Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study

Purpose

This study contrasts the medicalized conceptualization of mental illness with psychologizing mental illness and examines what the consequences are of adhering to one model versus the other for help seeking and stigma.

Methods

The survey “Stigma in a Global Context–Belgian Mental Health Study” (2009) conducted face-to-face interviews among a representative sample of the general Belgian population using the vignette technique to depict schizophrenia (N = 381). Causal attributions, labeling processes, and the disease view are addressed. Help seeking refers to open-ended help-seeking suggestions (general practitioner, psychiatrist, psychologist, family, friends, and self-care options). Stigma refers to social exclusion after treatment. The data are analyzed by means of logistic and linear regression models in SPSS Statistics 19.

Results

People who adhere to the biopsychosocial (versus psychosocial) model are more likely to recommend general medical care and people who apply the disease view are more likely to recommend specialized medical care. Regarding informal help, those who prefer the biopsychosocial model are less likely to recommend consulting friends than those who adhere to the psychosocial model. Respondents who apply a medical compared to a non-medical label are less inclined to recommend self-care. As concerns treatment stigma, respondents who apply a medical instead of a non-medical label are more likely to socially exclude someone who has been in psychiatric treatment.

Conclusions

Medicalizing mental illness involves a package deal: biopsychosocial causal attributions and applying the disease view facilitate medical treatment recommendations, while labeling seems to trigger stigmatizing attitudes.     

Psychiatric diagnosis and other predictors of experienced and anticipated workplace discrimination and concealment of mental illness among mental health service users in England

Purpose

This study aims to examine whether psychiatric diagnosis is associated with likelihoods of experienced and anticipated workplace discrimination and the concealment of psychiatric diagnoses.

Methods

5924 mental health service users in England were interviewed as part of the Viewpoint survey between 2009 and 2014 using the Discrimination and Stigma Scale. Associations of psychiatric diagnosis with experienced and anticipated work-related discrimination or the concealment of mental illness were examined with the use of logistic regression models.

Results

25.6% of the participants reported experiencing discrimination in at least one work-related domain, contrasting with the 53.7% who anticipated workplace discrimination and the 72.9% who had concealed their mental illness. There was strong evidence that patients with schizophrenia and schizoaffective disorder had a decreased risk of experienced discrimination in keeping a job compared to those with depression, anxiety disorder, bipolar disorder or personality disorder. Furthermore, patients with depression were more likely to report anticipated discrimination in applying for education or training compared to those with schizophrenia and schizoaffective disorder. In addition, patients with depression were more likely to conceal their mental illness compared to those with schizophrenia and schizoaffective disorder and bipolar disorder.

Conclusion

This study suggests that psychiatric diagnosis is a predictor of experienced and anticipated workplace discrimination and the concealment of mental illness and that more support is needed for employees with common mental disorders and their employers to enable better workplace outcomes for this group.

     

Viewpoint survey of mental health service users’ experiences of discrimination in England 2008–2012

Purpose

Research suggests levels of discrimination among mental health service users in England are high, but fell over the course of the first phase of the Time to Change programme to reduce stigma and discrimination (2008–2011). The aim of this study was to determine changes in discrimination levels, both overall and by the area of life in which discrimination is experienced, since Time to Change began and over the first year of its second phase (2011–2012).

Method

Separate samples of mental health service users were interviewed annually from 2008 to 2012 using the Discrimination and Stigma Scale. In 2011 and 2012, social capital was also measured using the Resource Generator-UK.

Results

Sample percentages of participants reporting the experience of discrimination in one or more life areas for years 2008–2012 were 91.4, 86.5, 86.2, 87.9 and 91.0 %, respectively. A multivariable logistic regression model was performed to test for significant differences by study year, weighted to match the study population and adjusted for employment status and diagnosis as potential confounding factors. The odds of reporting discrimination in one or more life areas were significantly lower as compared to 2008 for all subsequent years except for 2012 (0.76, 95 % CI 0.49–1.19). However, a weighted multiple regression model provided evidence of decreased mean overall discrimination in 2012 as compared to 2008 (mean decrease ?7.57, 95 % CI ?11.1 to ?4.0, p < 0.001). The weighted mean number of social resources was 13.5 in 2012 as compared to 14.0 in 2011 (mean difference ?0.60, 95 % CI ?1.25 to 0.06).

Conclusions

While the overall level of discrimination across the life areas studied has fallen over 2008–2012, there is no evidence that more people using mental health services experience no discrimination. We suggest that the pattern suggesting a recent rise in discrimination following an earlier reduction may be linked to economic austerity. Further, the welfare benefits system has become an increasing source of discriminatory experience.     

Mental illness and lost income among adult South Africans

Purpose

Little is known regarding the links between mental disorder and lost income in low- and middle-income countries. The purpose of this study was to investigate the association between mental disorder and lost income in the first nationally representative psychiatric epidemiology survey in South Africa.

Methods

A probability sample of South African adults was administered the World Health Organization Composite International Diagnostic Interview schedule to assess the presence of mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, version IV.

Results

The presence of severe depression or anxiety disorders was associated with a significant reduction in earnings in the previous 12 months among both employed and unemployed South African adults (p = 0.0043). In simulations of costs to individuals, the mean estimated lost income associated with severe depression and anxiety disorders was $4,798 per adult per year, after adjustment for age, gender, substance abuse, education, marital status, and household size. Projections of total annual cost to South Africans living with these disorders in lost earnings, extrapolated from the sample, were $3.6 billion. These data indicate either that mental illness has a major economic impact, through the effect of disability and stigma on earnings, or that people in lower income groups are at increased risk of mental illness. The indirect costs of severe depression and anxiety disorders stand in stark contrast with the direct costs of treatment in South Africa, as illustrated by annual government spending on mental health services, amounting to an estimated $59 million for adults.

Conclusions

The findings of this study support the economic argument for investing in mental health care as a means of mitigating indirect costs of mental illness.     

The influence of state mental health perceptions and spending on an individual’s use of mental health services

Purpose

To explore the possible contextual effects of state-level mental health perceptions and public spending for mental health treatment on an individual’s use of mental health services, independent of the individual’s own perceptions.

Methods

Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used. A total of 216,514 participants from 35 states and the District of Columbia were included in the study. Logistic regression and multilevel modeling were used to estimate the effects of individual-level characteristics and three state-level factors—per capita spending on community mental health services, aggregated perceptions of the effectiveness of mental health treatment and the stigma of mental illness—on the individual’s current use of mental health services.

Results

Adjusting for the individual’s perceptions and characteristics, state-level perception of treatment effectiveness was positively associated with the use of mental health services [odds ratio (OR) for 5 % increase in the percentage perceiving effectiveness = 1.08; 95 % confidence interval (CI): 1.01, 1.16]. This association was strongest for individuals who experienced 1–4 days of mental distress in the past 30 days (OR = 1.17; 95 % CI 1.06, 1.29). State-level public spending on community mental health services was also positively associated with an individual’s use of mental health services (OR for a $40 increase in spending = 1.09; 95 % CI 1.01, 1.17); however, state-level perceptions of mental-illness stigma was not.

Conclusions

Our findings suggest there may be contextual effects of state-level perceptions of treatment effectiveness and state spending on community mental health services on the use of mental health services.     

Does labeling matter? An examination of attitudes and perceptions of labels for mental disorders

Purpose

Labeling research in various domains has found that attitudes and perceptions vary as a function of the different labels ascribed to a group (e.g., overweight vs. obese). This type of research, however, has not been examined extensively in regards to labels for mental disorders. The present study examined whether common psychiatric labels (i.e., mental disease, mental disorders, mental health problems, and mental illness) elicited divergent attitudes and perceptions in a group of participants. These labels were also compared to the specific label of depression.

Methods

Undergraduate psychology students (N = 124) were given identical questionnaire packages with the exception of the label used. That is, each participant received a set of questionnaires that referred to only one of the five labels. The questionnaire package contained various quantitative measures of attitudes and social distance, in addition to a short qualitative measure.

Results

Analyses demonstrated equivalence among the four general psychiatric labels on measures of attitudes, social distance, and general perceptions. However, results also suggested that the general labels diverged from the depression label, with the latter being generally more negatively perceived. Some analyses demonstrated that participants’ understanding of the terminology might be incorrect. The results of the investigation are discussed with a focus on its relationship with current research in stigma.

Conclusion

Within the current sample, general psychiatric labels did not appear to distinguish themselves from each other on measures of attitude and social distance but did so when compared to a relatively more specific term. Future research should examine the underlying mechanism driving this finding, with the ultimate goal of reducing the stigma faced by those with mental disorders.     

Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities

Background

Most cultures in sub-Saharan Africa subscribe to the belief that the root cause of psychosis is supernatural. Individuals in the community who hold a religiomagical explanatory model of causation have been shown to exhibit more stigmatizing attitudes towards people with psychosis. Self-stigma among individuals with psychosis is less frequently studied.

Method

We used a mixed-method approach, consisting of key informant’s interviews to elicit information on explanatory models of causation of psychosis and questionnaire assessment of internalized stigma with an adapted version of the Scale for Internalized Stigma of Mental Illness. Twenty-four, 31, and 30 subjects with recent experience of utilizing the service of traditional or faith healers for severe mental disorders in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya), respectively, were interviewed.

Results

About 44 % (42.1 %) of the Nigerian respondents had a high (severe) level of self-stigma with the respective proportions among Ghanaian and Kenyan respondents being 20.7 and 37.5 %. Compared with 4 out of a total of 12 respondents (33.3 %) who reported low self-stigma reported supernatural attribution, 14 out of 20 respondents (70 %) with the highest level of self-stigma reported supernatural attribution across the three sites. When low scorers ascribed supernatural causation, it was often with a religious focus.

Conclusion

There is a greater tendency for persons with high levels of self-stigma than those with low levels to ascribe supernatural attribution to their experience of a severe mental health condition.

     

The experience and impact of stigma in Saudi people with a mood disorder

Background

Stigma plays a powerful role in an individual’s attitude towards mental illness and in their seeking psychiatric and psychological services. Assessing stigma from the perspective of people with mood disorders is important as these disorders have been ranked as major causes of disability.

Objectives

To determine the extent and impact of stigma experiences in Saudi patients with depression and bipolar disorder, and to examine stigma experiences across cultures.

Method

Ninety-three individuals with a mood disorder were interviewed at King Saud University Medical City using the Inventory of Stigmatizing Experiences (ISE).

Results

We detected no significant differences in experiences of stigma or stigma impact in patients with bipolar vs. depressive disorder. However, over 50% of respondents reported trying to hide their mental illness from others to avoiding situations that might cause them to feel stigmatized. In comparison with a Canadian population, the Saudi participants in this study scored significantly lower on the ISE, which might be due to cultural differences.

Conclusion

More than half of the Saudi participants with a mood disorder reported avoiding situations that might be potentially stigmatizing. There are higher levels of stigma in Canada and Korea than in Saudi Arabia. Our results suggest that cultural differences and family involvement in patient care can significantly impact self-stigmatization. The ISE is a highly reliable instrument across cultures.

     

Food insufficiency is associated with psychiatric morbidity in a nationally representative study of mental illness among food insecure Canadians

Purpose

Studies suggest that people who are food insecure are more likely to experience mental illness. However, little is known about which aspects of food insecurity place individuals most at risk of mental illness. The purpose of this study was to establish the prevalence of mental illness among food insecure Canadians, and examine whether mental illness differs between those who are consuming insufficient amounts of food versus poor quality foods.

Methods

This analysis utilized the publically available dataset from the Canadian Community Health Survey cycle 4.1. Bivariable and multivariable logistic regression were used to examine the associations between food insecurity and mental health disorder diagnosis, while adjusting for potential confounders. Stratified analyses were used to identify vulnerable sub-groups.

Results

Among 5,588 Canadian adults (18–64 years) reporting food insecurity, 58 % reported poor food quality and 42 % reported food insufficiency. The prevalence of mental health diagnosis was 24 % among participants with poor food quality, and 35 % among individuals who were food insufficient (hunger). After adjusting for confounders, adults experiencing food insufficiency had 1.69 adjusted-odds [95 % confidence interval (CI): 1.49–1.91] of having a mental health diagnosis. Stratified analyses revealed increased odds among women (a-OR 1.89, 95 % CI 1.62–2.20), single parent households (a-OR 2.05, 95 % CI 1.51–2.78), and non-immigrants (a-OR 1.88, 95 % CI 1.64–2.16).

Conclusion

The prevalence of mental illness is alarmingly high in this population-based sample of food insecure Canadians. These findings suggest that government and community-based programming aimed at strengthening food security should integrate supports for mental illness in this population.     

Desire for information of people with severe mental illness

Purpose

To assess (1) the desire of people with severe mental illness for information on their treatment and (2) whether the desire for information is associated with socio-demographic variables, diagnosis, illness duration, therapeutic relationship, needs and symptom severity.

Methods

588 outpatients with severe mental illness were recruited in six European countries (Germany, Denmark, Hungary, Italy, Switzerland, United Kingdom) during the “Clinical decision making and outcome in routine care of people with severe mental illness (CEDAR)” study (ISRCTN75841675). Desire for information was assessed by the Information subscale of the Clinical Decision Making Style Scale. Study participants with high desire for information were compared with those with moderate or low desire for information.

Results

80 % of study participants (n = 462) wanted to receive information on all aspects of their treatment (management, prognosis, alternative options for care). Participants with a high desire for information had less severe symptoms (OR = 0.988, CI = 0.977–1.000) and a better self-rated therapeutic alliance (OR = 1.304, CI = 1.130–1.508) with their clinician.

Conclusions

Most, but not all, people with severe mental illness have a high desire for information. Desire for information is associated with variables, such as therapeutic relationship and symptom severity, which are amenable to change during treatment.     

Effects of contact-based mental illness stigma reduction programs: age,gender, and Asian,Latino, and White American differences

Purpose

Mental illness stigma disproportionately affects help seeking among youth, men, and ethnic minorities. As part of a comprehensive statewide initiative to reduce mental illness stigma and discrimination in California, a broad set of contact-based educational programs were widely disseminated. This study examined whether the effects of contact-based educational programs varied depending on the age, gender, and race-ethnicity of participants.

Methods

Participants (N?=?4122) attended a contact-based educational program that was delivered as part of the statewide initiative to reduce mental illness stigma and discrimination. Self-administered surveys assessing beliefs, attitudes, and intentions toward mental illnesses and treatment were conducted immediately before and after participation in contact-based educational programs.

Results

Participant age, gender, and race-ethnicity significantly moderated pre–post changes in mental illness stigma. Although all groups exhibited significant pre–post changes across most of the stigma domains assessed, young adults, females, and Asian and Latino American participants reported larger improvements compared to older adults, males, and Whites, respectively.

Conclusions

Findings suggest that contact-based educational programs can achieve immediate reductions in mental illness stigma across a variety of sociodemographic groups and may particularly benefit young adults and racial–ethnic minorities. Further research is needed to assess whether contact-based educational programs can sustain longer-term changes and aid in the reduction of disparities in mental illness stigma and treatment.

     

Community attitudes and social distance towards the mentally ill in South Sudan: a survey from a post-conflict setting with no mental health services

Purpose

This study investigates attitudes and social distance towards the mentally ill in a post-conflict, low-income country.

Methods

A cross-sectional community survey (n = 1,200) was conducted in South Sudan. Associations between various sociodemographic variables and attitudes toward/social distance from the mentally ill were investigated.

Results

The regression analysis showed that lower levels of education were positively associated with social distance, and Christian or Muslim beliefs, compared with traditional beliefs, were negatively associated with social distance. Familiarity with mental illness or psychological distress was not significantly associated with social distance. Participants who endorsed community-oriented attitudes (rather than hospital/drug-oriented attitudes) about health care for the mentally ill were more likely show a decreased social distance. Participants who believed that the mentally ill were dangerous had higher scores on the social distance scale.

Conclusions

A high level of stigma towards the mentally ill exists in South Sudan, especially in the rural areas. Alongside efforts to build up mental health services in South Sudan, the existing stigma needs to be addressed. Information regarding the role of the community both in preventing mental illnesses and in service delivery should be prioritised.     

Has the public taken notice of psychiatric reform? The image of psychiatric hospitals in Germany 1990–2011

Purpose

In the context of mental health care reform in Germany, psychiatric hospitals have been transformed in terms of their infrastructure, staffing levels and therapeutic culture. The question arises as to what extent these improvements had an impact on the public image of these institutions.

Methods

In 1990 and 2011, population surveys were conducted in the “old” states of Germany, using the same sampling procedure, interview mode and measures.

Results

Over the last two decades, attitudes toward psychiatric hospitals have improved considerably. This improvement was particularly pronounced among those who had been in treatment for mental health problems. The public is now more inclined to regard psychiatric hospitals as similar to other hospitals, more ready to expect effective treatment in psychiatric hospitals, and less inclined to support the stereotype that psychiatric hospitals are primarily places where patients are locked away. However, there was a stronger tendency to agree with the notion that psychiatric hospitals are necessary to protect society from persons with mental illness.

Conclusions

The improvement of psychiatric care seems to pay off as regards the image of psychiatric hospitals among the general public. Further efforts are necessary to reduce the stigma attached to mentally ill people.     

A factor analytic investigation of the Tripartite model of affect in a clinical sample of young Australians

Background

To investigate and compare the predictors of personal and perceived stigma associated with depression.

Method

Three samples were surveyed to investigate the predictors: a national sample of 1,001 Australian adults; a local community sample of 5,572 residents of the Australian Capital Territory and Queanbeyan aged 18 to 50 years; and a psychologically distressed subset (n = 487) of the latter sample. Personal and Perceived Stigma were measured using the two subscales of the Depression Stigma Scale. Potential predictors included demographic variables (age, gender, education, country of birth, remoteness of residence), psychological distress, awareness of Australia's national depression initiative beyondblue, depression literacy and level of exposure to depression. Not all predictors were used for all samples.

Results

Personal stigma was consistently higher among men, those with less education and those born overseas. It was also associated with greater current psychological distress, lower prior contact with depression, not having heard of a national awareness raising initiative, and lower depression literacy. These findings differed from those for perceived stigma except for psychological distress which was associated with both higher personal and higher perceived stigma. Remoteness of residence was not associated with either type of stigma.

Conclusion

The findings highlight the importance of treating the concepts of personal and perceived stigma separately in designing measures of stigma, in interpreting the pattern of findings in studies of the predictors of stigma, and in designing, interpreting the impact of and disseminating interventions for stigma.     

A prediction model for the incidence of civil detention for crisis patients with psychiatric illnesses; the Amsterdam study of acute psychiatry VII

Objective

Given raised numbers of civil detentions in the Netherlands and other European countries, it is important to assess the patient risk profile with respect to the incidence of those far-reaching treatment decisions. The aim of the ASAP study is to develop a comprehensive prediction model that considers all possible patient-related predictors known from earlier research.

Methods

We took a random sample of 252 from the 2,682 patients coming into contact with two psychiatric emergency teams in Amsterdam between September 2004 and September 2006. We recorded socio-demographic and clinical characteristics, aspects of social support and psychiatric history. We interviewed the patients using the Verona Service Satisfaction Scale (Verona-EU) and the Birchwood Insight Scale. During a two-year follow-up period we noted their use of mental health care facilities.

Results

Stepwise logistic regression analyses with resulted in a final prediction model (P ≤ 0.001) including preceding involuntary admission (OR 9.4, 95 % CI 3.6–24.7, P ≤ 0.001), domestic situation alone (OR 4.5, 95 % CI 1.9–11.0, P = 0.001) and VSSS score satisfactory (OR 0.2, 95 % CI 0.0–0.8, P = 0.030) as predictors of civil detention during 2 years of follow-up.

Conclusion

With the presented prediction model it will be possible to identify patients at a high risk of civil detention: patients with a history of previous involuntary admissions who live alone and are not satisfied with the mental health care they got before. This suggests the possibility that timely preventive measures can be taken comprising the adjustment or intensification of the treatment plan for this specific group of patients.     

Severity of club drug dependence and perceived need for treatment among a sample of adult club drug users in Shanghai,China

Purpose

Examine the severity of club drug dependence and perceived need for treatment, and further identify their determinants among a sample of club drug users in Shanghai, China.

Methods

Two hundred and seventy-six club drug users were recruited using respondent-driven sampling (RDS). Severity of dependence on club drugs was measured using the Severity of Dependence Scale (SDS).

Results

69.9 % reported dependence on club drugs (i.e., SDS ≥ 4) and 36.6 % reported severe dependence (i.e., SDS ≥ 6). One-eighth (12.7 %) perceived need for drug treatment. Severe dependence on club drugs was more likely among those who reported recent use of ecstasy and those who had more depressive symptoms, but less likely among those reporting recent use of methamphetamine. Perceived need for treatment was more likely among those who lived with a spouse or boy/girlfriend, but less likely among those had prior drug treatment experience and more severe club drug dependence.

Conclusions

Our findings suggest that educational activities should be implemented to raise public awareness about the powerful addictive properties of club drugs, along with efforts to reduce stigma towards drug abuse and psychiatric disorders. Programs to motivate drug users to seek treatment and encourage treatment linkage are urgently needed.     

Relationships between stereotyped beliefs about mental illness, discrimination experiences, and distressed mood over 1 year among persons with schizophrenia enrolled in rehabilitation

Purpose

Research suggests stereotype endorsement or self-stigma serves as a barrier to functioning and well-being among persons with schizophrenia. Little is known about how stable self-stigma is and whether it is linked over time with related constructs such as discrimination experiences and psychological distress.

Methods

Stereotype endorsement and discrimination experiences were assessed using the Internalized Stigma of Mental Illness Scale and psychological distress was assessed using the Emotional Discomfort component of the Positive and Negative Syndrome Scale, at three points in time across 1 year.

Results

Path analyses indicated that the constructs of stereotype endorsement and discrimination experiences are stable over periods of 5–7?months and may fluctuate over 12?months. Further, the constructs of stereotype endorsement and discrimination experiences were related to one another concurrently, but analyses failed to detect a relationship over time. Neither construct was related to psychological distress over time.

Conclusions

Self-stigma is a stable construct in the short term, and is distinct from related constructs such as discrimination experiences and psychological distress.     

Gender effect on public stigma changes towards psychosis in the Hong Kong Chinese population: a comparison between population surveys of 2009 and 2014

Purpose

Public stigma is an important barrier to the recovery of patients with psychosis. The current study aimed to investigate the change in stigma towards psychosis and knowledge about psychosis between 2009 and 2014 among the Chinese population in Hong Kong, with a specific focus on gender role.

Methods

Random telephone survey of general population in Hong Kong was conducted in 2009 and 2014. Stigma was measured with the revised Link’s Perceived Discrimination-Devaluation Scale (LPDDS). Logistic regression was used to explore the effect of time on the change of knowledge of psychosis, and linear regression was used to explore the effect of time on the change of stigma. Change of knowledge and stigma based on gender was specifically explored.

Results

In total, 1016 and 1018 subjects completed the survey in 2009 and 2014, respectively. Significantly, more people agreed with medication treatment for psychosis and fewer people had misunderstanding about psychosis. However, there was no significant change in stigma levels. Males were found to have a significant deterioration of stigma (B = 0.099, SE = 0.033, β = 0.100, p = 0.003) but not females. Significantly, more males endorsed medication treatment for psychosis (χ ² = 5.850, df = 1, p = 0.016) but no change for females (χ ² = 1.401, df = 1, p = 0.238).

Conclusions

Results of this study suggested that there was an improvement in the biological understanding of psychosis but no change of public stigma within the Hong Kong Chinese population. The specific role of gender in relation to stigma and level of knowledge about psychosis indicates that this should be a consideration in designing future anti-stigma campaigns.

     

The effect of training interventions of stigma associated with mental illness on family caregivers: a quasi-experimental study

Background

Stigma is one of the most destructive features of mental illnesses that may affect the family caregivers. This study aimed to analyze the effect of training interventions of stigma on family caregivers of the mental illness patients.

Materials and methods

This quasi-experimental pre- and post-test study was performed on a single group of 43 family caregivers of mental illness patients in Hamadan Psychiatric Hospital, Iran, in 2015. The samples were taken through convenience sampling method and the data collection tool was a stigma questionnaire made by the researchers. The questionnaires were filled by the participants within pre-intervention and 1-month post-intervention. All the data were analyzed by SPSS version 16, and the mean and standard deviation by paired t test and Wilcoxon test.

Results

Findings of this study demonstrated that women included 60% of the family caregivers. The average age of caregivers and the duration of caregiving were 41.67?±?11.62 years and 66.28?±?7.99 months, respectively. The mean and standard deviation for pre-intervention stigma score were 82.47?±?12.23 indicating that the family caregivers suffered from some problems arisen from living with mental patients. They include not getting married, unable to find a job, embarrassment, humiliation by others, disgrace, and shame. Our results revealed that the mean and standard deviation of stigma score decreased to 29.28?±?7.52 after training, and this difference was statistically significant (P?<?0.001).

Conclusions

According to the results of present study, training interventions reduce the issues caused by stigma and help the family members of mental patients to face and cope with the problem.

     

How Does Direct to Consumer Advertising Affect the Stigma of Mental Illness?

Stigma interferes with life goals of people with mental illness. Direct-to-consumer advertising (DTCA) may impact stigmatizing attitudes. The purpose of this study is to examine the effects of psychiatric medication DTCA on the stigmatizing and affirming attitudes of the general population versus individuals self-identified with mental illness. Participants (n = 272) were randomly assigned to watch a DTCA about Cymbalta, an antidepressant, embedded in two other advertisements for non-pharmaceutical products. Participants completed measures of stigmatizing and affirming attitudes before and after viewing this DTCA. Results indicate that the Cymbalta DTCA worsened the attitudes of the general public. These participants were less likely to offer help, endorse recovery, and agree with self-determination attitudes towards people with mental illness following viewing the DTCA. The self-identified group reported less blame, less dangerousness, less social avoidance, more pity, and greater willingness to help after viewing the DTCA. Moreover, there was significant improvement in their endorsement of recovery. Results suggest that DTCAs about psychiatric medication may increase the public’s stigma towards people with mental illness but reduce stigma among individuals who identify as having a mental illness. Findings are somewhat limited by selection biases and self-report. Implications for further development of DTCAs are considered.