Causal Beliefs Research Articles

Beyond recognition: beliefs, attitudes, and help-seeking for depression and schizophrenia in Ghana

ABSTRACT Research on the beliefs and attitudes regarding specific mental disorders in Ghana is limited. A vignette study was conducted to examine the relationship between causal attributions, help-seeking, and stigma towards depression and schizophrenia using lay Ghanaians (N = 410). This adapted questionnaire presented two unlabelled vignettes about a hypothetical person with the above disorders for participants to provide their impressions. Next, participants answered questions on beliefs and attitudes regarding this person. The results showed that causal beliefs about mental disorders related to different treatment options, and stigma. Contrary to previous literature, religious belief did not negatively associate with professional help-seeking for the mental disorders. In conclusion, results suggest that integration of “idioms of distress' into mental health assessment and interventions may benefit Ghanaians. Our findings have implications for mental health literacy and anti-stigma campaigns in Ghana and other developing countries in the region.

Lived experiences matter: The role of mental health professionals' psychological crises and vulnerability in shaping their health beliefs and concepts.

Mental health professionals are often affected by mental health problems and disorders. Yet, the effects of these lived experiences on their causal beliefs and health concepts have not been investigated. The current study investigates how professionals' lived depressive experiences and their perceived vulnerability to mental illness affect their causal beliefs about mental disorders, their general concept of mental health and their specific concepts of depression and burnout. An online survey was conducted with 218 mental health professionals from 18 psychiatric clinic departments in the German federal states of Berlin and Brandenburg, investigating their experiences with depression, self-assessed vulnerability, their causal beliefs of mental illness, their general health concept and specific illness concepts of depression and burnout. A path model was calculated to examine the relationships between these variables. Participants with and without lived experience of depression were grouped. Lived experience of depression was indicated by 126 participants. For participants with no experience of depression, perceived vulnerability negatively predicted beliefs in biological causation, which positively predicted higher differentiation between depression and burnout. For participants with previous depression experiences, perceived vulnerability positively predicted beliefs in psychological and social causation. Continuum belief was predicted only in this group by the three variables of causal beliefs. Psychological and social causation was positively associated, while biological causes were negatively associated with continuum beliefs. Mental health professionals are not external to the clinical situation. Their lived experiences do matter, shaping their beliefs and concepts and, thus, possibly also their actions toward patients.

The Seeking Mental Health Care model: prediction of help-seeking for depressive symptoms by stigma and mental illness representations

BackgroundOnly about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).MethodAll variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).ResultsAltogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).ConclusionThe Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.Trial registrationGerman Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.

Traditional Igbo Belief in Causes of Disease: An Evaluation

The mystical causes of diseases related with the Igbo traditional belief system are briefly investigated in this research. The specific goals are to look at mystical/spiritual reasons and techniques of fighting diseases, as well as their benefits and drawbacks in terms of disease therapy. For data analysis, the study used a qualitative phenomenological research design and a descriptive approach. Personal interviews were the major source of data collecting, whereas library materials were the secondary source. According to the study, several mystical forces in Igbo cosmology, sorcerers, Ogbanje, curses arising from the violation of taboos and oaths are to be blamed for untimely deaths and sicknesses befalling people. As a result, even in the face of western Germ theory, the Igbo belief in mystical causes of disease has proven that Germ theory, as far as the Igbo traditional conception of disease causation is concerned, does not satisfy the Igbo belief in what causes diseases, as some diseases have defied western medication. The study proposes, among other things, that hospitals in Nigeria should take into account mystical agents as well as pathogenic agents in order to provide proper and adequate treatment for the people who believe in such traditional approached.

Understanding stigma toward schizophrenia

Schizophrenia is arguably one of the most stigmatized psychiatric disorders, with patients frequently seeing the burden of stigmatization as a “second illness.” Thus, the purpose of this study was to investigate the relationships among the main aspects of the stigma toward schizophrenia. This study used a vignette methodology with 2053 individuals from the general population in Italy. The main aspects of stigma — causal beliefs, recommended treatments, social distance, perception of dangerousness, and avoidance — were investigated through participants’ responses, and a latent variable structural equation model (SEM) approach was used to test the relationships among them. Perceived dangerousness predicts the desire for social distancing from an individual with schizophrenia, which predicts the desire for avoidance. In addition, biogenetic causal beliefs of schizophrenia and position on the appropriate medical treatment predict the perception of dangerousness and thus a greater desire for social distance. This study contributes to the literature on the stigmatization of mental health by improving our understanding of the phenomenon. Highlighting the relationships between aspects of stigma allows for a discussion of the implications for anti-stigma interventions.

Pre-registered replication of the gateway belief model – Results from a representative German sample

Consensus messaging aims to increase climate change awareness by communicating the scientific consensus on anthropogenic climate change. According to the gateway belief model, consensus messages improve the estimation of scientific consensus, which then causes subsequent changes in personal attitudes about climate change. Most studies investigating this communication strategy refer to US-American samples. Therefore, the present study replicated existing research on consensus messaging using a national representative German sample (N = 1110), which represents a high-consensus context. We further tested confidence in perceived scientific consensus as moderator variable in the gateway belief model. The consensus message improved the participants’ estimates of scientific consensus on anthropogenic climate change but had no statistically significant effect on the climate change attitudes (belief in climate change, belief in human causation of climate change, worry about climate change, support for action on climate change). Regarding the moderation analysis, confidence in perceived scientific consensus did not moderate the consensus messaging process. However, we found a significant main effect of confidence in perceived scientific consensus on worry about climate change. This finding adds to existing literature arguing that metacognition might influence political and societal beliefs.

Correction to: Where does disability come from? Causal beliefs and representations about disability among romanian children and preadolescents

Correction to: Where does disability come from? Causal beliefs and representations about disability among romanian children and preadolescents

Dementia literacy of racially minoritized people in a Chinese society: a qualitative study among South Asian migrants in Hong Kong

ABSTRACT Objectives Research on dementia literacy in Chinese societies is still emerging, and this is especially the case among racially minoritized groups. The present study explored the knowledge, causal beliefs, and help-seeking behaviors of South Asian migrants in Hong Kong about dementia. It also investigated existing community barriers related to dementia knowledge and help-seeking. Design We conducted a qualitative study from a purposive sample of 38 older people and family caregivers from India, Pakistan, and Nepal who lived in Hong Kong. Focus groups and individual in-depth interviews were used to gather information, while thematic analysis was employed to analyze the data. Results Five main themes were identified: normalization with stigmatization of dementia; spiritual and psychosocial attributions of dementia; familial responsibility despite potential caregiving burden; uncertainties versus openness to professional care; and barriers and opportunities in dementia literacy. Ethnic minorities recognized dementia as a disease of normal aging or a mental disorder. They also perceived spiritual and psychosocial factors as their main causes. While participants recognized the potential burden of dementia caregiving, families were their first point of help-seeking, as many of them expressed contrasting feelings of confidence or doubt toward professional services. Utilization of health education strategies, together with collaboration with community leaders, could address the barriers to dementia literacy. Conclusions This is the first study to explore how ethnic minorities in Asia perceive dementia and its related help-seeking behaviors in their communities. South Asian migrants in Hong Kong have a limited understanding of dementia and may experience delays in obtaining relevant community services. While culture influenced their knowledge, health education may address their misperceptions and help-seeking behaviors toward dementia. Culture- and language-specific programs could also improve dementia knowledge and health service access.

“No one told me anything about it and I cannot explain it”: Illness perception in symptomatic and asymptomatic patients with cancer-associated thrombosis

IntroductionPatients with cancer, have reported cancer-associated thrombosis (CAT), a distressing event in their overall illness. However, whether the clinical presentation of CAT; symptomatic versus asymptomatic, impacts illness perception is poorly elucidated. The aim of this study was to explore illness perception in patients with CAT, stratified by the clinical presentation. Materials and methodsIn a qualitative design, we conducted a three-step workshop. Patients were included from a specialised cardiology care unit for oncology patients. Data analysis was performed using framework analysis. The analytic framework was based on the five components of illness perception: (1) identity of illness, (2) causal beliefs, (3) timeline beliefs, (4) beliefs about control/cure and (5) consequences. ResultsElleven patients with CAT participated in the workshop; five symptomatic and six asymptomatic. Whitin each category of illness perception following notions emerged (1) the identity of CAT was only tangible for symptomatic participants, (2) the aetiology was considered important information for symptomatic participants, which was in contrast to asymptomatic participants, (3) asymptomatic participant did not consider recurrent CAT a threat towards their health, (4) asymptomatic participants were prone to information overload, whilst information was imperative to the sense of control in symptomatic participants, (5) low molecular weight heparin treatment was accepted in symptomatic participants due to remission of symptoms. ConclusionsThe clinical presentation of CAT (asymptomatic/symptomatic) proved essential to illness perception. These findings indicate that information level and communication within the medical consultation, should actively consider the clinical presentation of CAT in order to optimize management and compliance.

Attributions of aggressive behaviour in people with mild intellectual disabilities to borderline intellectual functioning in a secure forensic setting

ABSTRACT Aggressive behaviour is often displayed by people with intellectual disabilities (ID) in forensic healthcare settings. Research on the causal beliefs (i.e. attributions) of aggressive behaviour are commonly studied from the perspective of support staff. As aggressive behaviour is mostly a product of interaction between the person showing it and their environment, it is valuable to include the perspective of people with ID as well. Four group interviews, consisting of a total of 20 people with mild ID or borderline intellectual functioning and forensic and/or psychiatric problems, were held to explore incidents of aggressive behaviour. The attributions were analysed using the Leeds Attributional Coding System. Clients almost equally distributed the causes of aggressive behaviour to themselves (intrapersonal domain; 48.0%) and to other persons (interpersonal domain; 45.7%). There is a distinction related to the attributions given between the client as agent (intrapersonal domain), being uncontrollable (72.1%) and global (68.9%), versus other persons as agent (interpersonal domain), being controllable (86.2%) and specific (56.9%). This analysis of attributions regarding aggressive behaviour given by clients resulted in information on causal beliefs of aggressive behaviour from the perspective of clients. Incorporating their views will possibly increase involvement and commitment in support and treatment.

John Millie Dow Galloway

<h3>Objective</h3> To explore primary care polymyalgia rheumatica (PMR) patient beliefs about the causes of their PMR. <h3>Design</h3> Qualitative content analysis was conducted on patients9 written responses to the question of what they thought had caused their PMR. All data were coded and emergent categories of causal beliefs identified. <h3>Setting</h3> Community patients receiving primary care at general practitioner (GP) practices across England. <h3>Participants</h3> Participants were recruited from a primary care PMR inception cohort (n=654). Between June 2012 and June 2014 GPs referred 739 people with a new PMR diagnosis in the past 3 years into the study. Patients were mailed a baseline self-completion questionnaire, which included the question, ‘What do you think caused your PMR?’. Responses to this question form the data set for the present study. <h3>Results</h3> 296 (45%) patients gave a possible cause for their PMR, while 276 (42%) respondents wrote ‘no idea’. Common attributions include ageing (45, 18%), medication (18, 5%) and personal stress (53, 14%). 24 respondents (6%) thought their PMR was as a result of another medical condition. <h3>Conclusions</h3> This is the first study to examine causation beliefs in PMR, identifying a number of possible causes such as ageing, stress and as a complication of other medical problems. Understanding these patient beliefs may impact on treatment adherence and patient outcome.

Do Gender and Country of Residence Matter? A Mixed Methods Study on Lay Causal Beliefs about PTSD.

Laypersons’ causal beliefs about mental disorders can differ considerably from medical or psychosocial clinicians’ models as they are shaped by social and cultural context and by personal experiences. This study aimed at identifying differences in causal beliefs about post-traumatic stress disorder (PTSD) by country and gender. A cross-sectional, vignette-based online survey was conducted with 737 participants from Germany, Greece, Ecuador, Mexico, and Russia. Participants were presented with a short unlabeled case vignette describing a person with symptoms of PTSD. Causal beliefs were assessed using an open-ended question asking for the three most likely causes. Answers were analyzed using thematic analysis. Afterwards, themes were transformed into categorical variables to analyze differences by country and by gender. Qualitative analyses revealed a wide range of different causal beliefs. Themes differed by gender, with women tending to mention more external causal beliefs. Themes also differed between the five countries but the differences between countries were more pronounced for women than for men. In conclusion, causal beliefs were multifaceted among laypersons and shared basic characteristics with empirically derived risk factors. The more pronounced differences for women suggest that potential gender effects should be considered in cross-cultural research.

Traditional, religious, and cultural perspectives on mental illness: a qualitative study on causal beliefs and treatment use

ABSTRACT Purpose Limited information is known from studies regarding traditional, religious, and cultural perspectives on mental illness and the use of traditional and alternative therapies by mentally ill people in Indonesia. This study explored traditional, religious, and cultural beliefs about causes of mental illness and the use of traditional/alternative treatments for mentally ill patients. Method We adopted a qualitative content analysis method as proposed by Schreier. This study was conducted at a mental Hospital in Indonesia. We interviewed 15 nurses and 15 patients. Data were analysed using qualitative content analysis method. Results Five discrete but interrelated themes emerged: 1) Possessed illness and belief in supernatural forces; 2) Sinful or cursed illness; 3) Witchcraft or human-made illness; 4) traditional/alternative treatments; and 5) Barriers to treatment of mental illness. Conclusion Traditional/alternative treatments play an important role in meeting the need for mental health treatment. The findings are relevant for mental health nurses who provide direct to their patients, and for other areas of mental health practice. We also found a lack of knowledge about the causes of mental illness among patients and families. Education should be at the heart of mental health promotion to raise the level of mental health literacy in Indonesia.

Epistemic community in transboundary river regime: a case study in the Mekong River Commission regarding mainstream hydropower development.

Despite the importance of transboundary water management, cooperation mechanisms are limited, especially in the case of Mekong River basin where environmental and social aspects are threatened by recent anthropogenic pressures like hydropower development. Existing transboundary mechanism such as the Mekong River Commission (MRC) is challenged to facilitate the cooperation between riparian states. An epistemic community (EC) is considered to effectively influence international governance and is studied as part of transboundary river regimes. The existence of an MRC EC is part of that regime but understanding about its characteristics is yet limited. This research aims to fill in the gap by unraveling the main features of the EC in relation to hydropower development. We analyze shared causal beliefs and policy goals that developed in the EC framework of Haas applying literature review and semi-structured interviews of experts. Results show that the community experts share causal beliefs and policy goals only to a limited extent while disagreeing on many aspects. It resembles a "disciplined" or "professional" group rather than an EC. This suggests that the knowledge factor has not gained proper influence and attention in the region, resulting in incoherent policy advice leading to policymakers developing policies based on incomplete and fragmented knowledge. The role of the MRC in the decision-making process could become more relevant if it would facilitate the development of an EC. Bringing key stakeholders including policymakers and experts into a platform where policy goals and causal beliefs are facilitated to reach possible consensus is recommended. Narrowing the science-policy gap while acknowledging differences in interests and policy objectives is crucial to reach a sustainable transboundary management of the Mekong River given its rapid development, especially on hydropower.

Where does disability come from? Causal beliefs and representations about disability among romanian children and preadolescents

Where does disability come from? Causal beliefs and representations about disability among romanian children and preadolescents

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Rewilding—The farmers’ perspective. Perceptions and attitudinal support for rewilding among the English farming community

Abstract Rewilding is an increasingly common conservation approach, aiming to restore ecosystem processes and minimise human intervention. Rewilding has the potential to profoundly change landscapes and people–nature relations. These issues prompt an ongoing debate about how and if rewilding should be done. Farmers are key stakeholders in this debate; they stand to be both affected by and influence the trajectory of rewilding initiatives developing in the United Kingdom and globally. Despite this, a comprehensive understanding of farmers' perceptions towards rewilding is lacking. Here, we focus on how members of the farming community in England perceive common rewilding scenarios (beaver release, farm‐level rewilding and landscape‐scale rewilding), and how these perceptions shape farmers' attitudinal support for rewilding practices. Using thematic analysis of semi‐structured interviews with 36 farmers and farming representatives, we show that the diversity of famers' attitudes can be understood through the prism of perceptions on five core issues: (a) the perceived need for restoration action, (b) the ecological effectiveness of rewilding, (c) rewilding's compatibility with ensuring food security, (d) rewilding's compatibility with rural lifestyles, livelihoods and economies and (e) multidimensional justice of rewilding initiatives. These issues are rooted in collective farming values, and farmers' perceptions of these issues are influenced by mental models, perceived social impacts and perceived ecological outcomes of rewilding initiatives. Diverse perceptions result in a range of attitudes, from enthusiastic support to strong opposition to different rewilding practices. We argue that the scope to increase support for rewilding varies depending on the type of underlying negative perceptions. Where the negative perceptions are based on objectively verifiable causal beliefs (mental models), opponents' minds may be changed through the provision of positive experiences, social learning, and adhering to good governance principles. However, where negative perceptions are based on values, for example, a preference for traditional rural landscapes, they are unlikely to change easily. Pursuing rewilding ambitions that clash with the values of local farmers may risk social conflicts, but accommodating these values too much may compromise rewilding's own goals. Rewilding initiatives will need dialogue and social engagement to navigate their path around this tension. Read the free Plain Language Summary for this article on the Journal blog.

MENTAL ILLNESS: CAUSAL BELIEFS, ATTITUDE, HELP-SEEKING PATHWAYS AND COUNSELLING IMPLICATIONS

The purpose of this study was to investigate the causal beliefs, attitudes, and helping-seeking pathways of mental illness, as well as the counselling implications of adults in the Anambra State community of Ihiala. Three research questions guided the study. This paper adopted a descriptive survey research design. To select 200 participants from Ihiala, a semi-urban Igbo community in Anambra State, multi-stage (random and opportunity) sampling was used. This study had three structured questionnaires, each covering a specific purpose. The instruments were subjected to face and content validation to make sure they were valid. The Cronbach Alpha Method was used to determine the internal consistency of the instruments, and an overall co-efficient of 0.89 was obtained. Ten undergraduate students were recruited and briefed to help with the administration of the questionnaires to the participants. Frequency counts and percentages were used to answer the research questions 1, while the arithmetic mean and standard deviation were used to answer the research questions 2 and 3. The findings revealed that the most frequently endorsed causal categories were misuse of substances, evil forces, brain injury, and hereditary. There was a lot of prejudice and negative attitude given to mentally ill people as well as pathways to mental healthcare for mental illness among Igbo people in Anambra State. Based on the study’s findings, it was suggested that the government, in collaboration with counsellors and non-governmental organizations, launch comprehensive mental health prevention programs. The effectiveness of these programmes will assist in reducing high-risk problems experienced as a result of a lack of mental health information. Such information and mental health education could essentially decrease the number of people that are victims of various forms of health diseases and illnesses. KEYWORDS: Mental Illness, Mental Health, Causal Beliefs of Mental Illness, Attitude, Help-seeking Pathways

What Causes Cancer in Women with a gBRCA Pathogenic Variant? Counselees' Causal Attributions and Associations with Perceived Control.

Laypersons have a strong need to explain critical life events, such as the development of an illness. Expert explanations do not always match the beliefs of patients. We therefore assessed causal attributions made by women with a pathogenic germline variant in BRCA1/2 (gBRCA1/2-PV), both with and without a cancer diagnosis. We assumed that attributions would be associated with the control experience. We conducted a cross-sectional study of N = 101 women with a gBRCA1/2-PV (mean age 43.3 ± 10.9). Women answered self-report questionnaires on perceived causes and control. Most women (97%) named genes as a causal factor for the development of cancer. Surprisingly, the majority of women also named stress and health behavior (both 81%), environment (80%), and personality (61%). Women with a cancer diagnosis tended to endorse more causes. The attributions to personality (ρ = 0.39, p < 0.01) health behavior (ρ = 0.44, p < 0.01), and environment (ρ = 0.22, p < 0.05) were significantly associated with personal control, whereas attribution to genes showed a small, albeit significant association with treatment control (ρ = 0.20, p < 0.05). Discussing causal beliefs in clinical counseling may provide a “window of opportunity” in which risk factors and health behaviors could be better addressed and individually targeted.

Causal beliefs regarding schizophrenia and help-seeking behaviors among patients with schizophrenia and family caregivers attending psychiatric clinics in Cambodia.

Schizophrenia often follows a chronic or recurrent course, placing an immense burden on patients and their families. Mental health services in Cambodia are still highly limited, thus there is a major treatment gap. It is common that people consult traditional healers (Kru Khmer) and monks. In this culture, people who receive psychiatric medical treatment are expected to exhibit higher mental health literacy, but little is known about this factor. In this study, we interviewed 59 patients with schizophrenia and 59 family caregivers attending psychiatric clinics in Cambodia. Through qualitative analysis using a thematic analysis approach, we extracted eight themes of causal beliefs regarding schizophrenia: (1) spiritual beliefs, (2) cultural symptoms, (3) physical problems, (4) heredity, (5) substance abuse, (6) traumatic events, (7) stress in human relationships or in one's social environment, and (8) socioeconomic position. We found that "thinking too much" (kit chroeun) and "worrying too much" (prouy / barom chroeun), cultural idioms of distress, were recognized as causal factors of schizophrenia by both parents and family caregivers. Some participants were aware of the possible causal factors in light of the latest psychiatry findings, such as genetic factors and childhood trauma. Our data show that causal beliefs are not a decisive factor in shortening the duration of untreated psychosis (DUP). In Cambodia, where the treatment for schizophrenia is pluralistic, we suggest that it is crucial to embed the meaning of psychiatric treatment into local meaning worlds for better help-seeking behaviors.