Anti-stigma Interventions Research Articles

Teaching Those Who Care How to Care for a Person With Substance Use Disorder.

Substance use disorder (SUD) is on the rise globally, and nurses are not prepared to care for this population. The purpose was to determine if a 4-hour antistigma intervention improved prelicensure student nurse attitudes and perceived stigma toward people with SUD. This was a nonrandomized quasi-experimental survey study. Participants completed the 20-item Drug and Drug Problems Perception Questionnaire (DDPPQ), the 8-item Perceived Stigma of Substance Abuse Scale (PSAS), and the 13-item Marlowe-Crowne Social Desirability Scale at baseline and repeated the DDPPQ and PSAS postintervention. Paired t tests were used to determine the mean differences in the total DDPPQ and total PSAS scores. After the antistigma intervention, there was a significant improvement in overall therapeutic attitudes (t = 8.4, df = 108, P < .001) and perceived stigma (t = -2.5, df = 108, P = .01) in undergraduate nursing students (n = 126). Incorporating antistigma educational approaches may lead to more involvement and compassionate care for people with SUD.

Theatre as a tool to reduce autism stigma? evaluating ‘Beyond Spectrums'

ABSTRACT Drawing from ‘intergroup contact theory,’ which states that direct contact between groups can reduce biases, we developed a theatrical intervention to provide members of a college community with positive contact with autistic people and their stories. Autistic people helped create and perform the piece. Audience responses revealed reduced stigma towards and increased knowledge about autism following the performance. Audience members reported that the performance was informative and effective, with the potential to transform attitudes toward autism. Future theatre-based anti-stigma interventions should develop increasingly more collaborative, immersive and entertaining ways of addressing misconceptions and fostering high-quality contact with diversity.

Stigmatizing Attitudes Towards Mental Disorders Among Non-Mental Health Professionals in Six General Hospitals in Hunan Province.

Background: There have been few studies on the stigma associated with mental disorders among non-mental health professionals in general hospitals in China. This study seeks to explore mental health-related stigma and the desire for social distance among non-mental health professionals in general hospitals in Hunan Province in China.Methods: The study was carried out with 1123 non-mental health professionals in six general hospitals in Hunan Province by using a questionnaire with a case vignette describing either schizophrenia, depression, or generalized anxiety disorder (GAD). Questions were asked about the attitudes of participants and other people towards individuals with mental disorders and the willingness to come into contact with them.Results: The people described in the vignette were considered dangerous by 84.4% of participants for schizophrenia, 72.0% of participants for depression, and 63.1% of participants for GAD. Besides being dangerous, people with schizophrenia were perceived as unpredictable and as the least suitable for voting for as a politician or employing. Around 50% of participants believed the problems described in the vignette were due to personal weakness. Over 70% of the non-mental health professionals were not willing to have the people described in the vignette marry into their family. The participants had gained their mental health-related knowledge mainly through the media, mostly from newspapers.Conclusions: The current study found a significant stigma towards individuals with mental disorders and a desire for social distance from such people among non-mental health professionals in general hospitals in Hunan Province. Anti-stigma interventions should focus on addressing non-mental health professionals' beliefs on dangerousness and unpredictability.

Social Stigma Towards People with Medically Unexplained Symptoms: the Somatic Symptom Disorder.

The majority of previous studies on mental health stigma have focused on medically explained symptoms and the studies on medically unexplained symptoms (MUS) have only assessed the consequences of internalized stigma. A new category in DSM 5, named as somatic symptom disorder (SSD), includes multiple somatic disorders with medically-explained or -unexplained somatic symptoms. This study aimed to test the effects of social stigma on people with SSD with MUS depending on the attribution model. In a class environment, 348 college students from different regions in Turkey were presented with a vignette on a person with SSD with MUS and asked to complete a survey including demographics and attitudes towards that person. Along the same lines with previous findings for other mental disorders, the path analysis using AMOS revealed that stigma-related cognitions (i.e., dependency, dangerousness and responsibility) shaped people's affective (i.e., anger and pity) and behavioral responses (i.e., social distance) to these people. The most important predictor of social distance was pity and the level of contact was not related to social distance. In conclusion, anti-stigma interventions towards SSD with MUS should involve building empathy towards these patients and educating people about this disorder contrary to the recommended interventions for other mental health disorders stressing the importance of contact.

Adolescent views of mental illness stigma: An intersectional lens.

Differences in mental illness (MI) stigma among adolescents were examined cross-sectionally across race, ethnicity, and gender to identify target populations and cultural considerations for future antistigma efforts. An ethnically and socioeconomically diverse sample of sixth graders (N = 667; mean age = 11.5) self-completed assessments of their MI-related knowledge, positive attitudes, and behaviors toward peers with MI and adolescent vignettes described as experiencing bipolar (Julia) and social anxiety (David) symptoms. Self-reported race, ethnicity, and gender were combined to generate 6 intersectional composite variables: Latino boys, Latina girls, non-Latina/o (NL) Black boys, NL-Black girls, NL-White boys, and NL-White girls-referent. Linear regression models adjusting for personal and family factors examined differences in stigma using separate and composite race, ethnicity, and gender variables. In main effects models, boys and Latina/o adolescents reported greater stigma for some outcomes than girls and NL-White adolescents, respectively. However, intersectional analyses revealed unique patterns. NL-Black boys reported less knowledge/positive attitudes than NL-Black and White girls. NL-Black and Latino boys reported greater avoidance/discomfort than NL-White girls. Moreover, NL-Black girls and boys and Latina/o girls and boys wanted more social separation from peers with mental illness than NL-White girls; NL-Black boys also reported more separation than NL-White boys, NL-Black girls, and Latina girls. Finally, NL-Black boys and Latina girls wanted more distance from David than NL-White and Black girls. Vital for informing future antistigma interventions, this study generates new knowledge about how differences in views about MI exist across racial and ethnic identity, and how gender intersects with these perceptions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Effect of Contact-Based Interventions on the Attitudes and Behaviors of Nursing Students towards People with Mental Illness: A Literature Review

Background: Student nurses and other healthcare students are the future mental health professionals and have the potential for changing the future of mental healthcare. Therefore, their negative attitudes and behaviors should be screened and corrected by effective anti-stigma interventions. Otherwise, they would likely withhold some health services and practice coercive treatments once planning care to people with mental illness. However, little is known on effective approaches to correct these negative attitudes and behaviors, despite the previous reviews that have shown that contact-based interventions have demonstrated positive attitudinal and behavioral changes for nursing students towards people with mental illness. Aim: The aim of this literature review was to compile the available research evidence on contact-based interventions that have targeted the attitudes and behaviors of nursing students towards people with mental illness. Methods: The relevant literature was extracted by searching electronic databases (MEDLINE, PsycINFO, and CINAHL) and by hand checking reference lists of past similar reviews. Results: Eleven studies were retrieved and included in this review. The included studies in this review either have employed social contact interventions, video-based social contact interventions, or both types for the aim of combining or comparing. Furthermore, the included studies either have targeted the attitudes of nursing students towards people with mental illness (including prejudice), or a combination of attitudinal and behavioral outcomes (including behavioral intentions and social distance). No studies have targeted behavioral outcomes solely. Conclusions: From the available literature, the current authors cannot draw conclusions on the most effective type, form, or ingredients of contact-based interventions among nursing students, as previous literature has large variations. No consistency was found in the previous studies regarding the types or contents of effective contact-based interventions. The compiled evidence in this review, has suggested that contact-based interventions (both social contact and video-based social contact) have been effective in changing the attitudes and behaviors of nursing students favorably, similarly to what previous reviews have found.

The evaluation of the impact of anti-stigma training led by "experts by experience" on participants' attitudes towards persons with mental illness.

The purpose of this study was to evaluate the impact of anti-stigma training led by people who had previously experienced mental health crises (i.e., "experts by experience") on various aspects of participants' attitudes towards the people with mental illness. The three-hour workshops were attended by 185 people; the training was held in 17 groups, with 3-19 people in each (11 on average). Almost half of the participants (45.4%) were employees of the mental health care system. The participants were asked to fill out a set of questionnaires immediately before and after the training, which evaluated the following aspects of their attitudes: social distance, stigmatizing attributions, beliefs about self-determination/ ability to attain important life goals by people with mental illness, and also beliefs about the social value of people with mental illness. The respondents were asked to complete the same set of questionnaires again online a month and six months after the training. The data were analyzed based on a piecewise latent trajectory model. Out of the 185 people who participated in the workshops, 115 (62.2%) filled out the questionnaires a month after, and 87 (47.0%) six months after the training. The analyses showed an improvement in all four measures of attitudes expressed directly after the training. In three out of the four examined aspects of attitudes (intensity of social distance, stigmatizing attributions and beliefs about self-determination of people with mental illness) the positive impact of the training continued after six months. The results provide preliminary empirical evidence that the structured antistigma intervention under evaluation, using the elements of education and interpersonal contact can be an effective tool for improving social attitudes towards people with mental illness.

Attitudes to psychiatry and to mental illness among nursing students: Adaptation and use of two validated instruments in preclinical education.

Stigma towards psychiatry and people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Internalized stigma among nurses can affect personal self-care and limit help-seeking behaviours. Stigma around mental health nursing can adversely affect recruitment into this already underserved field. This is the first report on the adaptation and use in a nursing student sample of two widely used stigma-related instruments that have been normed among medical students. The attitudes to psychiatry (ATP-30) and the attitudes to mental illness (AMI) instruments proved sensitive to change and can be useful in tracking specific anti-stigma curricular interventions. Interactive and participatory student activities in courses such as ours (that include simulation with standardized patients, clinical placements and patient interaction) need to be complemented by exposure to individuals with lived experience with mental illness in order to address stigmatized views of SMI. Nursing educators and fellow nurses willing to share their own experiences with mental illness-including diagnosis, health-seeking, treatment and recovery-may prove especially powerful and germane during nursing school. Even a strong academic curriculum is not sufficient to change stigmatized perceptions about mental illness, psychiatric care and mental health nursing as a profession. Comparison and potential synergy between ATP-30, AMI and OMS-HC (Opening Minds Scale for Health Care Providers) could prove fruitful in identifying a more comprehensive approach to stigma assessment over time. The addition of validated instruments, such as the Self-Compassion Scale-Short Form (SCS-SF) and the Self-Stigma of Seeking Help (SSOSH), which tap into internalized stigma and into health-seeking behaviours and intervening barriers could prove particularly useful in evaluating innovative interventions for stigma-decreasing initiatives in nursing education. Interactive and participatory didactic offerings need to be complemented by exposure to individuals with lived experience with mental illness and ideally to nursing educators and practicing nurses willing to share their histories of diagnosis, help-seeking, treatment and recovery. Introduction Stigma towards psychiatry and to people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Such stigmatized views can adversely affect recruitment into the already underserved field of mental health nursing. Aim/question We adapted two stigma-related instruments in a sample of nursing students and examined change in scores after participation in an eight-week preclinical psychiatry curriculum. Our goal was to identify stigma-malleable opportunities that would inform refinements in future iterations of a preclinical psychiatry curriculum in nursing. Method We made minor adaptations to the attitudes to psychiatry (ATP-30) and the attitudes to mental illness (AMI) instruments. We invited first-year nursing students to complete assessments at two time points: before and after completion of an eight-week core course in preclinical psychiatry. Results Seventy-one students completed the assessment at both time points. ATP-30 and three of its eight subscale scores improved by course's endpoint. By contrast, AMI scores did not change. Compared with medical student published norms, nursing students in our sample had higher (less stigmatized) average scores. Discussion The ATP-30 and the AMI can be easily adapted to a nursing student population and may prove useful in tracking specific anti-stigma educational interventions. Implications for practice A general psychiatry course during nursing school is, it and of itself, unlikely to change biased views about SMI and should be enhanced with exposure to, and interaction with individuals with lived experiences of mental illness, ideally by nurse educators and practicing nurses.

Mental Health Professionals' Attitudes to Severe Mental Illness and Its Correlates in Psychiatric Hospitals of Attica: The Role of Workers' Empathy.

To describe mental health workers' attitudes to severe mental illness and to explore its socio-demographic and professional correlates, including the influence of empathy. A total of 127 mental health staff working on the psychiatric hospitals of Attica participated in the study. Stigma was assessed with the Attitudes to Severe Mental Illness scale (ASMI) and the Greek Social Distance scale; whilst Empathy with the Interpersonal Reactivity Index. Participants' unfavourable attitudes to severe mental illness were limited to pessimism about recovery, difficulty in viewing people with mental illness as similar to other people and desire to keep distance in intimate encounters. Professional group and personal experience with mental illness were found to predict stigma. Only perspective taking was associated with both stigma measures; while Fantasy was positively correlated with social distance. Anti-stigma interventions in mental healthcare should prioritize nurses and psychiatrists and aim at enhancing perspective taking.

Stigma towards depression in a community-based sample in China

ObjectiveUnderstanding the general public's beliefs about depression is essential if public education and anti-stigma interventions are to be effective. This study aimed to examine Chinese respondents' personal attitudes towards depression and their perceptions about the attitudes of others regarding depression and to identify the correlates of personal stigma and perceived stigma towards depression. MethodsA community survey was conducted among 1697 residents aged between 16 and 89 years of a large city in central China using the Depression Stigma Scale. Participants completed questionnaires assessing experiences of depression and family functioning. ResultsParticipants reported high levels of stigma towards depression, with greater perceived stigma than personal stigma. Increasing age was correlated with greater personal stigma and perceived stigma. Higher personal stigma was also significantly correlated with being male, unemployed and good family function. ConclusionConcerningly high levels of stigmatizing beliefs towards depression were prevalent among the public. This may be a reason why people with mental disorders do not seek assistance. This highlights the importance of the need for health education and promotion activities. Findings from this study suggest that targeted, culturally appropriate education programs are needed to improve knowledge about depression in the broader community.

Factors associated with the evolution of attitudes towards mental illness in a cohort of nursing students

WHAT IS KNOWN ON THE SUBJECT?: People with mental health difficulties have poorer physical health than the general population. The stigmatizing attitude of health professionals impacts the quality of care for these people. There is a broad background on the effectiveness of activities based on theoretical training, clinical practices or social contact to improve nursing students' attitudes towards people with mental health difficulties. There is an important need to assess whether the benefits identified in the short term are maintained in the longer term. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The positive evolution of attitudes towards mental illness does not last over time. Some students' attitude towards people with a mental health difficulty worsened in the final stage of their training after completing clinical practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is necessary for tutors incorporate an understanding of stigma throughout the degree training and to discuss with the students the emotional aspects experienced during the performance of clinical practices. The design of any anti-stigma intervention must include the factor of "time". ABSTRACT: Introduction The stigma of health professionals is a contributing factor to morbi-mortality among people with mental health difficulties. There is a lack of research on long-term outcomes in nursing students. Objective To identify factors associated with the evolution of stigmatizing attitudes towards mental illness in a cohort of students trained in mental health. Method A prospective observational study of the impact of training in mental health care. Age, gender, stigma, level of previous familiarity with mental illness, self-education by Internet, academic performance and the place where practicums are conducted were evaluated on three occasions over 15months. Results Academic performance, online consultation and the size or origin of the theoretical group were indicators of better attitudes. The positive evolution of attitudes does not last over time. Discussion Instability over time could be explained by students' experience in the practicum, although the time itself has been identified as a determining factor. Practical implications Further studies should be promoted in academia to assess the content of mental health training and its influence on the evolution of the stigmatizing attitude. It is also necessary to address stigma in small groups, where students with better academic results lead anti-stigma activities.

The Impact of Indigenous Identity and Treatment Seeking Intention on the Stigmatization of Substance Use

Substance use disorders are one of the most stigmatized mental health issues. There is a disproportionate burden of substance use disorders (SUDs) and related harms on Indigenous peoples in Canada. The current study examined the public stigma associated with substance use and how that stigma intersects with Indigenous identity and treatment seeking intention. Participants (N = 711) were randomly assigned to read one of four vignettes depicting a person living with a SUD and then complete an online survey. Vignettes differed on the character’s ethnicity (Caucasian vs. First Nations) and their treatment seeking intention (seeking treatment vs. not seeking treatment). Participants then completed a series of questionnaires to assess stigma, including measures of perceived unpredictability and incompetence, desired social distance, and emotional response. Significant main effects of both ethnicity and treatment seeking were found on all three outcome measures of stigma. Specifically, participants assigned a vignette depicting a First Nations person responded with more stigmatizing attitudes than participants assigned a vignette of a Caucasian person. Additionally, participants assigned a vignette of a person not seeking treatment responded with more stigmatizing attitudes than participants assigned a vignette of a person who sought treatment. These findings highlight the need for future anti-stigma interventions and educational programming for substance use in general and within an Indigenous context. Furthermore, documenting and addressing prejudice towards Indigenous populations is a crucial step in working towards reconciliation.

INTERVENTIONS TO REDUCE STIGMA OF DEMENTIA: FINDINGS FROM A SCOPING REVIEW

Although there is significant stigma attached to dementia, there is a paucity of knowledge on stigma reduction interventions. Guided by a strength-based approach, this presentation consists of two objectives: 1) to identify the literature on interventions to reduce dementia-related stigma; and 2) to recognize the strength-based components of existing anti-stigma interventions. A five-stage scoping review process was used to examine peer-reviewed literature of anti-stigma interventions of dementia from 2008 to 2018. From 744 initial records, 21 articles matched our inclusion criteria and were reviewed. A stigma reduction framework was used for classifying interventions: education (to dispel myths with accurate information), contact (to provide interaction with people with dementia), mixed (education and contact interventions), and protest (to challenge negative attitudes of dementia). A range of education, contact, and mixed interventions were identified. Strength-based components of education interventions included using: facts to dispel myths, multiple mediums to support dementia information, and culturally-informed strategies for specific audiences. Key components of contact and mixed interventions included: showcasing the achievements of people with dementia, relationship-building, and engaging in purposeful learning. Findings from this study can help to inform future interventions to reduce stigma and improve the quality of life for people affected by dementia.

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.

‘We will soon be dead’: stigma and cascades of looping effects in a collaborative Ebola vaccine trial

ABSTRACT Can the careful implementation of global health research reduce the stigmatization of involved human subjects? This study analyses stigma in an Ebola vaccine clinical trial in West Africa that deployed complex community engagement strategies including a sensitization component. Qualitative research found that stigma against trial subjects manifested in various forms beyond the reach of these anti-stigma interventions. Drawing on and advancing Hacking’s notion of ‘looping effects’, this paper argues that stigma was a product of a wider socio-historical context beyond the control of community-based interventions. This case prompts global health practitioners to think through the limitations of community-based interventions in practice.

Media language preferences and mental illness stigma among Latinx adolescents.

Media-a powerful influence on mental illness stigma-varies by language and culture. Nevertheless, recent meta-analyses have demonstrated scant attention to Spanish language media as well as historically low Latinx participation in mental illness anti-stigma intervention. To better inform how to improve equity in mental health service utilization, this study assessed how language preferences in mass media influence stigma among Latinx adolescents, compared to family language and social preferences. Sixth-graders self-identifying as Latinx self-completed assessments of mental illness knowledge/positive attitudes and desired separation from peers and adolescent vignette characters experiencing mental illness (N = 179; Texas, U.S., 2011-2012). Participants also responded to measures of language preferences (any Spanish versus only English) for consuming media (film/television, music/radio) and speaking with family (parents/grandparents), and social preferences for parties or social gatherings (Latinx versus Anglo persons). Linear regression models adjusting for student and household factors examined the associations between media and family language and social preferences on mental illness stigma. Latinx adolescents preferring any Spanish versus English-only media reported less mental illness knowledge/positive attitudes and greater social separation from peers and vignette characters with a mental illness, net of all covariates. Family language and social preferences were not associated with any mental illness stigma outcomes. Spanish media preference is associated with greater stigma suggesting more stigmatization may exist in Spanish- versus English-media. Ensuring anti-stigma messaging in Spanish media may reduce disparities in mental illness stigma among Latinx adolescents. These findings have implications for populations with other non-English media preferences.

Evaluating an antistigma intervention combining personal account with musical performance among rural adolescents.

Evaluating an antistigma intervention combining personal account with musical performance among rural adolescents.

Public stigma toward mental illness and its correlates among patients diagnosed with schizophrenia

Background: Patients diagnosed with schizophrenia confront high degree of exclusion and prejudice, but the correlates of stigma among these patients have yet to be established.Aims: To assess stigma toward mental illness and its correlates among patients diagnosed with schizophrenia.Methods: A cross-sectional research design was used. One hundred and sixty Jordanian outpatients suffering from schizophrenia completed the study. Participants completed measures of demographic variables, pain intensity, depression and stigma toward mental illness.Results: Participants had a moderate level of perceived public stigma. Gender, age, family income, frequency of relapse, reasons for visit to the psychiatric clinic, perceived physical pain, and severity of depressive symptoms were significantly correlated with stigma toward mental illness. Clinical variables accounted for 15% additional variance above and beyond the 13% variance accounted for by demographic variables.Conclusions: Nurses should consider both demographic and clinical variables when implementing anti-stigma intervention programs for patients with schizophrenia.

Effects of education and social contact on mental health-related stigma among high-school students

Poor knowledge and stigma toward people with mental illness negatively affect intentions to seek help among adolescents. The study aimed to assess the impact of three school-based interventions and to explore whether positive changes in attitudes were linked to more favorable changes in desire for social distance and seeking help. A total of 221 upper secondary students were allocated to three interventions: 1. social contact; 2. Mental Health Literacy (MHL) conducted by clinicians; 3. MHL conducted by dis-peer instructors. Measures of knowledge, attitudes, views on empowerment and recovery, willingness to interact, and help seeking were collected. Generalized Estimating Equations and Structural Equation Modeling (SEM) were used to evaluate scores differences between interventions through time, and to test the interrelationships between knowledge, attitudes variables and the two outcomes of interest. Findings showed that all groups improved in knowledge, attitudes, empowerment, willingness to interact, and seeking help. SEM revealed that the increase in knowledge was significantly associated with the General attitudes toward people with mental illness construct that, in turn, was positively associated with willingness to interact and seeking help. Results encourage the use of anti-stigma interventions in order to decrease negative attitudes toward mental illness and improve behavioral intentions among students.

Is the Royal Commission into Victoria’s Mental Health System an anti-stigma intervention?

Is the Royal Commission into Victoria’s Mental Health System an anti-stigma intervention?