Effect of psychiatric labels on attitudes toward mental illness in a Turkish sample

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.

Public stigma of obsessive compulsive disorder and schizophrenic disorder: Is there really any difference?

A substantial delay for help-seeking is a serious problem for people with obsessive-compulsive disorder (OCD), a heterogeneous and debilitating mental health condition. Stigma is a major barrier to treatment seeking and further cause social and occupational impairment. Lack of comprehensive research led us to examine the public's stigmatizing attitudes towards checking, contamination, sexuality, aggression, and religion-related OCD symptoms, compared to schizophrenia. After reading one of six random case vignettes, 621 adults completed social distance scale. Analysis of Covariance or ANCOVA indicated that social distance towards violence and sexuality-related OCD symptoms and schizophrenia did not differ; but social distance for those was higher than religion, contamination, and checking subtypes. Although the contamination vignette did not differ from religion and checking vignettes, the theme of religion had a higher social distance than checking symptoms. Consequently, the current findings imply that there is a difference in public stigma among various symptoms of OCD and symptoms related to sexuality and violence, as well as schizophrenia, are associated with more social rejection. Thus, the general public needs access to educational methods of intervention and contact to eliminate stigma and improve the quality of life for people with mental health disorders.

Epidemiological survey of knowledge, attitudes, and health literacy concerning mental illness in a national community sample: a global burden

The aim of this study was to examine the knowledge, attitudes, and practices concerning mental illness among Qatari and other Arab expatriates.

METHOD

This is a cross-sectional survey conducted from October 2008 to March 2009. A questionnaire was designed to assess knowledge, attitude, and practice regarding mental illness.

RESULTS

Of 2254 subjects surveyed, 49.6% were Qataris, 50.4% other Arab expatriates, 54.8% males, and 45.2% females. A majority of the respondents thought that substance abuse like alcohol or drugs could result in mental illness (84.7%). Fewer than half of the subjects believed that mentally ill people are mentally retarded (40.6%). 48.3% believed that mental illness could result from punishment from God. The most common information source on mental illness was media (64.2%). Recognition of common mental disorders in the studied population was poor (72.5%).

CONCLUSION

Knowledge of mental illness among the Arabic-speaking population of Qatar was quite poor.

The effects of symptom recognition and diagnostic labels on public beliefs, emotional reactions, and stigma [corrected] associated with intellectual disability

Labels are firmly rejected by the disability rights movement, yet the complex effects of labeling on lay beliefs are poorly understood. This study examined the effects of labeling on the general public's reactions to people with intellectual disabilities. A sample of 1,233 adult members of the UK general population were randomly presented with either a diagnostically labeled or unlabeled case vignette, and their emotional reactions, causal beliefs, and social distance were assessed. Providing a label reduced social distance, increased biomedical attributions, and had a small positive direct effect on emotional reactions. Making a diagnosis of mild intellectual disability known may prevent misattribution to more stigmatizing causes and thus reduce social distance. Some undesirable effects were observed though on causal beliefs and associated emotional reactions.

Effects of a psychiatric label on medical residents' attitudes

BACKGROUND

Few data are available on the effects of a psychiatric label on medical residents' attitudes towards an individual.

AIMS

To investigate the effect of a psychiatric label on the attitudes of medical residents towards an individual.

METHODS

Medical residents were randomly assigned to one of two vignettes describing the same apparently healthy person, differing only in the presence of a psychiatric label for one of them. Participants (N = 322) reported their attitudes towards the described individual and their willingness to treat this person.

RESULTS

Residents allocated to the psychiatric-diagnostic label group reported being less at ease with becoming the individual's nextdoor neighbour, working in the same place, sharing a house, having him look after their children, having a member of their family date him, having their finances run by the individual, less willing to become friends with the described individual and more uneasy having to examine him the next time he visits the emergency room.

CONCLUSION

Implementing effective programmes to combat stigma in the curriculum of medical residents appears to be needed.

An elective psychiatric course to reduce pharmacy students' social distance toward people with severe mental illness

OBJECTIVE

To determine whether an elective course on mental health could reduce pharmacy students' social distance toward people with severe mental illness.

DESIGN

Course activities included assigned readings, class discussions, student presentations, review of video and other media for examples of social distance, presentations by patients with mental illness, and visits to hospitalized patients in a variety of psychiatric settings.

ASSESSMENT

The Social Distance Scale (SDS) was administered at the beginning and end of the semester to students enrolled in the elective and to a comparator group of students not enrolled in the course. Pharmacy students who did not complete the elective had significantly higher SDS scores than students who completed the elective (18.7 vs. 15.6, p < 0.001). Students enrolled in the course had lower precourse SDS scores, were more likely than their peers to have a personal association with mental illness, and had a decrease in precourse to postcourse scores.

CONCLUSION

A course designed to reduce stigma towards the mentally ill can reduce pharmacy students' social distance.

Desire for social distance from people with mental disorders

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to make sense of this confusion, the present review focuses on research on the most commonly measured component: social distance. The review examines measurement of social distance; characteristics of people who desire greater social distance; experiences that affect social distance; characteristics of people that elicit social distance; the effects of psychiatric labelling; the effects of causal explanations for mental disorders; and interventions to reduce social distance. It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.

Stigmatising attitude of medical students towards a psychiatry label

BACKGROUND

The aim of this study is to evaluate the effect of a psychiatric label attached to an apparently normal person on the attitude of final year medical students at a Nigerian university.

METHODS

A questionnaire with sections on demographic information, a single-paragraph case description illustrating a normal person, a social distance scale and questions on expected burden was used to elicit responses from 144 final year medical students who have had previous exposure to psychiatric posting. The students consisted of two randomly assigned groups; group A received a case description with a psychiatric label attached while group B received the same case description but without a psychiatric label.

RESULTS

A total of 68 (47.2%) of the students responded to the questionnaire with the attached psychiatric label, while 76 (52.8%) responded to the questionnaire without the attached label. There was no statistical difference in age (p = 0.187) and sex (p = 0.933) between the two groups of students. The students who responded to the questionnaire with the attached psychiatric label would not rent out their houses (p = 0.003), were unwilling to have as their next-door neighbour (p = 0.004), or allow their sister to get married (p = 0.000) to the man depicted in the case description compared with those that responded to the questionnaire without label. This group also felt that the man would exhaust them both physically (p = 0.005) and emotionally (p = 0.021) in any relationship with him.

CONCLUSION

These results strengthen the view that stigma attached to mental illness is not limited to the general public; medical students are also part of the stigmatizing world. There is, therefore, a need to incorporate issues concerning stigma and its reduction as a core component of the mental health curriculum of medical schools.

Social distance and perceived dangerousness across four diagnostic categories of mental disorder

OBJECTIVES

To examine whether laypersons make categorical distinctions between psychoses, neuroses, and addictive behaviours relative to desired social distance and whether degree of familiarity and perceived dangerousness influences social distance judgements.

METHOD

Two studies were undertaken using the mental health literacy framework. The first study involved surveying lay beliefs and perceptions of a mentally ill person who exhibited behavioural cues of one of the following: schizophrenia, depression, alcohol abuse, or substance dependence. The second study involved a partial replication and refinement of the first study to determine whether discriminate judgements across diagnostic categories were influenced by perceived dangerousness.

RESULTS

Findings from study 1 indicated that laypersons do differentiate between psychological disorders and respond to them differently relative to social distance. Results from study 2 confirmed those of study 1 and in addition suggested that perceived dangerousness influences social distance, largely with respect to schizophrenia.

CONCLUSIONS

Laypersons make categorical distinctions between different types of disorders. Perceived dangerousness is more strongly associated with schizophrenia, than is warranted when considered against acts of violence and aggression committed by individuals with alcohol abuse and substance dependence problems.

Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach

OBJECTIVE

Many anti-stigma programmes use the 'mental illness is an illness like any other' approach. This review evaluates the effectiveness of this approach in relation to schizophrenia.

METHOD

The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes.

RESULTS

The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as 'illness', are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance.

CONCLUSION

An evidence-based approach to reducing discrimination would seek a range of alternatives to the 'mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.

Determinants that shape public attitudes towards the mentally ill: a Dutch public study

BACKGROUND

The stigmatisation of the mentally ill is considered a well-established fact. To improve negative attitudes among the general public, we need to identify the factors that cause them. Drawing from previous studies, we combined a variety of variables to examine a comprehensive explanative model.

OBJECTIVES

We examined a sample of the Dutch public on their willingness to interact with mental patients. We examined a number of determinants concerning their influence on levels of social distance: demographical characteristics of the public, their beliefs about stereotypes of mental patients, their beliefs about causes of mental problems, their familiarity with mental illness.

METHODS

We employed a questionnaire survey among two sub-samples of the Dutch public (n = 812, response 33%).

RESULTS

Attributing psychiatric problems to structural causes (i.e. causes beyond patients' control and responsibility, such as genetic transmission) is associated with less social distance. Conversely, attribution to individual factors (e.g. drug abuse) related to more distant attitudes. Stereotypical beliefs about mental patients (e.g. untrustworthiness, aggressiveness, causing disturbances) relate to more social distance from mental patients.

CONCLUSIONS

Results implied that our comprehensive model explains only a modest amount of variance, but shows that to improve public mental health literacy and attitudes should first deal with the most negative stereotypical beliefs.

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.

Social distance in response to psychiatric labels

Several factors contribute to the amount of social distance individuals desire from each other, including the presence of a psychiatric label. This study examines aspects of the relationship between four specific psychiatric labels and social distance. A social distance scale was developed for this purpose and used in a pilot study. Three-hundred-and-thirteen participants answered questions about their willingness to be involved in relationships of varying degrees of closeness with people who have psychiatric diagnoses. We found that individuals who have a close friend or family member with a mental illness, in contrast to those who have no such relationship, desire less social distance from people with mental illness. Those who were given some information about specific diagnoses desired greater social distance from people who have mental illness than participants who were given only diagnostic labels. These findings highlight the need to evaluate how people who are not in the helping professions learn about psychiatric conditions and how this knowledge impacts beliefs and behaviors.

Response of Japanese patients to the change of department name for the psychiatric outpatient clinic in a university hospital

There has long been controversy over the stigma associated with mental illness and psychiatric facilities. In Japan, the department name "Department of Psychiatry" (in Japanese, Seishin-ka) itself evokes the lay public's and psychiatric patients' feelings of stigma. This phenomenon may hamper psychiatric treatment of adequate duration and quality. On July 1st, 1999, the Juntendo University Hospital changed the department name from "Department of Psychiatry and Neurology" (in Japanese, Seishin-Shinkei-ka) to Mental Clinic, accompanied by an increased number of new outpatients, as reported previously. In the present study, we turn our attention to the opinions of those patients who have received treatment in the department under both names. Questionnaires asking for their opinions about the department names revealed that the majority have feelings of stigma associated with the name "Department of Psychiatry and Neurology." This result did not correlate with demographic factors or the length of psychiatric treatment. However, those who experienced psychiatric admission were significantly less uncomfortable with the name than those who did not. It was also revealed that the change in the name lessened their feelings of stigma and negative self-image as patients of a general hospital. These results suggest the importance of the name of the psychiatric department in general hospitals, in Japan, from therapeutic, psychosocial and ethical viewpoints.

Against over-interpretation: the understanding of pain amongst Turkish and Kurdish speakers in London

The understanding of experienced pain has recently moved from the biological to the metaphorical. Detailed interviews with twelve Turkish and Kurdish patients in London who had been unsuccessfully investigated medically for chronic pain showed that their understanding reflected local, typically humoural, conceptions of self and body. However there was little to suggest interpretation of the illness as a more specific and grounded idiom for social or political experience. It is suggested that the current vogue for 'interpretation' in medical anthropology and social psychiatry may occasionally be, as Umberto Eco puts it, 'over-interpretation'.

Psychiatric labelling, sex role stereotypes and beliefs about the mentally ill

This study aimed to investigate the effect of two main variables on specific attitudes and beliefs about mental illness. The first variable tested the labelling theory proposal that the label of mental illness per se is stigmatizing for those so labelled. The second tested the proposal of Rosenfield (1982) that males and females receive a more severe societal reaction for deviance when the deviant behaviour is inconsistent with traditional sex role norms. Questionnaires with vignettes describing four behaviour types were given to young adult respondents. The expected effect of a psychiatric diagnosis and of deviance from sex role stereotypes were not confirmed. It was concluded that while several variables combine to influence specific attitudes and beliefs about the mentally ill, the type of behaviour displayed is the crucial factor.

A comparison of public attitudes in Britain and Saudi Arabia towards auditory hallucinations

BACKGROUND

The successful introduction of community interventions is partly dependent on public beliefs about the aetiology and treatment of psychiatric difficulties and tolerance of community integration.

METHOD

This study examined community attitudes towards auditory hallucinations in Saudi Arabia (SA) and the United Kingdom (UK) concerning (a) causes of auditory hallucinations, (b) the efficacy of interventions and (c) levels of social rejection.

RESULTS

Responses from 281 patients attending their general practitioners indicated that those living in Saudi Arabia were most likely to believe that hallucinations are caused by Satan or due to magic, while the UK sample were more likely to cite schizophrenia or brain damage. While the Saudi sample believed that religious assistance would be most effective, the UK sample supported medication and psychological therapies. Beliefs about aetiology and treatment were unrelated to educational attainment. There was a greater degree of social rejection of patients in Saudi Arabia, but here educational attainment was of significance.

CONCLUSIONS

These results suggest that beliefs about aetiology are related to treatment recommendations and social distancing, and thus have implications for the care of Arabic patients living in Western countries as well as for the use of Western interventions in non-Western cultures.