Prognostic Pessimism Research Articles

The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstruction.

Exacerbation of COPD complicated by respiratory acidaemia is the commonest indication for noninvasive ventilation (NIV). The NIV outcomes (NIVO) score offers the best estimate of survival for those ventilated. Unfortunately, two-thirds of cases of COPD are unrecognised, and patients may present without COPD having been confirmed by spirometry. In the 10-centre NIVO validation study there was no pre-admission spirometry in 111 of 844 consecutive patients (termed "clinical diagnosis" patients). We compared the performance of the NIVO, DECAF and CURB-65 scores for in-hospital mortality in the clinical diagnosis cohort. Usual clinical practice was not influenced, but confirmation of COPD in the year following discharge was captured. In the clinical diagnosis cohort, in-hospital mortality was 19.8% and rose incrementally across the NIVO risk categories, consistent with the NIVO validation cohort. NIVO showed good discrimination in the clinical diagnosis cohort: area under the receiver operating curve 0.724, versus 0.79 in the NIVO validation cohort. At 1 year after discharge, 41 of 89 clinical diagnosis patients had undertaken diagnostic spirometry; 33 of 41 had confirmation of airflow obstruction (forced expiratory volume in 1 s/(forced) vital capacity <0.7), meaning the diagnosis of COPD was incorrect in 19.5% of cases. These data support the use of the NIVO score in patients with a "clinical diagnosis" of COPD. NIVO can help guide shared decision-making, assess risk-adjusted outcomes by centre and challenge prognostic pessimism. Accurate diagnosis is critical to ensure that acute and long-term treatment is optimised; this study highlights failings in the follow-up of such patients.

A Cure for Prognostic Pessimism Among Neonatologists

A Cure for Prognostic Pessimism Among Neonatologists

America's perceptions of opioid related impairment: A national randomized study examining how different individuals may stigmatize addiction in response to different terminology

IntroductionPrior research has found that different ways of describing opioid-related impairment influences the types and degrees of stigmatizing beliefs held by the American public. In this study we examined the extent to which different characteristics of the American public (i.e., age, gender, race/ethnicity, religiosity, sexual orientation, political affiliation, personal history of addiction/mental health problem) are associated with holding different types and degrees of stigmatizing beliefs when asked to consider someone treated for opioid-related impairment. We also assessed whether any observed differences in stigmatizing beliefs related to participant characteristics are dependent on how an opioid-impaired patient is described in terms of both the nature of the impairment (e.g., as a “chronically relapsing brain disease”, “brain disease”, “disease”, “illness”, “disorder”, or “problem”) as well as the gender of the depicted opioid-impaired person. MethodsA nationally representative sample of the U.S. population (N = 3643) was randomized to one of six vignettes describing a patient being treated for opioid-related impairment that differed only in the way the impairment was described (as a “chronically relapsing brain disease”, “brain disease”, “disease”, “illness”, “disorder”, or “problem”). Participants subsequently were asked to rate statements assessing five stigma dimensions (blame, prognostic pessimism, continuing care, dangerousness, and social distance). ResultsSeveral characteristics were associated with different types and higher levels of stigmatizing beliefs: older age, male gender, White race, heterosexual orientation, being religious, Republican political affiliation, and having no prior alcohol/drug or mental health problem history (ps < 0.001). With very few exceptions, the way the opioid-impairment was described or whether the depicted patient was a man or a woman did not influence the strength of these associations. ConclusionsCertain characteristics of members of the US population were associated with holding different types and degrees of stigmatizing attitudes when asked to consider someone receiving treatment for opioid-related impairment and these were largely unaffected by how the impairment was labeled or the opioid-impaired person's gender. Depending on the specific target of clinical and public health anti-stigma campaigns, both addiction terminology and the beliefs held by certain population sub-groups will need to be considered when creating opioid use disorder related anti-stigma campaigns.

Beliefs about depression relate to active and avoidant coping in high-symptom adolescents

BackgroundPerceptions of personal attributes as less malleable are associated with more severe depression symptoms and less active coping in youth. Perceptions of depression itself as relatively fixed have been linked to more severe depression symptoms; however, it is not known how beliefs about depression relate to active and avoidant coping behaviors in particular. MethodsWe gathered information about beliefs about depression and activation and avoidance behaviors among 104 adolescents with high depression symptoms. The primary depression belief examined was prognostic pessimism, or the belief that depression is relatively permanent. We calculated correlations between this belief and activation and avoidance/rumination behaviors. ResultsPrognostic pessimism was negatively correlated with behavioral activation scores (r = −0.31; p = .001), and was positively correlated with behavioral avoidance/rumination scores (r = 0.30; p = .002). LimitationsThis data was cross-sectional, and relied on self-report measures of depression beliefs and behaviors. ConclusionsAdolescents who believe that depression is relatively permanent might feel less motivated to engage in effortful activation behaviors, instead favoring avoidance. These results may help elucidate the ways in which malleability beliefs relate to mental health outcomes among adolescents, and highlight prognostic pessimism as a potential treatment target for reducing depressogenic behaviors.

Early and late withdrawal of life-sustaining treatment after out-of-hospital cardiac arrest in the United Kingdom: Institutional variation and association with hospital mortality

AimFrequency and timing of Withdrawal of Life-Sustaining Treatment (WLST) after Out-of-Hospital Cardiac Arrest (OHCA) vary across Intensive Care Units (ICUs) in the United Kingdom (UK) and may be a marker of lower healthcare quality if instituted too frequently or too early. We aimed to describe WLST practice, quantify its variability across UK ICUs, and assess the effect of institutional deviation from average practice on patients’ risk-adjusted hospital mortality. MethodsWe conducted a retrospective multi-centre cohort study including all adult patients admitted after OHCA to UK ICUs between 2010 and 2017. We identified patient and ICU characteristics associated with early (within 72 h) and late (>72 h) WLST and quantified the between-ICU variation. We used the ICU-level observed-to-expected (O/E) ratios of early and late-WLST frequency as separate metrics of institutional deviation from average practice and calculated their association with patients’ hospital mortality. ResultsWe included 28,438 patients across 204 ICUs. 10,775 (37.9%) had WLST and 6397 (59.4%) of them had early-WLST. Both WLST types were strongly associated with patient-level demographics and pre-existing conditions but weakly with ICU-level characteristics. After adjustment, we found unexplained between-ICU variation for both early-WLST (Median Odds Ratio 1.59, 95%CrI 1.49–1.71) and late-WLST (MOR 1.39, 95%CrI 1.31–1.50). Importantly, patients’ hospital mortality was higher in ICUs with higher O/E ratio of early-WLST (OR 1.29, 95%CI 1.21–1.38, p < 0.001) or late-WLST (OR 1.39, 95%CI 1.31–1.48, p < 0.001). ConclusionsSignificant variability exists between UK ICUs in WLST frequency and timing. This matters because unexplained higher-than-expected WLST frequency is associated with higher hospital mortality independently of timing, potentially signalling prognostic pessimism and lower healthcare quality.

Causal Explanations, Treatability, and Mental Illness Stigma: Experimental Study.

The purpose of this study was to test the effects of causal explanations, information about treatability, and type of psychiatric diagnosis on how the public reacts to an individual described as having a specific mental illness versus subclinical distress. A 5 (mental health condition) × 2 (treatability) × 4 (causal explanation) vignette experiment was embedded in an online survey, followed by assessments of prognostic optimism and desire to maintain social distance from the vignette character. Data were collected, in late 2022, from a probability sample (N=1,607) representative of the U.S. adult population. Ordinary least-squares regression was used to estimate the effects of the experimental conditions, covariates, and interactions on respondents' desire for social distance and their prognostic optimism. Attribution of mental illness to a genetic predisposition (vs. no attribution) significantly (p<0.001) predicted unwillingness to socially interact with the vignette character, regardless of the character's psychiatric diagnosis. Describing the illness as treatable with medication or psychotherapy (vs. no treatability information) also reduced willingness to socially interact, yet it also increased optimism for recovery. Desire for social distance and prognostic pessimism were greater for alcohol use disorder, opioid use disorder, or schizophrenia compared with major depression or subclinical distress. Attributing mental illness solely to genetics predicts social rejection of people diagnosed as having psychiatric disorders. Efforts to reduce stigma, increase social acceptance, and protect the mental health of individuals diagnosed as having a mental illness should include not framing mental illness exclusively in genetic terms.

Influence of Biogenetic Explanations of Mental Disorders on Stigma and Help-Seeking Behavior: A Systematic Review and Meta-Analysis.

Biogenetic causal explanations of mental disorders are commonly used for public education and campaigns. However, the influence of biogenetic explanations on the ideas about and attitudes toward mental illness is unclear. We examined the influence of biogenetic explanations on attitudes toward mental disorders using a meta-analytic method accompanied by subgroup analyses. The protocol for this meta-analysis was registered in PROSPERO (CRD42020158656) in March 2020. Experimental and correlational studies were analyzed separately. Five outcome measures related to attitudes toward mental disorders were included: 'attitude toward help-seeking,' 'blame,' 'perceived dangerousness,' 'prognostic pessimism,' and 'social distance.' Subgroup analyses were performed for the type of mental disorder, population, and geographic region for which a biogenetic explanation was provided. A total of 44 studies were included, of which 24 were experimental and 20 were correlational. A positive attitude toward help-seeking was associated with having a biogenetic concept (d = 0.43; 95% confidence interval [CI], 0.18 to 0.67; P < 0.001) in general population and in Eastern countries in particular. Although a biogenetic explanation was associated with a decreased level of blame (d = -0.20; 95% CI, -0.38 to -0.02; P = 0.029) in the general population, it was also associated with significantly higher levels of perceived dangerousness (d = 0.13; 95% CI, 0.03 to 0.23; P = 0.008). A tendency toward a higher level of prognostic pessimism and social distance was associated with a biogenetic concept of mental disorders although there was no statistical significance. Having a biogenetic concept of the cause of mental disorders was related with a positive attitude toward help-seeking, particularly in the general population and individuals living in Eastern countries. Providing a biogenetic explanation decreased blame toward individuals with mental illness but was associated with increased perceived dangerousness and prognostic pessimism. Therefore, although a biogenetic explanation promotes public use of mental health services, it should be carefully applied to avoid an increase in negative thoughts, such as that mental illness is biologically irreversible and untreatable.

Adolescents’ Continuum and Categorical Beliefs, Help-seeking Intentions, and Stigma Towards People Experiencing Depression or Schizophrenia

The present study investigated the relationships between continuum and categorical beliefs, stigma, and help-seeking in response to vignettes depicting depression and schizophrenia. Participants were 193 adolescents aged 13-18 years. Results showed no relationships between continuum beliefs and stigma or help-seeking intentions for the depression vignette when controlling for other predictors. Stronger categorical beliefs were associated with greater social distance, and endorsement of dangerousness, avoidance, and fear. For the schizophrenia vignette, higher continuum beliefs predicted lower prognostic pessimism, social distance, and stigmatising attitudes. Surprisingly, continuum beliefs predicted greater intentions to not seek help. Categorical beliefs were associated with greater prognostic pessimism, social distance, and stigmatising attitudes. Future research is needed to explore the effect of continuum belief interventions on adolescent mental health stigma.

Effects of online continuum and categorical belief manipulations on schizophrenia stigma, help-seeking, and help-provision

Most research investigating the effect of continuum beliefs on stigma has used weak manipulations which may contribute to mixed findings within the experimental literature. There is also a lack of research into how continuum belief manipulations may impact help-seeking and help-provision. This study used an online manipulation of continuum and categorical beliefs about schizophrenia to examine the subsequent impacts on stigma, help-seeking, and help-provision. A total of 271 participants were randomised into either a continuum, categorical, or control condition. Participants received an informational video, a magazine article, and research highlights relevant to their condition. Prosocial support behaviour was assessed through a novel volunteering measure. The magnitude of change between pre-intervention and post-intervention measures of continuum and categorical beliefs was large. Continuum presentations reduced prognostic pessimism and negative stereotyping. Meanwhile, categorical presentations increased prognostic pessimism. Participants across conditions showed increased help-providing intentions after removing the highest scores to avoid ceiling effects. Fear and blame also decreased significantly across all conditions. There was no difference between conditions on our novel volunteer help-provision measure. Our findings have implications for anti-stigma programs and may help inform the design of future continuum belief manipulations.

Views of Schizophrenia Among Future Healthcare Professionals: Differences in Relation to Diagnostic Labelling, Causal Explanations, and Type of Academic Degree Program.

ObjectiveStereotyped beliefs about schizophrenia are well-established in the society and relatively common among healthcare professionals and students. The aim of this study was to investigate the opinions about the causes, treatment, and outcome of schizophrenia among healthcare students.MethodUndergraduate nursing and psychology students completed selected items of the Opinion on Mental Illness Questionnaire after reading a clinical vignette of undiagnosed schizophrenia.ResultsStudents who labelled the description as schizophrenia were more pessimistic regarding full recovery from the disorder. Those who acknowledged greater relevance to biogenetic risk factors were more convinced of the efficacy of medications. Respondents’ opinions on the efficacy of psychological interventions were more positive among psychology students than among nursing students.ConclusionsThe study confirmed the associations of schizophrenia labelling with prognostic pessimism and beliefs about the efficacy of pharmacological treatment among future healthcare professionals. Students’ opinions were less influenced by differences between academic degree programs. Information about current recovery rate and comprehensive care for schizophrenia may support future healthcare professionals in the relationship and the clinical management of PWS.

Uptake of Clinical Prognostic Tools in COPD Exacerbations Requiring Hospitalisation

Clinical prognostic tools are used to objectively predict outcomes in many fields of medicine. Whilst over 400 have been developed for use in chronic obstructive pulmonary disease (COPD), only a minority have undergone full external validation and just one, the DECAF score, has undergone an implementation study supporting use in clinical practice. Little is known about how such tools are used in the UK. We distributed surveys at two time points, in 2017 and 2019, to hospitals included in the Royal College of Physicians of London national COPD secondary care audit program. The survey assessed the use of prognostic tools in routine care of hospitalized COPD patients. Hospital response rates were 71/196 in 2017 and 72/196 in 2019. The use of the DECAF and PEARL scores more than doubled in decisions about unsupported discharge (7%–15.3%), admission avoidance (8.1%–17%) and readmission avoidance (4.8%–13.1%); it more than tripled (8.8%–27.8%) in decisions around hospital-at-home or early supported discharge schemes. In other areas, routine use of clinical prognostic tools was uncommon. In palliative care decisions, the use of the Gold Standards Framework Prognostic Indicator Guidance fell (5.6%–1.4%). In 2017, 43.7% of hospitals used at least one clinical prognostic tool in routine COPD care, increasing to 52.1% in 2019. Such tools can help challenge prognostic pessimism and improve care. To integrate these further into routine clinical care, future research should explore current barriers to their use and focus on implementation studies. Supplemental data for this article is available online at https://dx.doi.org/10.1080/15412555.2021.1959540

Testing the mixed-blessings model: What is the role of essentialism for stigmatizing attitudes towards schizophrenia?

It is well established that emphasizing a biogenetic etiology of mental health problems in anti-stigma interventions inadvertently increases potentially stigmatizing attitudes. The “mixed-blessings” model suggests that biogenetic explanations and greater stigma are linked by essentialism. The present study tests this hypothesis experimentally. In this online experiment, 367 subjects read either a biogenetic or a psychosocial explanation for the etiology of schizophrenia, followed by a vignette describing an individual who has schizophrenia. Subsequently, we measured (a) causal beliefs on the etiology of schizophrenia (as a manipulation check), (b) the degree of essentialist beliefs (mediator), (c) the extent to which subjects subscribed to assumptions of dangerousness, (d) prognostic pessimism, and (e) desire for social distance. Subjects reported a stronger agreement with the etiology they had been presented. Against our expectations, this did not result in higher levels of stigmatizing attitudes in the biogenetic vignette group. Correspondingly, mediation through essentialism could not be tested. In the psychosocial vignette group, biogenetic causal beliefs were associated with a stronger desire for social distance. Essentialist thinking fully mediated this effect. The evidence we found for the assumptions of the mixed-blessings extended to the psychosocial vignette group only. We explain this by the subjects’ different readiness to subscribe to biogenetic and psychosocial causal beliefs. We argue that the same levels of essentialism between the experimental groups contributed to the equal levels of stigmatizing attitudes. This underlines the fundamental importance of essentialism in stigma, going beyond a role in the psychological effects of biogenetic causal models.

The Influence of Implicit Theories of Depression on Treatment-Relevant Attitudes

Implicit theories (beliefs about the malleability of self-relevant traits) of emotion are associated with various motivational and emotional responses. Less is known about implicit theories of depression. The present study examined the effects of a manipulation of implicit theories of depression on depression symptom severity, engagement in a self-help task, and treatment-relevant attitudes. Participants experiencing clinically significant levels of depression (N = 142) were randomly assigned to receive education about depression emphasizing either the malleability of depression (incremental condition) or depression as a chronic condition (entity condition). Participants subsequently completed a self-help task for depression. Symptom severity, stigma, prognostic pessimism, psychotherapy and antidepressant credibility, psychological flexibility, and time spent on the self-help task were assessed. Participants in the incremental condition endorsed a greater incremental theory of depression than did those in the entity condition. To the extent that the experimental condition was associated with the adoption of an incremental theory of depression, depression symptom severity and stigma decreased, and treatment-relevant attitudes were more favorable. The experimental condition had no effect on self-help task persistence. Presenting depression as malleable may be associated with more positive attitudes towards treatment, although the impact on actual treatment engagement warrants future investigation.

The Effect of Treatability Information and Genetic Explanations on Schizophrenia Stigma

Attributing mental illness to genetic factors has been shown to reduce blame; however, doing so may create other negative attitudes. Genetic attributions can increase the desire to remain distant from someone with a mental illness (desire for social distance), reduce one’s beliefs that an ill person can get better (prognostic pessimism), and cause people living with mental illness to be perceived as more dangerous. Presenting information about how mental illnesses can be treated alongside a genetic causal attribution may combat these negative side effects. Participants (N = 268) were recruited through Amazon’s Mechanical Turk to read vignettes about a man (“John”) with schizophrenia. Participants randomly received either a genetic or environmental attribution for John’s illness, and then received treatability information or no information. A genetic explanation of schizophrenia led people to believe that the symptoms of schizophrenia described in the vignette were more permanent, p &lt; .01, ηp2 = .07; however, this finding was qualified by a significant interaction where the type of attribution had no impact on prognostic pessimism when presented with treatability information, p = .04, ηp2 = .01. The present findings suggest the potential importance of emphasizing treatability information for disorders that are perceived to be genetically influenced.

The beliefs of non-psychiatric doctors about the causes, treatments, and prognosis of schizophrenia.

To examine the causal beliefs about schizophrenia of non-psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors' views about treatments and prognosis. Three hundred and five non-psychiatric doctors working in outpatient community centres completed the 'Opinions on mental disorders Questionnaire' after reading a clinical description of people with schizophrenia. The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy-five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty-two per cent of respondents thought it 'completely true' that drugs are useful in schizophrenia, and 33.9% thought it 'completely true' that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia. These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed. Viewing schizophrenia as mainly due to a biological cause is associated with greater confidence in the usefulness of drugs, higher belief in the need for lifelong pharmacological treatments, and greater prognostic pessimism. Belief in a biologically oriented model of schizophrenia may lead doctors to underestimate the value of psychologists. Prognostic pessimism among doctors may negatively influence clinical decisions, the information doctors provide to their clients, and clients' own beliefs about their chances of recovery. Belief in the need for lifelong pharmacological treatments in schizophrenia may lead doctors to resist drug withdrawal in case of severe side effects.

Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory.

Understanding depression as biologically caused has been shown to impact both treatment preferences and prognostic pessimism. Attribution theory has been posited as an explanation for this relationship. Given that evidence-based psychotherapy is effective yet often not delivered to individuals with depression, the present study sought to determine factors that impact treatment credibility. Non-treatment-seeking, depressed individuals (n=229) were randomly assigned to read a psychoeducation article about depression that consisted of a biological causal explanation, psychosocial causal explanation, or a non-causal control. Attributional dimensions of locus, stability, and control were examined as mediating the relationship between causal explanation and treatment credibility and prognostic pessimism. Individuals in the biological condition were more likely to find antidepressant medication a credible treatment for depression. The manipulation had no direct effect on preference for psychotherapy orprognostic pessimism. Attributional dimensions of locus, stability, and control did not mediate the relationship between causal explanation and treatment credibility. To the extent that the psychosocial article increased perceived instability of the depression cause, however, prognostic pessimism was reduced. The present study has implications for framing education about depression in mental health literacy programs and public awareness campaigns. This study found that conceptualizing depression as biologically caused increased the credibility of medication but not psychotherapy Participants reading a biological explanation of depression demonstrated an increase on some aspects of stigma and prognostic pessimism Emphasizing the person-environment interaction rather than biological causes decreased the perceived stability of depression which was associated with a decrease in prognostic pessimism.

Survival and predictors of outcome among patients with decompensated liver disease in a non-liver transplant intensive care unit. Pessimism is historical and unjustified.

Recent literature emanating from the United Kingdom and United States has reported decreasing mortality rates in patients with decompensated cirrhosis and organ failures presenting to the intensive care unit (ICU). To determine if there were comparable outcomes in a single-centre non-transplant unit in Australia. A retrospective observational study was conducted in a tertiary, non-liver transplant unit in Sydney, Australia. Admission data and mortality outcomes were collected from patients with cirrhosis non-electively admitted to ICU between 2013 and 2017. Liver-specific and general intensive care scoring tools were also assessed for their discriminative ability to predict short-term prognostic outcomes. Sixty-three patients were admitted with decompensated liver disease who fulfilled the inclusion criteria. The overall hospital mortality was 37% (95% CI: 0.26-0.49). There was no difference in survival based on aetiology of liver disease (P = 0.96) but a significant difference was found based on the presenting diagnosis, with greater survival among patients diagnosed with hepatic encephalopathy on ICU admission (P = 0.02). There was 4% mortality in patients with no organ failure and 52% mortality in those with ≥3 organs in failure (P < 0.001). The ICU prognostic Sequential Organ Failure Assessment score was the better discriminative tool in predicting short-term outcomes when compared to liver prognostic scores. The outcomes of this single-centre Australian study align with current overseas literature. These results reinforce and expand on limited local evidence, corroborating the former universal prognostic pessimism towards cirrhotic patients with organ failure as unwarranted.

The Effect of Psychological Perspectives on Stigmatic Thinking Regarding Mental Disorders [University of Wisconsin River Falls

This study examined how an individual’s psychological perspective affects stigmatic thinking regarding mental disorders. Several research studies have examined how different explanations for mental disorders contribute to stigmatic thinking. For example, research done by Lebowitz et.al (2013) found that biochemical and genetic attributions for depression were associated with prognostic pessimism. Another study done by Lebowitz &amp; Ahn (2014), found that mental health clinicians who held a biological perspective reported less empathy towards those who experience depression than did those that held psychosocial perspectives. Up until now, researchers have only differentiated between broad biological and psychological perspectives. This study went beyond previous research by breaking down both the biological and psychological perspectives into narrower theoretical explanations; and by attempting to assess the individual theoretical perspectives of each participant. The goal of this study was to determine whether different psychological perspectives of mental disorders related to stigmatic thinking.

Impact of causal explanations for social anxiety disorder on stigma and treatment perceptions

Background and aims: There is evidence to suggest that biogenetic explanations for symptoms of mental disorders have become increasingly popular. Research suggests that such explanations provokes mixed blessings: biological explanations may reduce blame but also encourage prognostic pessimism and promote perceptions of pharmacological treatment over psychotherapy. The goal of this study was to evaluate the impact of different causal explanations on social anxiety disorder.Method: About 205 adults completed an experiment where they read a vignette describing an individual with social anxiety disorder and were randomly assigned to a symptom explanation that was: (1) biological, (2) biopsychosocial, (3) psychosocial, or (4) no explanation.Results: The psychosocial condition yielded the highest perceived credibility and lowest attributions of blame. The biological condition promoted positive expectations for medication effectiveness compared to other conditions. Conditions did not differ on prognostic expectations.Conclusions: Calls attention to the risk of generalizing from previous research to mental disorders as a whole.

Neuroscientific explanations and the stigma of mental disorder: a meta-analytic study

Genetic and other biological explanations appear to have mixed blessings for the stigma of mental disorder. Meta-analytic evidence shows that these “biogenetic” explanations reduce the blame attached to sufferers, but they also increase aversion, perceptions of dangerousness, and pessimism about recovery. These relationships may arise because biogenetic explanations recruit essentialist intuitions, which have known associations with prejudice and the endorsement of stereotypes. However, the adverse implications of biogenetic explanations as a set may not hold true for the subset of those explanations that invoke neurobiological causes. Neurobiological explanations might have less adverse implications for stigma than genetic explanations, for example, because they are arguably less essentialist. Although this possibility is important for evaluating the social implications of neuroscientific explanations of mental health problems, it has yet to be tested meta-analytically. We present meta-analyses of links between neurobiological explanations and multiple dimensions of stigma in 26 correlational and experimental studies. In correlational studies, neurobiological explanations were marginally associated with greater desire for social distance from people with mental health problems. In experimental studies, these explanations were associated with greater desire for social distance, greater perceived dangerousness, and greater prognostic pessimism. Neurobiological explanations were not linked to reduced blame in either set of studies. By implication, neurobiological explanations have the same adverse links to stigma as other forms of biogenetic explanation. These findings raise troubling implications about the public impact of psychiatric neuroscience research findings. Although such findings are not intrinsically stigmatizing, they may become so when viewed through the lens of neuroessentialism.