Stigma experience of families supporting an adult member with substance misuse

Stigmatization of families supporting an adult member with substance misuse is common and undermines their capacity to support the person and maintain their own well‐being. The aims of the present study were to understand affected family members (AFMs)’ experience of stigma within the context of substance misuse, and to explicate what steps, if any, they took to try to counteract stigma and social isolation. Semistructured, audio‐recorded qualitative interviews were conducted with 31 AFMs from Victoria in Australia. Interpretative phenomenological analysis was used to guide data collection and analysis. Two main themes and related subthemes abstracted from the data illustrated how participants perceived and responded to stigma associated with a family member's substance misuse: ‘engaging in secrecy, and minimizing contact with others’ and ‘lack of knowledge and empathy, and judgmental attitudes reinforcing isolation’. A third theme, ‘adopting measures to moderate the effect of stigma’, highlights how some attempted to respond to stigma by challenging informal supports’ misconceptions about substance misuse, and being open selectively with others about their situation. Stigma against AFMs should be identified and challenged. Mental health nurses and other clinicians in the alcohol and other drugs field are in a strong position to support AFMs, with a particular focus on reducing courtesy stigma, challenging some clinicians’ judgmental attitudes, and improving ways of communicating with families.     

Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review

Title. Psychosocial treatments for people with co‐occurring severe mental illness and substance misuse: systematic review. Aim. This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. Background. Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. Data sources. Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. Review methods. Results from studies using meta‐analysis, randomized and non‐randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. Results. Fifty‐four studies were included: one systematic review with meta‐analysis, 30 randomized controlled trials and 23 non‐experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long‐term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. Conclusion. These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups.     

Defining dual diagnosis of mental illness and substance misuse: some methodological issues

This paper discusses methodological issues arising in the initial stages of a larger epidemiological case-control study. Practitioners from both Generic Mental Health and Substance Misuse Services (n = 170) were asked to identify which of their clients, from a time-limited caseload (n = 2341), had comorbid mental health and substance misuse problems. Although practitioners were provided with a definition of 'singly diagnosed' and 'dually diagnosed', it became apparent that these definitions were applied pragmatically, depending on the nature of the client's primary problem and the agency they were presenting to. Issues raised include the time period in which a client was considered to have a concurrent mental health problem and substance misuse, how a 'mental health problem' was defined and whether a personality disorder should be categorized as a 'mental health problem'. There was also some disagreement about whether clients who were being treated primarily by Substance Misuse Services, but were also taking prescribed antidepressants, implicitly had a 'mental health problem'. We raise these methodological issues, as they have implications for determining the prevalence of 'dual diagnosis' and the subsequent provision of services.     

Stigma in the media: Investigating journalism students attitudes towards mental illness

Given the profound role that media play in public opinion, there exists an ongoing necessity to understand the portrayal of mental illness by journalists. There is a plethora of studies that have examined how mental illness is portrayed in the media, but few studies have sought to understand what journalist opinions about mental illness are, and none could be found regarding journalism students’ opinions. This study aimed to bridge this gap by examining journalism student’s attitudes towards mental illness using the Social Distance Scale (SDS). This study adheres to STROBE guidelines for cross-sectional studies. One hundred and seventy-two undergraduate journalism students (n = 172) completed the SDS with findings suggesting that students had moderate stigmatizing attitudes, with varying degrees of stigma present depending on the social context. Positively framed reporting and constructive media coverage surrounding mental illness may be improved by shared communication and education with health professionals who specialize in mental health: mental health nurses.     

African American women's beliefs about mental illness,stigma, and preferred coping behaviors

We examined African American women's representations/beliefs about mental illness, preferred coping behaviors if faced with mental illness, whether perceived stigma was associated with treatment‐seeking, and if so, whether it was related to beliefs and coping preference, and whether these variables differed by age group. Participants were 185 community‐dwelling African American women 25 to 85 years of age. Results indicated the women believed that mental illness is caused by several factors, including family‐related stress and social stress due to racism, is cyclical, and has serious consequences but can be controlled by treatment. Participants endorsed low perceptions of stigma. Major preferred coping strategies included praying and seeking medical and mental health care. Age differences were found in all variables except stigma. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:480–492, 2009     

Experience of stigma among family members of people with severe mental illness: A qualitative systematic review

Family members of people with severe mental illness are subjected to stigmatization, and a better understanding of their experience of stigma is important for developing anti‐stigma interventions to reduce the related adverse consequences. This review aimed to systematically identify, evaluate, and synthesize existing findings from qualitative studies regarding the experience of stigma among family members of people with severe mental illness. A systematic literature search for primary studies was conducted in PubMed, EMBASE, Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, ProQuest Dissertations and Theses (PQDT), SinoMed (China), Chinese Citation Database (CNKI), and Wanfang Data (China) until March 2019. Findings from the included qualitative studies were extracted and aggregated using meta‐synthesis, guided by the Joanna Briggs Methodology for Qualitative Systematic Reviews. The results revealed that family members experienced stigma and suffered from various negative consequences related to it. Five major categories were identified in 20 studies: ‘negative public images of mental illness’, ‘structural discrimination against mental illness’, ‘stigma encountered in everyday life’, ‘psychological distress associated with stigmatization’, and ‘coping with stigma’. The study contributes to our understanding of the stigma experienced by family members of people with severe mental illness. It is suggested that culturally appropriate multi‐level interventions targeting the general public, health professionals, communities, and family members need to be developed to reduce the harmful influence of associated family stigma.     

Stigma in relation to families living with parental mental illness: An integrative review

Stigma is a pervasive social mechanism with negative ramifications for people who experience mental illness. Less is known about the stigma experiences of families where a parent has a mental illness. This review aims to identify and synthesize evidence on the concept of stigma and stigma‐related experiences and outcomes reported by parents and children living with parental mental illness. An integrative review method was employed, with PRISMA (Preferred Reporting Items of Systematic Review and Meta‐Analyses) guidelines to search and select literature and extract and analyse data. This approach allows for inclusion of theoretical and empirical literature and for concept definition. Fifty‐eight papers, mostly from the USA, Australia, and the UK, met the inclusion criteria. Stigma was primarily conceptualized in families as a marked difference that was negatively appraised, and which could be internalized. Some articles examined how underpinning assumptions could shape the behaviour of individuals and groups and be embedded within social institutions and structures. For parents, mental illness stigma was interconnected with stigma relating to perceived violations of social and cultural norms related to parenting. Children’s experience of stigma resulted in bullying, embarrassment, guilt and social isolation, and efforts to conceal their parent’s mental illness. One outcome was that stigma prevented children and parents from seeking much needed supports. Public health policies and campaigns that focus exclusively on promoting open disclosure of mental illness to foster community education outcomes are unlikely to be effective without additional strategies aimed at preventing and redressing the structural impacts of stigma for all family members.     

Migraine and Psychiatric Comorbidities Among Sub‐Saharan African Adults

Background.— Despite being a highly prevalent disorder and substantial cause of disability, migraine is understudied in Africa. Moreover, no previous study has investigated the effects of stress and unipolar psychiatric comorbidities on migraine in a sub‐Saharan African cohort. Objective.— To evaluate the prevalence of migraine and its association with stress and unipolar psychiatric comorbidities among a cohort of African adults. Methods.— This was a cross‐sectional epidemiologic study evaluating 2151 employed adults in sub‐Saharan Africa. A standardized questionnaire was used to identify sociodemographic, headache, and lifestyle characteristics of participants. Migraine classification was based on the International Classification of Headache Disorders‐2 diagnostic criteria. Depressive, anxiety, and stress symptoms were ascertained with the Patient Health Questionnaire and the Depression Anxiety Stress Scale, respectively. Multivariable logistic regression models were used to estimate adjusted odds ratio (OR) and 95% confidence intervals (CIs). Results.— A total of 9.8% (n = 212) of study participants fulfilled criteria for migraine (9.8%, 95% CI 8.6‐11.1) with a higher frequency among women (14.3%, 95% CI 11.9‐16.6) than men (6.9%, 95% CI 5.5‐8.3). Similar to predominantly Caucasian migraine cohorts, sub‐Saharan African migraineurs were more likely to be younger, have a lower education, and more likely to report a poor health status than non‐migraineurs. However, in contrast with historical reports in predominantly Caucasian migraine cohorts, sub‐Saharan African migraineurs were less likely to report smoking than non‐migraineurs. Participants with moderately severe depressive symptoms had over a 3‐fold increased odds of migraine (OR = 3.36, 95% CI 1.30‐8.70) compared with those classified as having minimal or no depressive symptoms, and the odds of migraine increased with increasing severity of depressive symptoms (P trend < 0.001). Similarly, those with mild, moderate, and severe anxiety symptoms had increased odds of migraine (OR = 2.28, 95% CI 1.24‐4.21; OR = 1.77, 95% CI 0.93‐3.35; and OR = 5.39, 95% CI 2.19‐13.24, respectively). Finally, those with severe stress had a 3.57‐fold increased odds of migraine (OR = 3.57, 95% CI 1.35‐9.46). Conclusion.— Although historically it has been reported that migraine prevalence is greater in Caucasians than African Americans, our study demonstrates a high migraine prevalence among urban‐dwelling Ethiopian adults (9.9%) that is comparable with what is typically reported in predominantly Caucasian cohorts. Further, among employed sub‐Saharan African adults and similar to predominantly Caucasian populations, migraine is strongly associated with stress and unipolar psychiatric symptoms. The high burden of migraine and its association with stress and unipolar psychiatric symptoms in our study of well‐educated and urban‐dwelling African adults has important clinical and public health implications pending confirmation in other African populations.     

精神疾病病人病耻感体验的质性研究

目的:探讨精神疾病病人病耻感体验及应对方式。方法:对12例病人进行深度访谈以获取资料,用现象学分析法分析资料。结果:精神疾病病人在患病后都会产生羞耻心理;遭遇歧视时被他人躲避而感到无奈,工作、升职受到不公平待遇而痛心;在遭遇歧视后病人多采取回避社交、刻意的隐瞒病情等错误的应对方式;由于精神疾病,有些病人放弃了原本的工作以及对未来生活产生不确定感。结论:对精神疾病病人要加强疾病的健康宣教,改变病人不正确的认知;做好心理护理,提供情感支持;加强对公众精神卫生知识的宣教和普及。     

Experiences of self‐stigmatization and parenting in Chinese mothers with severe mental illness

Mental health stigma has serious ramifications on people with a severe mental illness (SMI). Stigma damages self‐esteem, recovery outcomes, family relationships, socialization abilities, access to housing, and career prospects. The cultural tendencies of Chinese people have been shown to be associated with particularly high levels of stigmatization. These cultural tenets can result in high levels of self‐stigma due to experiencing shame and a perceived need to keep mental illness a secret. Although there is a lack of existing evidence, it is possible that such experiences present unique challenges to Chinese mothers diagnosed with SMI when they parent their children. Therefore, this qualitative study explored the experiences of parenting and self‐stigmatization of Chinese mothers with SMI. Individual semi‐structured interviews were conducted with 15 mothers who were direct carers of their children aged under 18 and who were receiving community‐based care in Hong Kong. Manual inductive thematic analysis was used to analyse the interview data. Three main themes related to self‐stigmatization emerged from the interviews: (i) distancing and being distanced; (ii) doubting myself; and (iii) struggling for control. The experiences of self‐stigmatization appeared to damage these mothers’ self‐efficacy, which may negatively affect their parenting self‐esteem, tendency to seek professional help, and ability to manage their own mental health. Strategies to improve self‐efficacy, including psychoeducation, and additional childcare support/resources are required for mothers with SMI so they can better manage and balance the demands of motherhood and their mental healthcare needs.