Experiences of mental health discrimination in New Zealand

Discrimination against people with experience of mental illness is a recognised problem, and there is a lack of information in New Zealand regarding the nature of this discrimination. The Like Minds, Like Mine project is a New Zealand initiative to combat the stigma and discrimination associated with mental illness. This paper reports on a study undertaken as part of this initiative, and describes the nature of discrimination that people with experience of mental illness face in New Zealand. A written survey was undertaken with people with experience of mental illness from throughout New Zealand, using a mixture of qualitative and quantitative questions. This questionnaire was distributed throughout the country in 2003, using a variety of distribution methods, and 785 responses were received and analysed from people self-identifying as having experienced mental illness. Respondents reported discrimination in all areas of their lives. The most commonly reported areas were discrimination by friends and family (59%), a fear of being discriminated against (46%), and discrimination in looking for employment (34%) and mental health services (34%). Discrimination can limit the participation of people with experience of mental illness in our society. We all need to examine our own attitudes and behaviours and take responsibility for discrimination.     

The quality of life, mental health, and perceived stigma of leprosy patients in Bangladesh

The present study aims to determine the quality of life (QOL) and general mental health of leprosy patients compared with the general population, and evaluate contributing factors such as socio-economic characteristics and perceived stigma. A total of 189 patients (160 outpatients, 29 inpatients) and 200 controls without leprosy or other chronic diseases were selected from Dhaka district, Bangladesh, using stratified random sampling. A Bangladeshi version of a structured questionnaire including socio-demographic characteristics-the Bangla version of the World Health Organization Quality of Life Assessment BREF (WHOQOL-BREF)-was used to assess QOL; a Self-Reporting Questionnaire (SRQ) was used to evaluate general mental health; the Barthel Index to control activities of daily living (ADL); and the authors' Perceived Stigma Questionnaire was used to assess perceived stigma of patients with leprosy. Medical records were examined to evaluate disability grades and impairment. QOL and general mental health scores of leprosy patients were worse than those of the general population. Multiple regression analysis revealed that factors potentially contributing to the deteriorated QOL of leprosy patients were the presence of perceived stigma, fewer years of education, the presence of deformities, and a lower annual income. Perceived stigma showed the greatest association with adverse QOL. We conclude that there is an urgent need for interventions sensitive to the effects of perceived stigma, gender, and medical conditions to improve the QOL and mental health of Bangladeshi leprosy patients.     

Body weight,perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: insights from the modified labelling approach

With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight‐based discrimination has also intensified. While research has demonstrated the negative effects of weight‐based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self‐perceived weight‐based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi‐stage probability sample of non‐institutional, English‐speaking adults, ages 35 to 89 in 2005–2006. Our findings demonstrate that the effect of weight‐based discrimination on psychological well‐being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self‐rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well‐being.     

Implications of perceived physical and social aspects of the environment for self-reported physical and mental health

The purpose of the present study is to explore the relative importance of certain socio-demographic variables, perceived physical and social attributes of the home and neighborhood for self-reported physical and mental health. The sample of the present study comprised 137 men and women (51.83% women and 48.17% men) ranging in age from 26 to 54 years selected randomly from shoppers visiting a crowded shopping plaza. A sociodemographic data sheet, scales to measure perceptions of the physical environment and neighborhood characteristics, and the SF-36 to assess physical and mental health components were used. Data were analyzed using multivariate analyses of variance, Pearson's correlation coefficients and multiple regression analysis. No age and gender differences in physical and mental health scores emerged (p < 0.05), but people who perceived their socio-economic status as low also reported lower total mental health scores (p < 0.05). No socioeconomic differences were noted on indices of physical health (p > 0.05). Correlation analysis revealed that negative perceptions of the interior home environment were associated negatively with physical and mental health scores (p < 0.05). Regression analysis indicated that perceived decay and disorganization in the home interior as well as perceived socioeconomic status accounted for a significant portion of the variance in mental health scores.     

Violence,stigma and mental health among female sex workers in China: A structural equation modeling

Intimate partner violence is prevalent among female sex workers (FSWs) in China, and it is significantly associated with mental health problems among FSWs. However, limited studies have explored the mechanisms/process by which violence affects mental health. The purpose of this study was to explore the relationships among partner violence, internalized stigma, and mental health problems among FSWs. Data were collected using a self-administered cross-sectional survey administered to 1,022 FSWs in the Guangxi Zhuang Autonomous Region (Guangxi), China during 2008–2009. We used structural equation modeling to test the hypothesized relationships. Results indicated that violence perpetrated by either stable sexual partners or clients was directly and positively associated with mental health problems. Violence also had an indirect relation to mental health problems through stigma. Results highlight the need for interventions on counseling and care for FSWs who have experienced violence and for interventions to increase FSWs’ coping skills and empowerment strategies.     

Mental illness stigma and employer evaluation in hiring: Stereotypes,discrimination and the role of experience

Mental illness stigma can constitute a significant barrier to entering employment. Drawing on 20 interviews with Norwegian employers, this article investigates how mental illness stigma affects employer evaluation of jobseekers who disclose a history of mental illness. It also explores how employers use accounts of their previous experience with employees with mental illness in their evaluations. Prior to the interviews, the employers received pairs of fictitious applications in which one of the candidates disclosed a history of mental illness. Thus, the interview data were paired with behavioural data on how the employers responded to mental illness disclosure in a genuine recruitment situation. The analysis reveals common stereotypes of people with mental illness as fragile and unreliable. Furthermore, discriminating and inclusive employers are juxtaposed in their approach to mental health stigma, characterised by either taboo and avoidance or empathetic dialogue. The findings indicate how negative experience is coupled with negative attitudes and behaviour and how positive experience is coupled with positive attitudes and behaviour. A central argument is that experience is something that employers play an active part in constructing by choosing to either engage or not engage in a two-way dialogue with employees struggling with mental illness.     

Associations between comorbid health conditions and the use of mental health services among adults with bipolar disorder

Using a nationally representative sample, this study examined to what extent the number of comorbid health conditions was associated with various mental health service utilization among people with bipolar disorder. The results of logistic regression models indicate that a greater number of comorbid medical conditions were associated with higher odds of using specialty mental health service, while they were not associated with utilization of services provided by general health care providers. The type of bipolar disorder, functional impairment, and marital status were found to be associated with the use of a specialty service, while ethnicity was the only covariate significantly related to general health care use.     

杭州市空巢老人身心健康和社会支持对生命质量的影响调查

目的探讨杭州市空巢老人身心健康状况和社会支持现状对生命质量的影响及交互作用,为提高空巢老人生命质量研究提供科学依据。方法利用分层整群随机抽样法抽取杭州市2个城区和3个郊县的992名空巢老人进行健康相关生活质量量表(ED-5Q)、社会支持量表(SSRS)以及老年抑郁量表(GDS-15)调查,分析不同特征空巢老人生命质量得分情况,根据各量表得分,利用Pearson相关性分析研究身心健康和社会支持与生命质量的相关关系。结果身体健康得分为(73. 41±13. 52)分,抑郁量表得分为(4. 11±1. 79)分;社会支持量表测得调查对象社会支持总分为(28. 79±6. 66)分,客观支持为(6. 09±2. 59)分,主观支持为(15. 92±4. 00)分,社会支持利用度得分为(6. 78±2. 28)分,EQ-5D效用值为(0. 75±0. 13)分。已婚组空巢老人生命质量得分高于离婚组和丧偶/单身组,差异有统计学意义(F=8. 462,P <0. 01);收入水平越高的空巢老人生命质量得分越高,差异有统计学意义(F=18. 329,P <0. 01);患有慢性病的空巢老人...     

The measurement of current perceived health among Chinese people in Guangzhou and Hong Kong,southern China

General percelved health might be considered as a trait measure of perceived health and has been shown to be a reliable predictor of mortality. Current perceived health might be thought of as a state measure and as such should be more sensitive to short-term changes in health status. This paper describes the development of an instrument, the CPH-42 which measures current perceived health among Chinese people. Over 1000 items associated with ill-health were collected after inter-viewing 90 subjects from out-patient and in-patient settings. To these were added 38 items from section 1 of the Nottingham Health Profile (NHP) and the Chinese Health Questionnaire (CHQ30), measures of functional status and mental health respectively. These items were administered to four groups of subjects and 42 items were extracted using discriminant analysis to create the CPH-42. Results show low levels of conceptual overlap between the CHQ30 and CPH-42, and slightly more overlap between the NHP and CPH-42. Subjects' health care utilization behaviour was linearly related to rated current perceived health. It is concluded that the instrument is both a valid and reliable tool (Guttman's split-half coefficient r=0.85) which measures a distinct area of subjective health and is shown to predict health services utilization behaviour significantly better than general perceived health.     

Associations of perceived stigma,perceived environmental inaccessibility,and self-compassion among people with physical disability in Hong Kong

BackgroundPeople with physical disability are chronically stigmatized. They might internalize ableist attitudes and behaviors that they perceive from others, which can negatively affect social participation and well-being. It is essential to explore potential risk and protective factors associated with stigma perceptions.ObjectiveThe present study proposed and tested the positive associations of perceived environmental inaccessibility and self-coldness with perceived stigma, and the negative associations of self-warmth with perceived stigma, respectively, among people with physical disability in Hong Kong.MethodsA cross-sectional sample of 98 adults with physical disability (42.3% female, mean age = 36.4 years) from 10 nongovernmental organizations in Hong Kong participated in the study. They filled in a self-report questionnaire on perceived stigma, perceived environmental inaccessibility, self-compassion, basic activities of daily living (ADL), instrumental activities of daily living (IADL), and demographics.Main resultsHierarchical multiple regression showed that ADL and IADL alone (Model 1) did not significantly predict perceived stigma. The full model of ADL, IADL, perceived environmental inaccessibility, self-warmth, and self-coldness to predict perceived stigma (Model 2) was significant and explained 53.9% variance in perceived stigma. Perceived environmental inaccessibility and self-coldness were significantly and positively associated with perceived stigma, respectively. Self-warmth was significantly and negatively associated with perceived stigma.ConclusionsThe findings supported the important associations of both external contexts (i.e., as environmental inaccessibility) and internal resources (i.e., as self-compassion) with perceived stigma among people with physical disability. The findings inform future research and three-pronged design approaches to stigma reduction programs for people with physical disability.     

Perceived discrimination,humiliation, and mental health: a mixed-methods study among Haitian migrants in the Dominican Republic

Objective. Many Haitian migrants live and work as undocumented laborers in the Dominican Republic. This study examines the legacy of anti-Haitian discrimination in the Dominican Republic and association of discrimination with mental health among Haitian migrants.

Design. This study used mixed methods to generate hypotheses for associations between discrimination and mental health of Haitian migrants in the Dominican Republic. In-depth interviews were conducted with 21 Haitian and 18 Dominican community members and clinicians. One hundred and twenty-seven Haitian migrants participated in a pilot cross-sectional community survey. Instruments included culturally adapted Kreyòl versions of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) and a locally developed function impairment scale.

Results. Haitian migrants described humiliation (imilyasyon) as a reason for mental distress and barrier to health care. Dominicans reported that discrimination (discriminación) was not a current social problem and attributed negative social interactions to sociocultural, behavioral, and biological differences between Dominicans and Haitians. These qualitative findings were supported in the quantitative analyses. Perceived discrimination was significantly associated with depression severity and functional impairment. Perceived mistreatment by Dominicans was associated with a 6.6-point increase in BDI score (90% confidence interval [CI]: 3.29, 9.9). Knowing someone who was interrogated or deported was associated with a 3.4-point increase in BAI score (90% CI: 0.22, 6.64).

Conclusion. Both qualitative and quantitative methods suggest that perceived discrimination and the experience of humiliation contribute to Haitian migrant mental ill-health and limit access to health care. Future research should evaluate these associations and identify intervention pathways for both improved treatment access and reduction of discrimination-related health risk factors.     

Associations of multiplicity of comorbid health conditions,serious mental illness,and health care costs

Using a nationally representative U.S. sample, this study analyzed the effects of serious mental illness (SMI) and comorbid medical conditions on the cost of health care. The results of path model indicated that SMI and comorbid health conditions each increased total health care costs. Additionally, individuals with SMI were likely to have more comorbid medical conditions, which in turn, increased total health care costs. Findings raise awareness of an increased risk of medical conditions among individuals with SMI and the concern of high expenditures associated with comorbid SMI and medical conditions.     

Subjective well-being, sociodemographic factors, mental and physical health of rural residents

Objective: To ascertain the relationship between subjective well‐being and sociodemographic factors, mental and physical health of a sample of rural residents. Design: Cross‐sectional survey with stratified random sampling of persons based on the 2000 State Electoral Role. Questionnaire was forwarded to 23 000 residents throughout a rural area. Setting: Households within Gippsland. Participants: Five thousand three hundred and ninety‐one adults aged 18 years and above. Main outcome measures: Residents completed a self‐reported questionnaire assessing life satisfaction/subjective well‐being, psychological distress, sociodemographic factors, physical and mental health problems. Results: Completed survey indicated that participants with lower levels of psychological distress, physical disability and mental disability had higher odds of being satisfied with their life. Participants with severe mental disability had the lowest odds of being satisfied with life. On average, participants were satisfied with their life (mean score of 21, SD = 5.9), are within the normal range of the Kessler‐10 (mean score = 16.31, SD = 5.85), had no mental disability (mean score = 51.8, SD = 7.36) on the mental component of the Short Form‐12 Health Survey, but are mildly physically disabled (mean score = 48.9, SD = 7.74). Conclusions: The results of this study indicate that sociodemographic factors, psychological distress, physical health and mental health contribute to subjective well‐being. Compared with other age groups, those aged 66 years and above had the highest level of life satisfaction. Those living with partner/spouse without children, with no mental or physical disability and no psychological distress had highest level of life satisfaction. Women also had higher levels of life satisfaction compared with men.     

威海市居民身心健康状况及影响因素分析

目的 了解山东省威海市居民身体与心理健康状况及其影响因素.方法 采用分层整群随机抽样方法抽取样本,利用自制调查问卷和世界健康调查(WHS)精选量表对其自评身心状况进行访谈式调查,用SPSS 13.0软件进行统计分析.结果 调查15岁及以上城乡居民11698人,70.2%的人自认为总体健康状况好或者很好,有36.6%的人身心状况不佳,其身心状况得分的总体分为(8.32±2.58)分;单因素和多因素分析结果显示,女性、丧偶、受教育程度低、2周内患病、半年内患慢性病、性格模糊、无知心朋友、生活单调、自感消极、生活工作压力大、过去1年有自杀念头、过去2年有重大挫折或不幸、失眠等是居民自评身心状况差的因素.结论 居民的自评身心状况受一般因素(如性别、年龄等)、躯体的客观健康状况、心理相关因素、伤害相关因素及其他因素(如失眠)影响,超过1/3居民身心健康状况不佳.     

Correlates of comorbid mental disorders in a regional community-based sample

Objective:  The common coexistence of psychiatric disorders has been identified as a significant factor contributing to the disability associated with mental illness. Identifying indicators to the development of coexisting disorders has potential clinical implications. This study aimed to investigate the correlates and impact of coexisting disorders in a rural setting.
Design:  Cross-sectional analyses of data from a cohort interviewed in two phases.
Setting:  A regional community sample in Northern New South Wales, Australia.
Participants:  A total of 1407 participants were interviewed and 968 were re-interviewed at follow up.
Main outcome measures:  Multinomial logistic regression modelling compared subjects with multiple psychiatric disorders with those with a single disorder for sociodemographic characteristics, measures of personal and social vulnerability, psychological distress, functional disabilities and help-seeking behaviours.
Results:  Participants with coexisting disorders were more likely to be male, report a history of severe childhood assault and had higher levels of neuroticism, psychological distress and help-seeking behaviour.
Conclusions:  The findings suggest the role of early developmental factors on the complexity and severity of adult mental illness in a rural setting and the significant clinical consequences of comorbidity.     

The impact of the disability support pension on mental health: evidence from 14 years of an Australian cohort

Objective: To assess the effect of the Australian Disability Support Pension (DSP) on the symptomology of depression and anxiety over and above the effects of reporting a disability itself. Methods: We used the Household Income Labour Dynamics in Australia (HILDA) survey from 2004 to 2017. We used fixed effects regression to understand mental health differences (using the Mental Health Inventory‐5 [MHI‐5]) when a person reported: i) a disability; or ii) a disability and receiving the DSP) compared to when they reported no disability. The models controlled for time‐varying changes in the severity of the disability and other time‐related confounders. Results: There was a 2.97‐point decline (95%CI ?3.26 to ?2.68) in the MHI‐5 when a person reported a disability compared to waves in which they reported no disability and 4.48‐point decline (95%CI ?5.75 to ?3.22) when a person reported both a disability and being on the DSP compared to waves in which they reported neither. Conclusions: Results suggest that accessing and being in receipt of the DSP can impact the mental health of people with disabilities. Implications for public health: Government income support policies should address the unintended adverse consequences in already vulnerable populations.     

中等卫校女生的身心健康与体育教学探讨

该文根据中等卫校体育教学实际,着重研究中等卫生职业学校女生的运动生理、心理特点与体育教学训练之间的关系,探讨女子体育教学的规律,分析中等卫校女生的身心健康与体育教学中应采取的教学措施。