Attitudes of Turkish and American clinicians and Turkish psychology students toward mental patients

Public attitudes towards depression and schizophrenia in an urban Turkish sample

Stigma towards mental illness influences help-seeking behavior and prevents individuals with a mental illness from seeking the appropriate treatment for their condition. In Turkey, a shift from inpatient psychiatric mental health care towards a community-based, low-threshold system highlights the importance of understanding public attitudes towards the mentally ill. This study aims to underpin developments in mental health care through culturally sensitive research. Public stigma towards schizophrenia and depression is examined for the first time simultaneously in a community sample. Unlabeled case vignettes of either schizophrenia or depression as well as an assessment of mental illness attribution and the desire for social distance (SDS) were presented to an urban Turkish sample (N = 295). Analysis of variance revealed that attribution to mental illness determines significant levels of stigma for schizophrenia, however not for depression. Furthermore, desire for social distance (SDS) was significantly higher for the schizophrenia condition compared to depression. Depression and schizophrenia evoke different reactions within the Turkish population, specifically the attribution to mental illness increases stigma. This finding is discussed in light of the contact hypothesis, and furthermore contextualized within literature on familiarity with depression symptoms on the one hand, and perceived dangerousness and symptom severity of schizophrenia on the other hand. Implementation of timely and culturally sensitive adapted interventions within the ongoing reform of the Turkish mental health care system is recommended.

The Effect of Clinical Exposure to Patients on Medical Students' Attitude Towards Mental Illness

BACKGROUND

Stigma of mental disorders causes a reduction in seeking help from the health care professionals and is evident across the world.

OBJECTIVES

The current study aimed to compare medical students' attitude towards mental illness after two different psychiatry clerkships in terms of the level of clinical exposure to patients with mental illness.

PATIENTS AND METHODS

Through a quasi-experimental study, all of the 4^th-year medical students were invited to enroll this study conducted in Tehran University of Medical Sciences (TUMS). They were non-randomly assigned into two different psychiatry clerkships from January 2009 to January 2010. One group was enrolled in the traditional lecture-based course (low-exposure) while the second group participated in a novel method with increased hours of patient exposure (high-exposure). Attitude towards mental illness (AMI) was measured by a 22-item questionnaire before and after the clerkship and data were compared between the two groups in terms of changing attitude towards mental illness in five different categories.

RESULTS

A total of 211 participants were enrolled in the study (115 female) of which 115 students (54.5%) were in low-exposure group and 96 students (45.5%) in the high-exposure group. Generally, AMI scores did not differ between the two groups and did not show any significant changes before and after the psychiatry clerkship. The only exceptions to this were AMI4 category (the concept of etiology of the mental illness), which significantly improved after the clerkship in the low-exposure (P = 0.011) and the high-exposure groups (P = 0.024), respectively.

CONCLUSIONS

Exposure of medical students to patients with mental illness did not improve attitude towards mental illness and psychiatric conditions.

Personnel attitudes toward people with mental illness at a psychiatric hospital in Taiwan

BACKGROUND

The attitudes of psychiatric hospital personnel are critically related to the quality of mental health care, but few studies have investigated this issue.

AIMS

This study is aimed at an exploration of the attitudes of psychiatric hospital personnel toward people with mental illness and at an examination of the associated factors.

METHOD

A self-report questionnaire, the Mental Illness Attitude Scale (MIAS), was used to collect data from psychiatric hospital personnel in Taiwan (n = 290). The MIAS included 46 items and 4 dimensions: acceptance, rehabilitation and prognosis, social distance and recommendations for interventions.

RESULTS

Rehabilitation and prognosis had the highest item average scores (4.03) and social distance had the lowest item average scores (3.22). Stigmatization and the number of different types of contacted clients were two significantly associated attitude factors.

CONCLUSION

Psychiatric hospital personnel in Taiwan tend to have positive attitudes toward people with mental illness in general situations but hold less positive attitudes in terms of community integration-related issues and intimate relationships. More evidence-based community services should be conducted to decrease personnel concerns about the successful community integration of those who are mentally ill. Future studies can investigate the concept and impact of stigmatization more deeply.

Factors influencing social distance from people with schizophrenia

The aim of this study was to investigate the nature of the relationship between public causal beliefs and social distance from people with schizophrenia. Regression analysis of the results of a vignette-based opinion survey was conducted on a representative population sample in Erzincan (n = 856). The findings of this study suggest that there is a positive relationship between biological causal beliefs (i.e. 'brain and disease' and 'heredity') and social distance from people with schizophrenia. It would be premature to draw conclusions with regard to interventions aimed at reducing discrimination based on stigma. However, our study provides stimulus for reconsidering the assumptions underlying biological concepts among the public, which might not contribute to a desired reduction in social distance from people with schizophrenia.

Nursing students' attitude change towards mental illness and psychiatric case recognition after a clerkship in psychiatry

Attitudes towards mental illness were measured in all 92 students of the seventh semester in the School of Nursing of Athens University before (time 1) and after (time 2) the completion of 40 and 90 hours of lectures on clinical psychiatry and clerkship, respectively. The instrument used to measure attitudinal dimensions was the Cohen and Struening's Opinions about Mental Illness (OMI) scale, which yieldsfive factors and was proven to be reliable and valid in previous studies. Hypothetical case vignettes were used to assess psychiatric case recognition. In factors A, B, and D statistically significant differences in attitudes towards mental illness between time I and 2 were observed. It seems that the completion of training in psychiatry influenced the students' opinions about mental illness; they expressed less authoritarianism and discriminatory beliefs as well as positive views about social integration of mentally ill persons. The group of students who failed to recognize the case vignettes satisfactorily also expressed negative views in four out of five OMI scale factors.

Attitudes of hospital staff toward mentally ill patients in a teaching hospital, Turkey

The aim of this study was to examine the attitudes of hospital staff toward major mental diseases: schizophrenia and depression. Negative attitudes were common among all of the hospital staff, and were more common among academicians, resident physicians and nurses. Causes of attitude variations were discussed.

BACKGROUND

Attitudes of hospital staff are important for admission, early diagnosis and treatment, and the rehabilitation process of mentally ill patients.

AIMS

The main objective of this study was to investigate and compare hospital workers' attitudes toward and knowledge of schizophrenia and depression.

METHODS

In 2001, a total of 160 hospital staff (40 academicians, 40 resident physicians, 40 nurses and 40 hospital employees) in a teaching hospital were interviewed with a questionnaire. The questionnaire included items about background information, a one-paragraph vignette, questions on social distance and expected burden, recognition of mental illness, hospitalization, prognostic outcome, and to whom and where the patient should be admitted.

RESULTS

Although academicians, resident physicians, and nurses have sufficient knowledge about schizophrenia and depression, the frequency of their negative attitudes towards mentally ill subjects was more than that for uneducated hospital employees.

CONCLUSIONS

It was commented that this difference might be as a result of negative effects of the medical education system.

University students' attitudes towards mental patients and psychiatric treatment

BACKGROUND

Public attitudes towards mental patients and psychiatric treatment are mostly unfavorable. Mental patients tend to conceal their illness or selectively disclose their treatment histories to someone they trust.

AIMS

To examine the university students' attitudes towards different information regarding a person labeled as mentally ill.

METHODS

We designed seven descriptions of a mentally ill person of varying past and current treatment histories and randomly assigned 308 university undergraduates to read one of the descriptions. Subjects rated their willingness to interact with the hypothetical case using a 19-item social distance scale.

RESULTS

Greater social distance was associated with non-medical field of study, no previous contact with the mentally ill and female gender. Subjects without previous contact with mentally ill individuals kept greater distance from a discharged mental patient receiving psychiatric care than a mental patient who did not require medications nor psychiatric follow-up. In contrast, respondents who had previous contact with the mentally ill were more willing to interact with a discharged mental patient receiving psychiatric care comparing with a person labeled as mentally ill alone and a mental patient who had never been admitted to hospital.

CONCLUSIONS

Implications of our findings in clinical management and designing stigma-reducing programme are discussed.

Influence of a 3-week psychiatric training programme on attitudes toward mental illness in medical students

The present study was carried out to assess the influence of psychiatric training, including direct patient contact, on attitudes toward mental illness. An experimental group consisting of medical students going through their 3-week training in psychiatry was compared with a control group going through training in ophthalmology. The psychiatric training involved direct patient contact and course work. Attitudes toward three different vignettes were assessed before and after training. Analyses showed that there were no significant changes in the attitudes of the psychiatry group when compared to the ophthalmology group. Inconsistent findings in the literature were pointed out and a more analytical approach, focusing on the specific features of exposure, was suggested.

Influence of having a hospitalized mentally ill member in the family on attitudes toward mental patients in Turkey

The influence of having a mentally ill member in the family on various attitudes was assessed. An exposed group (those having a mentally ill member) was compared with a no-exposure group. The attitudes assessed toward two vignettes included recognition of mental illness, social distance, expected burden, expected influence on one's health, treatment choice, and prognosis. The total sample consisted of 84 subjects selected from the family members of patients from psychiatric (exposed) and other (no-exposure) clinics. Direct experience with a mentally ill family member did not make a significant difference in the attitudes toward the vignettes, but the type of psychopathology did. The results were discussed within the context of findings from Western cultures.

Experienced Turkish nurses' attitudes towards mental illness and the predictor variables of their attitudes

General attitudes towards mental illness, attitudes towards two vignettes, and possible predictor variables of these attitudes were investigated among experienced Turkish nurses. The analyses showed that the nurses accepted both organic and psychological causation and had rather positive views on drug treatment, psychotherapy, and prognosis. However, they were more favourably disposed towards psychological causation and psychotherapy; the paranoid schizophrenia description was more readily perceived as mental illness and more 'negative' ratings were recorded for this than was the case in the description of neurosis. In terms of predictors, university education was related to lower acceptance of psychotherapy and chances of recovery; older respondents showed higher social distance to the neurosis vignette. The findings were discussed within the context of previous findings from Turkey and other countries.

Attitudes of Chinese and American male students towards mental illness

Attitudes towards mental illness were measured by the Opinion About Mental Illness Scale (OMI) for 83 male graduate college students from American and Chinese cultural backgrounds. The OMI questionnaire consisted of five factors: A) Authoritarianism, B) Benevolence, C) Mental Hygiene Ideology, D) Social Restrictiveness, and E) Interpersonal Etiology. Statistically significant differences between the two groups of subjects on Factors A, B, D and E of the OMI were found. American students performed lower on "Authoritarianism", on "Social Restrictiveness", and on "Interpersonal Etiology", and higher on "Benevolence" than Chinese subjects.

Attitudes towards mental illness. A review of the literature

With the advent of community psychiatry, the pressure of care of the mentally ill will increasingly fall on the family and the community. In order for this transition to succeed, it is important to bear in mind the attitudes of the community and the caregivers. This article reviews the literature on public attitudes and suggestions are made for future research and lessons to be learnt from the experience in North America.

Attitudes toward mental illness: recognition, desired social distance, expected burden and negative influence on mental health among Turkish freshmen

Attitudes toward three types of disorders and a normal subject portrayed in vignettes were assessed among university students. The variables assessed were: perception of mental illness in the vignettes; desired social distance; emotional and physical burden expected; and expected negative influence on one's mental health from association with the type of persons portrayed in the vignettes. Analysis revealed that, in terms of variables assessed, the most "negative" ratings were recorded for the paranoid schizophrenic case and the most "positive" recorded for the normal subject. The simple schizophrenia and the anxiety neurosis/depression cases fell between the other two cases. Finally, with a few exceptions, all the variables assessed were significantly correlated with each other.

Effects of labeling patients "psychiatric" or "medical": favorability of traits ascribed by hospital staff

A modified version of the Adjective Checklist was developed to test whether labeling patients “psychiatric” or “medical” would affect caretakers' attitudes. 97 psychiatric hospital employees (47 men and 50 women) completed valid questionnaires during their initial employment processing. Compared to medical patients, psychiatric patients were rated as less likable and were viewed as having more unfavorable and fewer favorable traits. Specifically, psychiatric patients were characterized as more irresponsible, less dependable, and less clear-thinking than medical patients. No significant attitudinal effects were found for the factors of perceivers' sex or role (direct-care versus support personnel). The over-all findings indicate that, despite a generation of professional advocacy of the medical model, those charged with the care of psychiatric patients continue to view them as less socially desirable than medical patients.

Causal attributions for psychological illness among Turkish psychiatric in-patients and their relationships with hope

The causal attributions for psychological illness were investigated in a sample of seventy Turkish psychiatric in-patients, using the levels of causal attributions proposed by the transtheoretical model of Prochaska (1984). The factor analysis of replies to a questionnaire tapping various levels of causality revealed seven factors which were greatly overlapping with the causal attributional levels proposed by the transtheoretical model and verified in western samples. However, there were important dissimilarities on attributions to family, self, and interpersonal conflicts. Family conflicts and interpersonal conflicts appeared as two separate causal factors, whereas attributions to personal symptoms and family conflicts merged under a single higher-order factor. Results also revealed that types of attributions were related to hope for future well-being. The results and their implications were discussed within the framework of the transtheoretical model, attribution theory research and studies on the Turkish family structure and values.