distance towards those afflicted. Our results indicate that this may not generally be an effective way to reduce stigma.

Fighting psychiatric stigma in the classroom: the impact of an educational intervention on secondary school students' attitudes to schizophrenia

BACKGROUND

Adolescents constitute an appealing target group for fighting stigma and discrimination surrounding mental illness, since it is during this developmental period that adult attitudes about mental illness are formed and consolidated.

AIM

The aim of the present study was twofold, to explore adolescents' beliefs and attitudes to schizophrenia and to evaluate the effectiveness of an anti-stigma intervention in altering them.

METHODS

A total of 616 high school students participated in the study, divided into a control condition and an anti-stigma intervention group. Data were collected at three time points: before the intervention, upon its completion and at a 12-month follow-up.

RESULTS

Baseline measurements indicated that students espoused certain stereotypical beliefs about patients with schizophrenia and were reluctant to interact with them on some occasions. Upon completion of the intervention, positive changes were recorded in students' beliefs, attitudes and desired social distance; however, only the changes in beliefs and attitudes were maintained after one year.

CONCLUSION

For anti-stigma interventions to be effective, they should be continuously delivered to students throughout the school years and allow for an interaction between students and patients. Health promotion programmes might be an appropriate context for incorporating such interventions.

Involuntary admission in Greece: a prospective national study of police involvement and client characteristics affecting emergency assessment

BACKGROUND

and aim: Mental health legislation varies considerably from one country to the other. This study aims to describe the characteristics of the individuals who are brought in by the police for psychiatric assessment and the police involvement in this procedure in Greece.

METHOD

Prospective study of the incident books of the police departments throughout Greece concerning involuntary psychiatric admissions. These books were completed by the police officers who brought the individuals for involuntary psychiatric examination.

RESULTS

In total, 2,038 involuntary assessments were evaluated and examined in relationship to the demographic characteristics of the examined individuals. The main findings are as follows. Males were more often assessed (69%) at a younger age than females (p < 0.001). The majority of the assessments led to involuntary admission (87.5%). Immigrant status did not lead to increased involuntary commitment. The chance for involuntary admission was greater for younger Greek nationals offering resistance. An unexpected finding is that police officers were unnecessarily present in almost half of the mental health assessments (49.4%).

CONCLUSION

The psychiatrists in Greece who perform mental health assessments under the Greek Mental Health Law admit the majority of individuals. They also accept the presence of a police officer during the assessment more often than expected. This issue needs immediate addressing by means of better training and support of psychiatrists.

Gender differences in public beliefs and attitudes about mental disorder in western countries: a systematic review of population studies

AIMS

While quite a number of theories and hypotheses about gender differences in public beliefs and attitudes about mental illness have been proposed, the empirical evidence, particularly evidence based on population studies, is rather scarce.

METHODS

A systematic review of population-based studies providing information on gender differences in beliefs about mental disorders and attitudes towards the mentally ill was carried out.

RESULTS

While both genders are no different in their willingness to seek informal help for mental illness, women seem more ready to recommend professional help than men. They also evaluate treatment outcomes more favourably. Women are more likely to endorse psychosocial conceptualizations of mental illness than men, and, in consequence, are more in favour of psychotherapy. With a few exceptions, women do not seem to display more favourable attitudes than men towards people with mental disorder. Female patients seem to be rejected by the public less than male patients.

CONCLUSIONS

Our review suggests that gender matters in public beliefs and attitudes about mental illness. Some theoretical assumptions are supported by empirical findings, others not. However, as evidence is rather scarce, further studies testing theory-driven hypotheses are needed.

Medical students' beliefs and attitudes towards schizophrenia before and after undergraduate psychiatric training in Greece

AIMS

The aim of the present study was to explore medical students' beliefs and attitudes towards people with schizophrenia (PwS) prior to receiving any training in psychiatry and to assess the impact of the psychiatric placement on changing them.

METHODS

A questionnaire addressing beliefs, attitudes and desired social distance from PwS was distributed to all final year medical students before the beginning of their 4-week undergraduate psychiatric placement and upon its completion.

RESULTS

Students did not endorse stereotypes commonly attached to PwS, such as being dangerous, lazy or of lower intelligence, but they held the view that PwS are unpredictable and suffer from split personality. Furthermore, the baseline level of desired social distance was found to increase as the intimacy of the interaction increased, and the only variable associated with it was personal experience of serious mental illness. Moreover, the placement was found to have either no influence at all or in a negative direction. Upon its completion more students were found to believe that PwS cannot recover, have no insight into their condition, cannot make reasonable decisions, cannot work in regular jobs and are dangerous to the public. No difference was recorded in social distance scores.

CONCLUSIONS

A close and critical examination of the various elements of the undergraduate placement in psychiatry is needed in order to develop an evidence-based, fully rounded education with an anti-stigma orientation.

Recovery from schizophrenia: a four-year study of an inner city cohort

Converging evidence support the establishment of integrative approaches combining pharmacotherapy and psychosocial interventions for the treatment of patients with schizophrenia. Nonetheless, most studies have been limited with regard to treatment duration and their external validty has been questioned. The present study aimed at evaluating the effectiveness of the routine use of a continued integrative treatment approach in promoting clinical and social recovery from schizophrenia over 4 years. At a community mental health centre in Athens, 60 consecutive cases with a DSM-IV diagnosis of schizophrenic spectrum disorders were included into the study. Indepedent raters assessed the patients' level of functioning, cognitive impairment, disability, distress and caregivers' stress at baseline and annually for 4 years. The results of the study showed a stable linear pattern of improvement in all outcome measures with moderate to small effect sizes; while competitive employment and independent living emerged as the areas which benefited the least from the treatment program. Overall, the study supports the application of evidence-based integrative strategies to routine services, as long as they are provided in a timely and continued manner.

Factors associated with hospitalisation of patients with schizophrenia in four European countries

PURPOSE

To analyse factors associated with hospitalisation in patients with schizophrenia from four European countries, and to investigate whether national specificities might have an impact on the profile of inpatients.

METHOD

A randomly selected sample of psychiatrists (N = 744), from Germany, Greece, Italy and Spain, collected data on the five last patients with schizophrenia they had seen in consultation (N = 3996).

RESULTS

High positive symptoms, lack of insight, not living with the family, frequent past episodes, addiction to illegal drugs, global severity, uncooperativeness and smoking were significantly associated with hospitalisation, with OR between 4.1 and 1.26. Nevertheless, only high positive symptoms from the PANSS and lack of insight were systematically detected in the four countries. Among different results, the weight of "not living with the family" had national specificities, as Germany was the only country where this factor played no role (OR = 0.94).

CONCLUSION

Although some factors such as positive symptoms are associated with hospitalisation in a very homogenous way throughout different countries, discrepancies were detected between countries, for "living with the family", "number of past acute relapses" and "uncooperativeness". Linking these specificities to national healthcare systems might be useful to promote access to care for all patients.

A comprehensive systematic review on the perception and experience of stigma among people with schizophrenia

BACKGROUND

Research has shown that stigma associated with mental illness is pervasive in many countries. Schizophrenia is considered one of the most highly stigmatised psychiatric disorders due to an array of negative stereotypes associated with it. Stigma has deleterious consequences for people suffering a mental illness. A review on the subjective perception and experience of stigma may aid the development of effective anti-stigma programs and raise awareness of clinicians about the meaning of stigma for individuals in order to minimise harmful health outcomes.

OBJECTIVE

The overall objective of this systematic review was to determine perception and experience of stigma among people with schizophrenia.

INCLUSION CRITERIA

Types of participants Studies that included adults (18 years and over) diagnosed with any types of schizophrenia.Phenomena of interest Primary studies which explored the perception and experience of stigma among people with schizophrenia.Context Studies conducted in either inpatient, outpatient, or community settings and published in English.Types of studies Any interpretive studies and quantitative descriptive studies which explored the phenomena of interest.

SEARCH STRATEGY

The literature search sought published studies and papers. Electronic databases searched were: METHODOLOGICAL QUALITY: Qualitative and quantitative studies selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardised critical appraisal instruments from the JBI-SUMARI.

DATA EXTRACTION

Information was extracted by two independent reviewers from each paper using standardised JBI data extraction tools.

DATA SYNTHESIS

Meta-synthesis was carried out which resulted in eight synthesised findings. A narrative summary of the quantitative study findings is also presented.

RESULTS

Both qualitative and quantitative studies revealed similar findings, including negative attitudes, discrimination and lack of understanding from community, friends, colleagues, family members, as well as mental health professionals due to negative stereotypes and media portrayals. Self stigmatisation among individuals was revealed too.

CONCLUSION

Stigma affects important domains of individuals' lives, and is mainly due to a lack of knowledge and understanding of others towards people with schizophrenia. Self stigma, which contributes to negative self concept and perceptions, appears to be a prominent problem too.

IMPLICATIONS FOR PRACTICE

Education programs should be developed and targeted at various groups of people to enhance knowledge and understanding of mental illness. Additional legislation may be required to protect the rights of individuals. Media can help to disseminate accurate information to the public. Healthcare professionals have the responsibility to advocate for individuals, empower them in decision making, and understand the meaning and experience of stigma for individuals, in order to plan appropriate interventions to help them cope effectively.

IMPLICATIONS FOR RESEARCH

Further qualitative research investigating stigma could be conducted in different cultural settings. A systematic review on the association between stigma experiences and clinical or demographic characteristics may aid mental health professionals in recognising individuals at risk of the adverse effects of stigma. Periodic research in this area could evaluate the effectiveness of community-based educational programs or interventions introduced which combat stigma.