An uncertain revolution: why the rise of a genetic model of mental illness has not increased tolerance

This study uses the 2006 replication of the 1996 General Social Survey Mental Health Module to explore trends in public beliefs about mental illness in the USA. Drawing on three models related to the framing of genetic arguments in popular media, the study attempts to address why tolerance of the mentally ill has not increased, despite the growing popularity of a biomedical view. The key to resolving this paradox lies in understanding how genetic arguments interact with other beliefs about mental illness, as well as the complex ideational implications of genetic frameworks. Genetic arguments have contingent relationships with tolerance. When applied to schizophrenia, genetic arguments are positively associated with fears regarding violence. Indeed, in this regard, attributing schizophrenia to genes is no different from attributing schizophrenia to bad character. However, when applied to depression, genetic arguments are positively associated with social acceptance. In addition to these contingencies, genetic explanations have discontinuous relationships with beliefs regarding treatment. Although genetic arguments are positively associated with recommending medical treatment, they are not associated with the perceived likelihood of improvement. The net result of these assorted relationships is little change in overall levels of tolerance over time. Because of the blunt nature of the forces propelling a biomedical view-including the growing popularity of psychiatric medications-altering beliefs about the etiology of mental illness is unlikely, on its own, to increase tolerance.     

Health work, female sex workers and HIV/AIDS: global and local dimensions of stigma and deviance as barriers to effective interventions

This paper addresses the near global attribution of stigma and deviance to female sex workers, and the salience of this attribution for health interventions in HIV/AIDS. A conceptual frame is developed as a guide to comparative sociological study in this area, and the importance of explanation at the level of social structure emphasized. After a general review of the empirical literature, more sustained attention is paid to specific aspects of female sex work in three contexts or figurations, the cities of London, Bangkok and Kolkarta. It is argued that norms of shame and blame and the labelling process with which they are bound up always arise within a structure nexus. We emphasis, in particular, the figuration-specific tensions between the global and the local, system and lifeworld and, the relationship between structure, agency and culture. The article concludes with a discussion of attempts to empower female sex workers and with a series of five orienting themes comprising a research programme for the future.     

The relationship of acceptance or denial of HIV-status to antiretroviral adherence among adult HIV patients in urban Botswana

Adherence to antiretroviral therapy among HIV patients is the most important patient-enabled factor related to virological failure and can lead to drug resistance. It is important to avoid virological failure, especially in resource-limited settings where treatment options are limited and the effects of treatment failure are profound. This qualitative study aimed to identify the psycho-social factors related to adherence behaviour in Gaborone, Botswana, a high prevalence setting in southern Africa. One-to-one, in-depth interviews were conducted with adult antiretroviral patients in the private and public health sectors who had been on antiretroviral therapy for a minimum of 6 months. A grounded theory approach was adopted and patients were selected purposively and theoretical sampling determined the final sample size. Thirty-two patients were interviewed, 22 from the public-sector, the mean age was 9.5 years and 53% were women. We found that acceptance of HIV-status, the ability to avoid internalising stigmatising attitudes and identification of an encouraging confidante were key factors related to good adherence. Encouraging confidantes (including clinicians) and contributed to promoting hope and acceptance of HIV-status, enabling patients to develop a positive therapeutic relationship with their antiretrovirals and make lifestyle changes that promoted adherence. Active participation in a social network and a desire to avoid being thin and visibly identifiable as HIV-positive were also adherence-motivating factors. Conversely, participants who expressed some degree of denial about their HIV-status tended to express emotions associated with depression, and internalised stigma that inhibited the development of a relationship with a confidante. We feel it is important to identify individuals with HIV who are still in some degree of denial about their status and to identify depression among patients on antiretrovirals. This will enable more targeted, individualised support in the management of individuals' HIV disease.     

Stigma starts early: Gender differences in teen willingness to use mental health services

PurposeTo explore gender differences and the role of stigma in teen willingness to use mental health services.MethodsSelf-administered, written questionnaires were conducted with 274 eighth graders in a suburban community in a mid-Atlantic state. Teens reported on social support for emotional concerns, mental health experience and knowledge, and stigma and barriers associated with mental health service use. Data analysis included chi-square statistics and analysis of variance (ANOVA) to examine associations between gender and independent variables of interest. Logistic regression analyses assessed the relationship of gender, stigma, and willingness to use mental health services, adjusting for race and receipt of mental health services.ResultsMore girls than boys turned to a friend for help for an emotional concern, whereas more boys turned to a family member first. Boys had less mental health knowledge and experience and higher mental health stigma than girls. In adjusted analyses, girls were twice as likely as boys to report willingness to use mental health services (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.20–4.99). Parental disapproval and perceived stigma helped to explain the relationship between gender and willingness to use mental health services (OR 1.65, 95% CI .72–3.77).ConclusionsGender differences in negative mental health attitudes and willingness to use mental health services are present early in adolescence. Enhanced mental health education and services in middle school may reduce gender disparities by incorporating stigma reduction efforts that actively involve parents and address differences in knowledge and exposure to mental health issues.     

Stress, appraisal, and coping: a comparison of HIV-infected women in the pre-HAART and HAART eras

BACKGROUND: It has been widely suggested that highly active antiretroviral therapy (HAART) has improved the psychosocial aspects of living with HIV/AIDS. METHOD: A sample of 79 women living with HIV/AIDS in the pre-HAART era (1994-1996) were compared with a matched sample of 79 women with HIV/AIDS from the HAART era (2000-2003) on measures of stress, illness appraisals, and coping strategies. RESULTS: Contrary to expectations, HIV-infected women in the HAART era were significantly more likely than women in the pre-HAART era to report health-related stress, to report stress from stigma and disclosure, to view HIV as having caused them harm, to report that their health is due to chance, and to report more use of maladaptive forms of coping (e.g., escape-avoidant coping). CONCLUSION: Although HAART may have extended survival for many HIV-infected individuals, they have not resulted in equivalent psychosocial improvements. Thus, efforts are needed to address the psychosocial difficulties that HIV-infected women in the HAART era continue to experience.     

Does stigma predict a belief in dealing with depression alone?

Background

Community surveys indicate that many people with depressive disorders do not obtain professional help and that a preference for self-reliance is an important factor in this treatment gap. The current study sought to investigate whether stigmatising attitudes predict a belief in the helpfulness of dealing with depression without external assistance.

Methods

Data were collected as part of a national household survey of 2000 Australian adults aged 18 years and above. Participants were presented with either a vignette depicting depression (n = 1001) or a vignette depicting depression with suicidal ideation (n = 999) and asked if it would be helpful or harmful to deal alone with the problem. Logistic regression analyses were conducted to determine if belief in dealing with depression alone was predicted by personal stigma, perceived stigma or sociodemographic characteristics.

Results

Higher levels of personal stigma independently predicted a belief in the helpfulness of dealing alone with both depression and depression with suicidal ideation. By contrast, lower levels of perceived stigma were associated with a belief in the helpfulness of dealing alone with depression without suicidal ideation.

Conclusions

Personal stigma is associated with a belief in the helpfulness of self-reliance in coping with depression. Public health programs should consider the possibility that a belief in self-reliance is partly attributable to stigma. The findings also point to the potential importance of providing evidence-based self-help programs for those who believe in self-care.     

叙事疗法对永久性肠造口患者病耻感影响的研究

目的 评价叙事疗法对永久性肠造口患者病耻感的影响。 方法 选取2018年4月—11月在某三级甲等医院胃肠外科、结直肠肛门外科行腹会阴联合直肠癌根治术的47例患者,通过一对一、面对面或视频通话的形式,对患者进行每周1次、每次30~45 min、共8次的叙事疗法;采用社会影响量表和造口适应量表评价干预前后的效果。 结果 出院前1 d、干预结束、干预结束后1个月,患者社会影响量表得分分别为（59.64±6.62）分、（53.87±8.78）分、（47.98±8.47）分,不同时间点病耻感差异有统计学意义（F=179.078,P<0.001）;造口适应量表得分分别为（40.49±7.13）分、（45.68±6.87）分、（46.70±7.11）分,不同时间点社会心理适应水平差异有统计学意义（校正后F=75.295,P<0.001）。 结论 叙事疗法有助于降低永久性肠造口患者的病耻感并提高其社会心理适应水平。     

HIV感染者和AIDS患者病耻感的研究进展

从HIV感染者和艾滋病患者病耻感的测评工具、影响因素以及干预措施3个方面进行综述,旨在通过理论依据的总结,以期促进病耻感临床相关干预措施的实施。     

Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia

BackgroundKrokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to have injected the drug in 2011. In this paper we review the existing information on the production and use of krokodil, within the context of the region's recent social history.MethodsWe searched PubMed, Google Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as regional experts and NGO representatives.FindingsKrokodil production emerged in an atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from codeine, the active ingredient is reportedly desomorphine, but – given the rudimentary ‘laboratory’ conditions – the solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the localized and systemic injuries reported here. Links between health care and law enforcement, stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help.ConclusionA comprehensive response to the emergence of krokodil and associated harms should focus both on the substance itself and its rudimentary production methods, as well as on its micro and macro risk environments – that of the on-going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend more on political will than on the practical implementation of interventions. The legal status of opioid substitution treatment in Russia is a point in case.