Attitudes of mental health professionals toward people with schizophrenia and major depression

Several studies reveal poor knowledge about mental illness in the general population and stigmatizing attitudes toward people with mental illness. However, it is unknown whether mental health professionals hold fewer stigmatizing attitudes than the general population. A survey was conducted of the attitudes of mental health professionals (n = 1073) and members of the public (n = 1737) toward mental illness and their specific reaction toward a person with and without psychiatric symptoms ("non-case" as a reference category). Psychiatrists had more negative stereotypes than the general population. Mental health professionals accepted restrictions toward people with mental illness 3 times less often than the public. Most professionals were able to recognize cases of schizophrenia and depression, but 1 in 4 psychiatrists and psychologists also considered the non-case as mentally ill. The social distance toward both major depression and the non-case was lower than toward schizophrenia. However, in this regard, there was no difference between professionals and the public. The study concludes that the better knowledge of mental health professionals and their support of individual rights neither entail fewer stereotypes nor enhance the willingness to closely interact with mentally ill people.     

Physical activity and its determinants among adolescents with intellectual disabilities

Physical inactivity is a global public health problem, and it has been linked to many of the most serious illnesses facing many industrialized nations. There is little evidence examining the physical activity profile and determinants for the vulnerable population such as people with intellectual disabilities (ID). The present paper aims to describe the regular physical activity prevalence and to examine its determinants among adolescents with intellectual disabilities in Taiwan. Participants were recruited from 3 special education schools in Taiwan, with the entire response participants composed of 351 primary caregivers of adolescents with ID (age 16–18 years). There were 29.9% ID individuals had regular physical activity habits, and the main physical activities were walking, sports, and jogging. There were only 8% individuals with ID met the national physical activity recommendation in Taiwan which suggests at least exercise 3 times per week and 30 min per time. In a stepwise logistic regression analysis of regular physical activity habit, we found that the factors of caregiver's educational level and preference toward physical activity were variables that can significantly predict ID individuals who had regular physical activity habit in their daily livings after controlling other factors. To maximize the positive effect of physical activity on people with ID, the present study suggests that it is needed to initiate appropriate techniques used for motivation to participate in physical activity for this population.     

“It Is Only Natural….”: Attitudes of Young People With Intellectual Disabilities Toward Sexuality in Greece

Although there is an increasing awareness of the rights of people with intellectual disabilities, limited progress has been made in supporting people with intellectual disabilities to create and sustain intimate personal relationships in Greece. This article looks at the attitudes of 66 adolescents and young adults with intellectual disabilities toward sexuality. Selection of the sample was based on place of residence, participant’s age, and his/her degree of disability. Three Greek towns were chosen to provide the population for the study because they represented characteristics of contemporary Greece. Participants’ comments regarding a variety of sexual issues were examined through content thematic analysis. The above procedure led to five themes: sexuality as perogative, being ethical about sexuality, sexuality creating concerns, sexuality generating emotions, and talking about sexuality as informative. Findings revealed awareness of rights to sexual expression, protection, and enjoyment, but also of consequences when not following the social or legal rules. Analysis indicated issues of morality along with positive feelings toward intimate relationships like love, companionship, and mutual understanding. Finally, although participants expressed some uneasiness to talk about sexuality in general, there was great interest in getting appropriate knowledge and being prepared for the future.     

Interventions aimed at increasing knowledge and improving attitudes towards people with intellectual disabilities among lay people

Despite policies aimed at ensuring equal rights and maximising respect and social inclusion for people with intellectual disabilities, in their daily lives many continue to face negative attitudes and discrimination within society. Misconceptions about what it means to have an intellectual disability and about the capabilities of people with intellectual disabilities appear widespread, and may contribute to prejudice and discrimination. This review provides a summary and evaluation of empirical interventions aimed at increasing knowledge and targeting negative attitudes towards this population among lay people of working age. An electronic search using PsycINFO, Web of Science and PubMed identified 22 English language studies published between 1990 and early 2014 that reported a specific intervention with a lay population sample. The majority of studies reported promising outcomes, particularly those aimed at increasing knowledge of intellectual disability through education. Support for the positive influence of contact with people with intellectual disabilities was demonstrated across several interventions. Interventions delivered at least partly by individuals with intellectual disabilities, and educational interventions appear to hold the most promise. The evidence is limited though by the weaknesses of measurement tools employed.     

Subjective well-being among family caregivers of individuals with developmental disabilities: The role of affiliate stigma and psychosocial moderating variables

Studies have shown that stigmatization is linked to lower quality of life; however, only scant research has examined the association between family caregivers’ internalization of stigma (affiliate stigma) and their subjective quality of life (subjective well-being, SWB). Furthermore, studies have rarely examined this association via comparison between caregivers of individuals with different developmental disabilities in addition to examining the influence of psychosocial protective factors. These were the aims of the current study. Family caregivers (N = 176) of individuals with autism spectrum disorders (ASD), intellectual disabilities (ID), and physical disabilities (PD) completed a self-report structured questionnaire including scales measuring SWB, affiliate stigma, burden, positive meaning in caregiving, social support and self-esteem. Results showed that SWB of family caregivers was below the average normative level and especially low for caregivers of individuals with ASD. The strongest predictors of SWB were caregivers’ self-esteem, social support, positive meaning in caregiving, and affiliate stigma. Furthermore, an interaction was found between affiliate stigma and diagnosis, showing that among caregivers of individuals with ASD, greater levels of stigma were associated with lower ratings of SWB, whereas such an association was not found among caregivers of individuals with ID or PD. Findings from this study point to the importance of supporting caregivers across the life-span in order to decrease stigma, improve social support and self-esteem and improve SWB. Further, findings point to the need to respond differentially to the various developmental disabilities.     

Classical and modern prejudice: attitudes toward people with intellectual disabilities

In two studies, Study 1 and Study 2, we examine whether attitudes toward people with intellectual disabilities, like sexism and racism, consist of two forms-a classical and a modern, where the classical is overt and blatant and the modern is more subtle and covert. Self-report scales tapping these two forms were developed in Study 1. Based on confirmatory factor analyses, the results in Study 1 supported our hypothesis and revealed that the modern and classical forms are correlated but distinguishable. This outcome was replicated in Study 2. Construct and discriminatory validations of the scales provided further support for the distinction. The theoretical and practical importance of the results is discussed in relation to previous research on attitudes toward people with intellectual disabilities and other social outgroups.     

Alcohol-related problems in adolescents and adults with intellectual disabilities

PURPOSE OF REVIEW: Alcohol is widely available and one of the most commonly used psychoactive substances. This review examined the recent literature for empirical research addressing the cause, prevalence and treatment of alcohol-related problems in adolescents and adults with intellectual disabilities. RECENT FINDINGS: Adequate controlled research has not been conducted, and most of the studies were epidemiological and inconclusive. Despite the high variation in the reported prevalence in alcohol use and misuse rates, most published studies document that adolescents and adults with intellectual disabilities consume alcohol at substantially lower rates than the general population. Few treatment interventions have been reported, but limitations in the study design outline the emphasis for future research. SUMMARY: Alcohol misuse affects the physical and mental health of people with intellectual disabilities, leading to behavioural and social difficulties. Assessment and treatment of alcohol-related problems pose ethical considerations. Uncertainty surrounds the ability of alcohol services, and services for individuals with intellectual disabilities respectfully, to meet the needs of this population. Modification of existing treatment approaches, further staff training and development of liaison approach between alcohol services and services for people with intellectual disabilities need further evaluation of their effectiveness.     

Employment equity and mental disability

PURPOSE OF REVIEW: Recent research on the civil rights issue of employment equity for people with psychiatric disabilities is reviewed. RECENT FINDINGS: Mental disorders, particularly depression, are the most frequent source of occupational disability worldwide and are expected to grow. Employers are increasingly aware of the productivity costs associated with mental disorders and the importance of fostering a mentally healthy workforce. Few firms, however, have explicit policies to include disabled people in their workforce, and many employers continue to express prejudicial views toward people with mental disabilities which would exclude them from competitive work. At the same time, disability legislation has not offered the hoped-for protection for people with mental disorders. Employers have expressed concerns over the costs of making workplace accommodations and have successfully battled for a legal definition of disability that excludes many individuals with mental disorders. CONCLUSION: In the absence of antistigma efforts directed toward the business community, one wonders if the growing awareness of the productivity costs associated with mental disability will foster greater employment equity, or fuel more subtle forms of employment discrimination. Low employment levels among people with disabilities remain a major determinant of the social disparities they face.     

Prisoners with intellectual disabilities and detention status. Findings from a UK cross sectional study of prisons

The purpose of this study was to compare social and environmental historical and contextual risk factors between prisoners with intellectual disabilities and those without intellectual disabilities, and to investigate whether prisoners with intellectual disabilities were more likely to be placed on remand in prison (awaiting trial or sentencing) compared to those without intellectual disabilities, after controlling for socio-demographic factors such as age, gender, ethnicity, accommodation status and nature of offences. In this study, we carried out a secondary analysis of data from the 1997 Prison survey, which included 131 prisons in England and Wales. A fixed sampling fraction was used to obtain a representative sample of prisoners. A total of 3563 prisoners were approached and 3142 (88%) prisoners gave informed consent to be interviewed. Of these, 170 were identified as having intellectual disabilities using the Quick Test. Prisoners with intellectual disabilities were more likely to have lived in institutions or taken into local authority care and more likely to live in temporary accommodation. They were less likely to have had a paid job or any educational qualifications and more likely to perceive a lack of social support. Prisoners with intellectual disabilities were more likely to be placed on remand and were less likely to be sentenced, even after controlling for socio-demographic factors and nature of offence. This study suggests that prisons should be more pro-active at identifying people with intellectual disabilities and ensuring that their needs are met, including appropriate access to bail and court diversion schemes.     

Autonomic responses to dynamic displays of facial expressions in adolescents and adults with Williams syndrome

The behavioral phenotype characteristic of Williams syndrome(WS) is marked by strong interest in social interaction, manifestedin attention to human faces, empathy, approach behavior andsocial disinhibition, often coexisting with generalized anxiety.Despite their heightened social interest, people with WS showdeficits in explicit emotion recognition tasks similar to thoseof people with other developmental disabilities. In the currentstudy we explored whether individuals with WS show distinctiveautonomic responsiveness to social-emotional information, usingskin conductance response and heart rate measures. Autonomicactivation was investigated in response to facial expressionsof emotion in adolescents and adults with WS, compared to age-matchednormal controls and to age-, IQ- and language-matched individualswith learning or intellectual disabilities (LID). Overall participantswith WS were less electrodermally responsive to dynamicallypresented face stimuli than the age- and IQ-matched LID group,and showed more heart rate deceleration when viewing emotionalfaces than the controls. These findings, indicating hypoarousalbut increased interest in response to the dynamic presentationof facial emotions in WS, are consistent with the behavioralprofile of high approachability toward social stimuli in thispopulation.     

Longitudinal analysis of the impact and cost of person-centered planning for people with intellectual disabilities in England

Person-centered planning is central to United Kingdom policies regarding the support of people with intellectual disabilities. However, little evidence exists on the impact or cost of introducing person-centered planning. We examined the efficacy, effectiveness, and costs of introducing person-centered planning for 93 people with intellectual disabilities over 2 years across four localities in England. A person-centered plan was successfully developed for 65 people. Little change was apparent prior to introducing person-centered planning. After its introduction, modest positive changes were found in the areas of social networks; contact with family; contact with friends; community-based activities; scheduled day activities; and choice. The direct training and support cost of introducing person-centered planning was $1,202 per participant; indirect costs were negligible.     

Perceived stigma and community integration among clients of assertive community treatment

Facilitating the integration of persons with psychiatric disabilities is an important goal of community programs. In addition to limitations such as inadequate housing, poverty, and unemployment, a common barrier to community adjustment identified by people with psychiatric disabilities is their perception of being stigmatized. This study examined the relationships between perceived stigma and community integration in 95 clients of assertive community treatment (ACT) teams, using sequential multiple regression procedures. Findings indicate that despite their physical presence in the community and the intensive support they receive, ACT clients believe other community members will reject them. Moreover, this perception appears to interfere with their sense of belonging, particularly among those who also perceive less social support and who have greater psychosocial skill deficits. In the context of the present study, global self-esteem did not mediate this relationship. In addition to community focused antistigma campaigns, stigma-related issues should also be addressed with ACT clients themselves.     

Social support and intellectual disabilities: a comparison between social networks of adults with intellectual disability and those with physical disability

Background   Social support has been identified as a major protective factor in preventing mental health problems and also as a major contributor to quality of life. People with intellectual disabilities (ID) have been identified as having limited social support structures. Interventions have been focused on promoting their social presence and integration. However, previous studies have shown that this does not always lead to the formation of social relationships. To date few studies have looked at how having an ID leads to impoverished social networks. This study aimed to do this by contrasting the social relationships of people with physical disabilities (PD) and people with ID.
Methods   Two groups of participants were recruited; 30 people with mild ID and 17 people with PD. Social and functional support networks were assessed, in addition to life experiences. Between and within group differences were then explored statistically.
Results   Adults with ID had more restricted social networks than PD, despite being involved in more activities. Social support for adults with ID was mainly provided by family and carers and few relationships with non-disabled people were identified. In contrast adults with PD had larger social networks than had been reported in the mainstream literature and had a balance of relationships with disabled and non-disabled people.
Conclusions   The results suggest that there are additional processes attached to having an ID, which lead to continued impoverished lifestyles. The findings also endorse other work that suggests being physically integrated and engaged in a wide range of activities does not guarantee good social and emotional support.     

Quality of life in caregivers of children and adolescents with intellectual disabilities: Use of WHOQOL-BREF survey

The present study based on World Health Organization quality of life (WHOQOL-BREF) scale to examine quality of life of the caregivers caring for their children/adolescents with intellectual disabilities in Taiwan, and the factors contributing to their quality of life. Structured interviews were conducted with 597 caregivers of children/adolescents with intellectual disabilities. The results found that the mean scores in each domain of WHOQOL-BREF of the caregivers as the followings: physical capacity (PC) was 13.71 ± 2.35, psychological well-being (PW) was 12.21 ± 2.55, social relationship (SR) was 12.99 ± 2.43 and environment (EN) was 12.32 ± 2.38. These mean scores were lower than the general population and slight higher than the caregivers of adults with intellectual disabilities in Taiwan. Finally, multiple stepwise regressions were conducted to examine the characteristics of caregiver and children/adolescents with intellectual disabilities will more likely explained the WHOQOL-BREF mean scores. The study found the following three factors: self-perceived health status, household income and stress from insufficient family support were significantly correlated to all four domains in multiple stepwise regression analyses. The results highlights that caregivers of children and adolescents with intellectual disabilities seem to display a lower WHOQOL-BREF mean score than the general population, probably for a combination of stress, health and household income factors. These finding must be taken into account in policy making to provide better and more specific supports and interventions for the caregivers of people with intellectual disabilities.     

Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities

Little information is available on the prevalence and determinants of lifestyle related risk factors for poor health (obesity, poor diet, physical inactivity, smoking and alcohol abuse) among people with intellectual disabilities. This study reports the prevalence of these risk factors for 500 people with intellectual disabilities living in different forms of residential provision in the UK. Variables which predict the presence of these risk factors are also identified. While levels of smoking and alcohol abuse were low, the prevalence of poor diet, obesity in women and physical inactivity was high. Analyses of predictors of risk factors present a mixed pattern with regard to participant and service characteristics, with greater ability and less restrictive residential settings being associated with poor diet, smoking and obesity, but physical inactivity being associated with lower ability and more restrictive settings. It is argued that increasing levels of moderate or vigorous physical activity among people with intellectual disabilities would be the single most effective way of improving the health of people with intellectual disabilities.     

Midlife and aging parents of adults with intellectual and developmental disabilities: impacts of lifelong parenting

Using population data, this study included parents of individuals with intellectual and developmental disabilities (n = 220) and parents of individuals without disabilities (n = 1,042). Parents of individuals with intellectual and developmental disabilities were further divided into those who co-resided with their adult child and those whose adult child lived elsewhere, and the 3 groups were compared regarding parental patterns of attainment, social participation, psychological functioning, and health in midlife and early old age. In midlife, parents of individuals with intellectual and developmental disabilities were similar in general to comparison parents. However, by early old age, these parents had poorer health and mental health. Co-residence between the adult with intellectual and developmental disabilities and the parent was prevalent during midlife (51.4%) and in the early years of old age (38.6%), and there were different patterns of parental outcomes, depending on the residential status of the adult with intellectual and developmental disabilities.     

Importance and satisfaction of preventive health strategies in institutions for people with intellectual disabilities: a perspective of institutional directors

AIM: To explore the perceptions of institutional directors on the preventive health strategies for people with intellectual disabilities in institutions. METHODS: A structured questionnaire was conducted by a cross-sectional postal survey in all registered institutions in Taiwan in 2002. A total of 157 questionnaires were mailed, of which 121 valid questionnaire were analyzed in this study. RESULTS: The respondents indicated important perception to the preventive health strategies across the 17 criteria, the mean score of importance in preventive health strategies was from 8.4 to 9.7 (score 1-10). But the analysis found that there were many gaps of 'importance' compared with 'satisfactory' to implementation of preventive health strategies, particularly in the issues of 'thyroid screening for intellectual disabilities (ID) with Down syndrome', 'prevention and treatment of osteoporosis', and 'diagnosis and treatment of mental disorders', these health issues need to be improved in institutions. The present study found that the size and ownership of institutions were not related to the perceptions of importance and satisfaction toward preventive health strategies. CONCLUSIONS: The institutions should explore the reasons of why the failure to carry through important health plans into practice to ensure quality of health services for people with ID who living in institutions.     

Extra-individual sources of social support as described by adults with mild intellectual disabilities

The extra-individual social support responses provided by adults with intellectual disabilities on a social support survey were examined. Felton and Berry (1992) argued that extra-individual social support, support from larger than individual entities, is a valid source of social support for older adults. We hypothesized that extra-individual support would also be relevant to adults with intellectual disabilities. Results showed that 43% of participants with intellectual disabilities listed extra-individual support sources in their social networks or as providers of one of several support functions. The most popular forms of extra-individual support were those from "staff" and "work." Findings are discussed in terms of implications for social support measurement for persons with intellectual disabilities.     

Adherence to eating and drinking guidelines for adults with intellectual disabilities and dysphagia

The extent to which 40 individuals with intellectual disabilities and dysphagia and their caregivers adhered to speech and language pathology dysphagia guidelines was evaluated. These individuals were observed having a meal across four settings. In addition to monitoring overall adherence, guidelines were split into separate sections corresponding to consistency modification of food and drinks, physical positioning, use of equipment and utensils, and support and prompting recommendations. Adherence to speech and language pathology recommendations was generally high, particularly regarding consistency modification that can help reduce the risks of aspiration and asphyxiation. Significant differences in adherence were found across settings, across type of guidelines, and between people who were fed by caregivers and those who fed themselves.     

What makes them feel like they do? Investigating the subjective well-being in people with severe and profound disabilities

BackgroundBecause of the problems measuring subjective well-being in people with severe and profound intellectual disabilities, there are no studies to date which explore the factors contributing to the subjective well-being in these groups. We wanted to explore the client and service characteristics contributing to the subjective well-being of persons with severe and profound intellectual disabilities, as measured by the MIPQ (Ross & Oliver, 2003).Materials and methodsThe MIPQ was completed for 360 persons with severe or profound intellectual disabilities by a member of the direct support staff. They also provided us with information on client, service and informant characteristics.ResultsWe found that the subjective well-being of persons with profound intellectual disabilities was lower than the subjective well-being of people with mild, moderate or severe intellectual disabilities or people without disabilities. Client and informant characteristics but no service characteristics were found to have an influence on the subjective well-being of people with severe and profound intellectual disabilities.ConclusionAs it is important for policy making to identify residence service and staff factors related to subjective well-being of persons with severe and profound intellectual disabilities, further research should try to identify these factors, taking in account the client characteristics that are found to be related to subjective well-being in this study.