Evaluation of a campaign to improve awareness and attitudes of young people towards mental health issues

Purpose

This study evaluated the effectiveness of the In One Voice campaign for raising mental health awareness and improving attitudes of youth and young adults towards mental health issues. The campaign featured a prominent male sports figure talking about mental health issues and used online social media.

Methods

A successive independent samples design assessed market penetration and attitudinal changes among the young people. Two samples completed an online questionnaire either immediately before (T1: n = 403) or 2 months after (T2: n = 403) the campaign launch. Website analytics determined changes in activity levels of a youth-focused mental health website (mindcheck.ca).

Results

One-quarter (24.8 %, n = 100) of the respondents remembered the campaign. The proportion of respondents who were aware of the website increased significantly from 6.0 % at T1 to 15.6 % at T2. Average overall scores on standardized measures of personal stigma and social distance were not significantly different between T1 and T2 respondents. Attitudes towards mental health issues were statistically similar between respondents who were or were not exposed to the campaign. Those who were exposed to the campaign were significantly more likely to talk about and seek information relating to mental health issues.

Conclusions

The proximal outcomes of the campaign to increase awareness and use of the website were achieved. The distal outcome of the campaign to improve attitudes towards mental health issues was not successfully achieved. The brief social media campaign improved mental health literacy outcomes, but had limited effect on personal stigma and social distance.     

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.     

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.     

Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies

Purpose

The aim of this review is to identify consistent themes among the qualitative literature on stigma as experienced by patients with schizophrenia receiving community mental health care. With the treatment focus of schizophrenia nowadays shifting more and more towards community-based mental health care, professionals need to be aware of the increased vulnerability of their clients in their social environment as a result of stigma towards their disease. In-depth knowledge on stigma is critical in order to offer a dignifying community mental health care.

Methods

A systematic search of the qualitative literature in Web of Science, PubMed, PsycINFO and Francis was performed to review the subjective experiences and ideas on stigma in outpatients with schizophrenia.

Results

Three major themes were identified in 18 studies and need to be taken into consideration when implementing an adequate community mental health care: (i) the continuing existence of stigma inherent in the health care setting, (ii) the importance of relational aspects of stigma encounters in daily life and (iii) the significance of the behavioural aspects related to previous stigma experiences and beliefs among patients.

Conclusions

Despite much effort in community treatment, patients still experience stigma and discrimination. Community mental health care professionals should not only be aware of structural problems in mental health care, but should also pay considerable attention towards the relational and behavioural aspects in their clients’ life concerning stigma. Furthermore, they have the crucial role in the community to raise awareness about stigma in order to increase their clients’ acceptance in society.     

Challenges of caring for children with mental disorders: Experiences and views of caregivers attending the outpatient clinic at Muhimbili National Hospital, Dar es Salaam - Tanzania

Background

It is estimated that world-wide up to 20?% of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them.

Methodology

A qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis.

Results

The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with various income generating activities in the family, and extra expenses associated with the child??s illness.

Conclusion

Caregivers of mentally ill children experience various psychological and emotional, social, and economic challenges. Professional assistance, public awareness of mental illnesses in children, social support by the government, private sector, and non-governmental organizations (NGOs) are important in addressing these challenges.     

Another time point,a different story: one year effects of a social media intervention on the attitudes of young people towards mental health issues

Purpose

This study extends an evaluation of a brief, social media intervention, called In One Voice, for raising mental health awareness and improving attitudes of youth and young adults towards mental health issues.

Methods

A successive independent samples design assessed market penetration and attitudinal changes among the young people who completed an online questionnaire 1 year after (T3: n = 438) the intervention. This is compared with two samples that completed a survey either immediately before (T1: n = 403) or 2 months after (T2: n = 403) the campaign launch.

Results

The proportion of respondents who remembered the campaign grew from 24.8 % at T2 to 48.6 % at T3. Elevated website activity on mindcheck.ca was sustained 1 year after In One Voice had ended. Small but significant reductions in personal stigma and social distance were detected from T1 and T3, which were not observed at T2. Respondents’ self-rated ability to help others with mental health issues and to engage in positive behaviors relating to mental health issues (e.g., seeking information) did not improve significantly from T1 to T3.

Conclusions

Improved attitudes towards mental health issues were observed among young people 1 year following a brief social media campaign. The campaign was less effective at providing the tools young people need to feel capable of helping someone who may be experiencing mental health issues, and motivating them to engage in constructive behaviors related to mental health.     

Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: implications for reducing mental illness stigma in urban China

Purpose

As mental illness stigma contributes to poor outcomes for schizophrenia in China, locating strategies to reduce public stigma is imperative. It is currently unknown whether diagnostic labeling and contact with different help-seeking sources increase or decrease public stigma in China. Further, it remains unresolved whether prior personal contact acts to reduce stigma in this context. Advancing understanding of these processes may facilitate stigma-reduction strategies.

Methods

We administered an experimental vignette randomly assigning one of four labeling conditions to respondents to assess social distance towards a psychotic vignette individual in a sample of 160 Northern, urban Chinese community respondents.

Results

As expected, respondents given a “non-psychiatric, indigenous label”?+?“lay help-seeking” condition endorsed the least social distance. Unexpectedly, the labeling condition with a “psychiatric diagnostic label”?+?“lay help-seeking” condition elicited the greatest social distance. Unlike Western studies, personal contact did not independently decrease community stigma. However, prior contact reduced social distance to a greater extent in the labeling condition with a “non-psychiatric, indigenous label”?+?“lay help-seeking” condition when compared with all other labeling conditions.

Conclusion

The results indicate that cultural idioms do provide some protection from stigma, but only among respondents who are already familiar with what mental illness is. Our finding that the condition that depicted untreated psychosis elicited the greatest amount of stigma, while the “treated psychosis” condition was viewed relatively benignly in China, suggests that improved access to mental health services in urban China has the potential to decrease public stigma via labeling mechanisms.     

Biogenetic explanations and public acceptance of people with eating disorders

Purpose

It has been assumed that biogenetic causal models may improve public attitudes toward people with mental illnesses. The present study examines whether biogenetic attributions are positively associated with acceptance of people suffering from these disorders.

Methods

Population surveys were conducted in two large German cities. Respondents were presented with a vignette depicting a young female suffering from either anorexia nervosa (N = 680) or bulimia nervosa (N = 667), followed by a fully structured interview including questions on causal attributions, emotional reactions and desire for social distance.

Results

Attribution to hereditary factors showed hardly any relationship with attitudes toward people with symptoms of eating disorders. Respondents who endorsed brain disease as a cause tended more to hold those afflicted responsible for their condition, they also expressed more negative emotions and a stronger preference for social distance.

Conclusions

Our results do not support the notion that promulgating biogenetic causal models of eating disorders helps decrease the stigma surrounding these illnesses; it may even entail the risk of increasing it.     

Evaluating the impact of direct and indirect contact on the mental health stigma of pharmacy students

Purpose

Contact with mental health consumers has shown to be a promising strategy to address mental health stigma, particularly in the context of pharmacy education. This research aimed to compare the effectiveness of a direct (face-to-face) contact intervention with an indirect (film based) contact intervention in reducing the mental health stigma of pharmacy students.

Method

A two-group, non-randomized, comparative study was conducted with third year pharmacy students (n?=?198) allocated to the direct contact arm and fourth year pharmacy students (n?=?278) allocated to the indirect contact arm. Baseline and immediate post-intervention data were collected using a validated 39 item survey instrument to assess the impact of the interventions on mental health stigma as well as attitudes towards providing mental health pharmaceutical services.

Results

Participants in the direct contact group showed a significant improvement in 37 out of 39 survey items and participants in the indirect contact group showed a significant improvement in 27 out of 39 items (P?<?0.05). While direct contact had a stronger impact than indirect contact for 22 items (P?<?0.05), for numerous key measures of mental health stigma the impact of the two contact interventions was equivalent.

Conclusion

Both indirect and direct contact may positively impact mental health stigma. While the strength of the stigma-change process may be heightened by face-to-face interactions, the largely positive impact of indirect contact suggests that stigma reduction may depend less on the medium of contact but more on the transcendent messages contributed by the consumers facilitating the contact experience.     

Perceived stigma among non-professional caregivers of people with severe mental illness,Bahir Dar,northwest Ethiopia

Background

The stigmatization of mental illness is currently considered to be one of the most important issues facing caregivers of severely mentally ill individuals. There is a dearth of information about the prevalence and associated factors of perceived stigma among caregivers of people with severe mental illness in the study area.

Objective

To assess the prevalence and associated factors of perceived stigma among non-professional caregivers of people with severe mental illness, Bahir Dar, northwest Ethiopia.

Method

Institutional based cross-sectional study was conducted from May to June, 2016 at Felege Hiwot Referral Hospital among 495 caregivers of people with the severe mental illness. Pre-tested structured family interview schedule questionnaire was used. Binary logistic regression was applied to identify factors associated with perceived stigma and interpreted using odds ratio with 95% confidence interval. Statistical significance was considered at p value?<?0.05.

Result

The overall prevalence of perceived stigma was found to be 89.3%. Being female, rural residency, lack of social support, long duration of relationship with the patient and currently not married were found significantly associated with the perceived stigma of caregivers.

Conclusion

Prevalence of perceived stigma is very high in the current study. Thus, stigma reduction program and expanding of strong social support should better be implemented by different stakeholders for caregivers of people with severe mental illness.

     

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.

     

Posttraumatic stress disorder,trauma, and reconciliation in South Sudan

Purpose

South Sudan is embroiled in a conflict that erupted in December 2013. This study examines what people in South Sudan think is necessary to achieve reconciliation and how trauma exposure and PTSD are associated with those beliefs.

Methods

1525 participants (51.0% female) were selected using random and purposive sampling in six states and Abyei. Participants reported on traumatic events, PTSD symptoms, and attitudes towards reconciliation mechanisms.

Results

Results indicated that 40.7% met symptom criteria for probable PTSD. Most participants thought reconciliation was not possible without prosecuting perpetrators or compensating victims and did not support amnesty. Participants with probable PTSD were more likely to endorse confessions (OR 2.42 [1.75, 3.35]), apologies (OR 2.04 [1.46, 2.83]), and amnesty (OR 1.58 [1.21, 2.08]), and to report that compensation (OR 2.32 [1.80, 3.00]) and prosecution (OR 1.47 [1.15, 1.89]) were not necessary for reconciliation. The more traumatic events people experienced, the more they endorsed criminal punishment for perpetrators (OR 1.07 [1.04, 1.10]) and the less they endorsed confessions (OR 0.97 [0.95, 0.99]).

Conclusions

People with PTSD may prioritize ending violence via opportunities for reconciliation, while those with more trauma exposure may support more punitive mechanisms. Policy makers should take mental health treatment and trauma into account when designing conflict mitigation, peace building, and justice mechanisms.

     

Internalized Stigma, Social Distance, and Disclosure of HIV Seropositivity in Rural Uganda

Background

HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings.

Purpose

We sought to study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance.

Methods

We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda.

Results

Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners.

Conclusions

Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties.     

What do people in forensic secure and community settings think of their personality disorder diagnosis? A qualitative study

Purpose

The aim of this study was to explore the experience of having a personality disorder diagnosis within the context of forensic secure and community services.

Methods

We used an interpretative phenomenological analysis to analyse interviews with 10 service users purposively recruited from services in South London.

Results

Participants described two facets of their lived experience: (1) the way they see themselves now, in light of their offending and social background and (2) the pejorative nature of the personality disorder label, its relationship to mental illness and their need to distance themselves from it.

Conclusions

Having a forensic identity affects participants’ perceptions of their diagnosis and its treatment as well as their views about themselves.     

Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions

Purpose

Accessibility and availability of mental health care services are necessary but not sufficient for people to seek help for psychological problems. Attitudes and stigma related to help seeking also determine help seeking intentions. The aim of this study is to investigate how cross-national differences in attitudes and stigma within the general population are related to professional and informal help seeking intentions in low and high suicide rate regions.

Methods

By means of a postal structured questionnaire, data of 2999 Dutch and Flemish respondents between 18 and 65 years were gathered. Attitudes toward help seeking, perceived stigma, self-stigma, shame and intention to seek help were assessed.

Results

People in the Netherlands, where suicide rates are low, have more positive attitudes toward help seeking and experience less self stigma and shame compared to the people in Flanders, where suicide rates are relatively high. These attitudinal factors predicted professional as well as informal help seeking intentions. Perceived stigma was negatively associated with informal help seeking. Shame was positively associated with higher intention to use psychotropic drugs and perceived stigma was negatively associated with the intention to seek help from a psychotherapist in Flanders but not in the Netherlands.

Conclusion

Help seeking for psychological problems prevent these problems to aggravate and it is assumed to be a protective factor for suicide. Our results stress the importance of the promotion of positive attitudes and the reduction of stigma within the general population to facilitate help seeking from professional providers and informal networks. Focusing on these attitudinal factors is believed to be a key aspect of universal mental health and suicide prevention policies.     

The Dynamic Relationship Between Social Support and HIV-Related Stigma in Rural Uganda

Background

Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support.

Purpose

The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma.

Methods

We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma.

Results

Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations.

Conclusions

Interventions to reduce enacted stigma may strengthen social support for people living with HIV. Improved social support may in turn have a protective influence against future enacted and internalized stigma.     

AIDS-Related Stigma, HIV Testing, and Transmission Risk Among Patrons of Informal Drinking Places in Cape Town, South Africa

Background

AIDS-related stigma as a barrier to HIV testing has not been examined within the context of high at risk environments such as drinking venues. Of particular importance is whether AIDS-related stigma is associated with HIV transmission risks among people who have never been tested for HIV.

Purpose

We examined: (1) AIDS-related stigma as a barrier to testing, controlling for other potential barriers, and (2) whether stigma is associated with HIV risks among HIV-untested individuals.

Methods

We surveyed 2,572 individuals attending informal drinking establishments in Cape Town, South Africa to assess HIV testing status, AIDS-related stigma endorsement, and HIV transmission sexual risk behavior.

Results

Endorsement of AIDS-related stigma was negatively associated with HIV lifetime testing. In addition, stigma endorsement was associated with higher HIV transmission risks.

Conclusion

AIDS-related stigma must be addressed in HIV prevention campaigns across South Africa. Antistigma messages should be integrated with risk reduction counseling and testing.     

Structural Stigma and Hypothalamic–Pituitary–Adrenocortical Axis Reactivity in Lesbian,Gay, and Bisexual Young Adults

Background

Youth exposed to extreme adverse life conditions have blunted cortisol responses to stress.

Purpose

This study aims to examine whether growing up in highly stigmatizing environments similarly shapes stigmatized individuals’ physiological responses to identity-related stress.

Methods

We recruited 74 lesbian, gay, and bisexual young adults (mean age?=?23.68) from 24 states with varying levels of structural stigma surrounding homosexuality. State-level structural stigma was coded based on several dimensions, including policies that exclude sexual minorities from social institutions (e.g., same-sex marriage). Participants were exposed to a laboratory stressor, the Trier Social Stress Test (TSST), and neuroendocrine measures were collected.

Results

Lesbian, gay, and bisexual young adults who were raised in highly stigmatizing environments as adolescents evidenced a blunted cortisol response following the TSST compared to those from low-stigma environments.

Conclusions

The stress of growing up in environments that target gays and lesbians for social exclusion may exert biological effects that are similar to traumatic life experiences.     

Understanding reduced activity in psychosis: the roles of stigma and illness appraisals

Purpose

Increasing activity and social inclusion for people with psychosis is a primary goal of mental health services. Understanding the psychological mechanisms underlying reduced activity will inform more carefully targeted and effective interventions. Anxiety, depression, positive symptom distress and negative symptoms all make a contribution, but much of the variance in activity remains unaccounted for and is poorly understood. Appraisals of illness impact on adjustment to illness: mood, engagement in treatment and quality of life are all affected. It is plausible that illness appraisals will also influence activity. This study investigated the extent to which three components of illness appraisal accounted for variance in activity.

Method

50 people with psychosis completed measures of activity, positive and negative symptoms, anxiety and depression, cognitive functioning, stigma, insight and illness perceptions.

Results

Multiple regression revealed that internalised stigma, but not insight or illness perception, was significantly correlated with reduced activity. 42% of the variance in activity was accounted for by stigma, negative symptoms, positive symptom distress and social support. Affect, cognitive functioning and positive symptoms were not associated with activity.

Conclusion

For people with psychosis, activity levels appear to be compromised particularly by fears of what others think of them and how they will be treated by others. Directly targeting these fears should improve the impact of psychological interventions on functioning. Specific, individualised cognitive behavioural interventions could be a useful adjunct to recovery-focused narrative therapies and complement public information campaigns to reduce discriminatory attitudes and behaviours.     

Explicit and Implicit Attitudes of Canadian Psychiatrists Toward People With Mental Illness

Objective:

People with mental illness suffer stigma and discrimination across various contexts, including the health care setting, and clinicians’ attitudes play an important role in perpetuating stigma. Effective stigma-reduction interventions for physicians require a better understanding of explicit (that is, conscious and controllable) and implicit (that is, subconscious and automatic) forms of bias, and of predictors and moderators of stigma.

Methods:

Members of a Canadian university psychiatry department and of the Canadian Psychiatric Association (CPA) were invited to participate in a web-based study consisting of 2 measures of explicit attitudes, the Social Distance Scale (SDS) and the Opening Minds Scale for Health Care Providers (OMS-HC), and 1 measure of implicit attitudes, the Implicit Association Test (IAT).

Results:

Thirty-five psychiatry residents and 68 psychiatrists completed the study (response rates of 12.1% for the university sample and 3.3% for the CPA sample). Participants desired greater social distance from the vignette patient with schizophrenia. Mean IAT scores, although negative, did not reach the threshold for a meaningful effect size. Patient contact positively predicted IAT scores, while age, sex, and level of training (resident, compared with psychiatrist) did not. Neither patient contact nor implicit attitudes predicted SDS or OMS-HC scores.

Conclusion:

Psychiatrists did not differ from psychiatry residents on any measures of explicit or implicit attitudes toward mental illness. Explicit attitudes toward people with mental illness were relatively negative; implicit attitudes were neither negative nor positive; and implicit and explicit attitudes were not correlated. Greater patient contact predicted more positive implicit attitudes, but did not predict explicit attitudes.