Psychosocial Explanations Research Articles

Are causal beliefs associated with stigma? A test of the impact of biogenetic versus psychosocial explanations on stigma and internalized stigma in people experiencing psychosis.

Individuals with psychosis are often subject to external stigma and discrimination and commonly also experience internalized stigma. Attempts to improve attitudes have tended to medicalize the experiences associated with psychosis; however, research increasingly indicates an association between biogenetic attitudes and stigma. This study aims to evaluate this approach by investigating the impact of two different etiological explanations on both internalized and external stigma in people experiencing psychosis. A total of 60 participants who have a diagnosis of schizophrenia or meet criteria for early intervention services for psychosis were randomly allocated to one of two conditions (psychosocial vs. biogenetic). Attitudes were assessed before and after the intervention. Both interventions resulted in a decrease in internalized stigma. Only the psychosocial intervention decreased external stigma. Although further research is necessary, providing education to individuals could be an effective way to reduce internal stigma. Antistigma campaigns should avoid a singular focus on biogenetic explanations of psychosis, and a psychosocial viewpoint may be a suitable alternative.

When do psychosocial explanations of psychiatric problems increase stigma? Self-report and implicit evidence

Background and objectivesBiomedical explanations of psychiatric problems, compared to psychosocial explanations, may amplify psychiatric stigma. One limitation of existing research is the measurement of almost exclusively self-reported stigma. This study evaluated the stigma-related effects of biomedical versus psychosocial explanations of schizophrenia using conventional self-report and two other measurement approaches that may tap more deeply held attitudes. MethodsOne hundred three undergraduates listened to a vignette describing a man with (1) schizophrenia of biomedical origin, (2) schizophrenia of psychosocial origin, or (3) diabetes. They then completed an Implicit Association Test, conventional self-report stigma measures, and projected other measures that captured perceptions of most other people's likely impressions. Results: Participants were more likely to attribute stigmatizing views to others compared to themselves. The projected other measurement, but not the conventional self-report measurement, predicted implicit attitudes. We obtained no evidence that the psychosocial causal explanation of schizophrenia led to decreased stigma compared to the biomedical causal explanation. In fact, the psychosocial causal explanation increased stereotyped attitudes. LimitationsThe absence of a schizophrenia control group complicates interpretation of biomedical versus psychosocial group comparisons. ConclusionsFurther research is needed to evaluate discrepancies between the present findings and other published evidence pertaining to psychosocial causal explanations of psychiatric problems.

Understanding parental causal explanations and help seeking in attention-deficit/ hyperactivity disorder: perspectives from a developing Asian nation.

Research on parental understanding of causation and help-seeking for ADHD comes from ethnic minorities in developed nations; research from Asia is scarce. Our purpose was to explore perceptions of Indian parents regarding causation and diagnosis of problematic childhood behaviors diagnosed as ADHD or hyperkinetic disorder, and to understand the process of decision making and help seeking using a qualitative study design. In-depth, semi-structured interviews were conducted with 52 parents (33 mothers and 19 fathers), focusing on initial emotional reactions and cognitive appraisals, decision making, parental causal explanations and perceptions regarding diagnosis and symptom labeling. Mothers were decision makers for seeking professional help either singly or jointly in 76.1% of cases. Initial reactions ranged from those with negative valence (negative emotional reactions and cognitive appraisals) to ambi-valence (recognition of problems, but at the same time not accepting completely) and positive valence (sense of relief and hopefulness). Psycho-social explanations (63.46%) were more common than biological explanations (51.82%), with 19.23% reporting both explanations. Biological explanations included illness model (e.g. brain problem, obstetric complications), hereditary and intellectual disability. Psycho-social explanations included psychological (e.g. lack of motivation) and social (e.g. problems with disciplining at home) causations. Irrespective of initial reactions and causal explanations, a significant majority of parents were aware of the diagnosis and labeled problems as symptoms attributable to ADHD. Our findings provide insights for development of culturally sensitive psycho-social interventions; from understanding of causal attributions, process of decision making and help seeking.

The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model

BackgroundThe stigma of mental illness, especially personal attitudes towards psychiatric patients and mental health help-seeking, is an important barrier in healthcare utilisation. These attitudes are not independent of each other and are also influenced by other factors, such as mental health literacy, especially the public’s causal explanations for mental problems. We aimed to disentangle the interrelations between the different aspects of stigma and causal explanations with respect to their association with healthcare utilisation. MethodsStigma and causal explanations were assessed cross-sectional using established German questionnaires with two unlabelled vignettes (schizophrenia and depression) in a random-selection representative community sample (N = 1375, aged 16–40 years). They were interviewed through a prior telephone survey for current mental disorder (n = 192) and healthcare utilisation (n = 377). Structural equation modelling was conducted with healthcare utilisation as outcome and stigma and causal explanations as latent variables. The final model was additionally analysed based on the vignettes. ResultsWe identified two pathways. One positive associated with healthcare utilisation, with high psychosocial stress and low constitution/personality related causal explanations, via positive perception of help-seeking and more help-seeking intentions. One negative associated with healthcare utilisation, with high biogenetic and constitution/personality, and low psychosocial stress related explanations, via negative perception of psychiatric patients and a strong wish for social distance. Sensitivity analysis generally supported both pathways with some differences in the role of biogenetic causal explanation. ConclusionOur results indicate that campaigns promoting early healthcare utilisation should focus on different strategies to promote facilitation and reduce barriers to mental healthcare.

From Epigenetic Associations to Biological and Psychosocial Explanations in Mental Health.

The development of mental disorders constitutes a complex phenomenon driven by unique social, psychological and biological factors such as genetics and epigenetics, throughout an individual's life course. Both environmental and genetic factors have an impact on mental health phenotypes and act simultaneously to induce changes in brain and behavior. Here, we describe and critically evaluate the current literature on gene-environment interactions and epigenetics on mental health by highlighting recent human and animal studies. We furthermore review some of the main ethical and social implications concerning gene-environment interactions and epigenetics and provide explanations and suggestions on how to move from statistical and epigenetic associations to biological and psychological explanations within a multi-disciplinary and integrative approach of understanding mental health.

Individualism as Habitus: Reframing the Relationship between Income Inequality and Health

Public health literature has demonstrated a negative effect of income inequality on a number of health outcomes. Researchers have attempted to explain this phenomenon, drawing on psychosocial and neo-materialist explanations. This paper argues, however, that these approaches fail to recognize the crucial role of culture, focusing specifically on the cultural value of individualism. Through a review of the literature and Pierre Bourdieu’s theory of practice as a theoretical framework, I provide support for the proposition that an ideology based in individualism is the context within which income inequality, social fragmentation, material deprivation, and consequently poor health outcomes are produced. I further offer recommendations for continued research into the role of cultural determinants in the income inequality-health relationship.

Causal beliefs in people experiencing psychosis: The relationship to treatment accessed and the perceived helpfulness of treatment.

Research suggests that the way an individual understands a health difficulty can influence their subsequent behaviour. The aim of this study was to explore the psychometric properties of a new causal belief questionnaire for people who have experience of psychosis. We also planned to provide an overview of current causal beliefs within this group and to explore the relationship between these beliefs and the perceived helpfulness of treatment and the treatment accessed. Three hundred and eleven service-users with experience of psychosis completed a questionnaire designed to explore how they understand the cause of their difficulties. Additional information was collected about different aspects of treatment. The results of the exploratory factor analysis indicated a two-factor solution comprising a psychosocial and biogenetic scale. Individuals in this study endorsed a variety of different causes, with an overall preference for psychosocial explanations. No relationships were established between beliefs and perceptions about the helpfulness of treatment. Individuals who had accessed cognitive behavioural therapy were more likely to endorse the psychosocial factor. Individuals with psychosis consider a number of factors to be important in relation to the development of their experiences. These beliefs should be explored as part of the therapeutic process as this appears to be important to the individual and could potentially help inform treatment decisions. The causal belief questionnaire captured two underlying constructs relating to psychosocial and biogenetic causes. Individuals within this group endorsed a range of factors; however, they prefer psychosocial causes overall. There was an indication that some aspects of an individual's beliefs were associated with the treatment they accessed.

C.09.01 - Improvement of patient functioning is an unmet need in schizophrenia

Many anti-stigma campaigns emphasize biogenetic causes to convey that schizophrenia is an “illness like others”. A growing body of studies shows that although biogenetic explanations reduce blame, they tend to reinforce prognostic pessimism and harsher treatment of people with schizophrenia. In contrast, psychosocial explanations attenuate prognostic pessimism and perceived otherness, but seem less suitable to reduce blame. We hypothesized that a vulnerability-stress model that combines biogenetic and psychosocial explanations would yield clearer stigma-reducing effects than the mono-causal models. In an online-experiment, 416 participants from the general population randomly received either a vulnerability-stress, biogenetic, psychosocial or control-intervention, which consisted of information text and video presentation of a case-example. Causal beliefs, stereotypes and desired social distance were assessed by self-report. Baseline causal beliefs were weakly associated with stereotypes. The vulnerability-stress intervention did not reduce stigma more effectively than the biogenetic or psychosocial intervention and was less effective in reducing perceived blame than the biogenetic intervention. Compared to the control-intervention, no intervention showed significant stigma-reducing effects, but the psychosocial and vulnerability-stress conditions both increased blame. We found no evidence for vulnerability-stress explanations as a mean to reduce stigma. We propose further research to identify more effective ways to tackle stigma.

The role of secure attachment, empathic self-efficacy, and stress perception in causal beliefs related to mental illness - a cross-cultural study: Italy versus Israel.

BackgroundResearch suggests that “mental illness etiological beliefs” and attitudes toward mentally ill people are significantly related; it has also been demonstrated that adult attachment style and empathic self-efficacy affect such attitudes. Moreover, community or regional culture has a significant impact on etiology beliefs and attitudes toward the mentally sick.Materials and methodsWe carried out this study in Italy and Israel among psychology students to compare two cultures in regards to causal beliefs of mental disorders and the roles that specific variables, such as secure attachment, empathic self-efficacy, and stress, play in etiological beliefs. The participants (N=305) were students who belonged to two universities: Padua (N=183) and Haifa (N=122). The Many Facet Rasch Model (MFRM) was applied in a cross-cultural perspective to analyze the differential functioning of specific etiological beliefs in relation to the above mentioned variables; the effect of gender and religious beliefs was also entered in the MFRM.ResultsThe two cultures reacted differently to the biogenetic and psychosocial causal explanations of mental disorders: Israeli students endorsed the biogenetic causal beliefs model more frequently than the Italians. Among other findings, concerning the biogenetic model, the Italian students were predominantly males, who declared to be religious and reported lower levels of secure attachment than Israelis. On the other hand, the Israeli students who manifested a preference toward the biogenetic explanation were mostly females, who declared not to be religious and who manifested higher levels of secure attachment than the Italians.ConclusionThis article is expected to contribute to the improvement of the understanding of general public’s etiological beliefs of mental illness. Similarities and differences between the two cultures, Israel and Italy, have been highlighted on the basis of the MFRM analysis. The effect that interpersonal relations, such as attachment style, perceived empathy, and stress, have on etiological beliefs was also investigated.

Sex and gender differences in post-traumatic stress disorder: an update

ABSTRACTBackground: Women have a two to three times higher risk of developing post-traumatic stress disorder (PTSD) compared to men. Several factors are involved explaining this difference (Christiansen & Hansen, 2015). Both psychosocial and biological explanations (e.g. oxytocin related) have been suggested and will be reviewed in this paper. To date, we are still behind in gender- and sex-sensitive research and reporting.Prevalence and type of trauma: The lifetime prevalence of PTSD is about 10–12% in women and 5–6% in men. There are similar differences between the sexes for (comorbid) disorders such as major depression and anxiety disorders. PTSD subcluster scores have been found to be increased in women, e.g. for re-experiencing and anxious arousal (Charak et al., 2014). Men and women experience different types of trauma, both in private life and at work (e.g. police officers, Van der Meer et al., 2017), with women being exposed to more high-impact trauma (e.g. sexual trauma) than men, and at a younger age. Trauma early in life has more impact, especially when it involves type II trauma interfering with neurobiological development and personality. Traumatic stress affects different areas of the brains of boys and girls at different ages.Acute phase, stress-coping and psychotherapy: In the acute phase, women generally score higher than men on acute subjective responses, e.g. threat perception, peritraumatic dissociation and known predictors of PTSD. Women handle stressful situations differently and have evolved differentially to support these different behaviours. For instance, women in stressful situations may use a tend-and-befriend response rather than the fight-or-flight response that is often assumed. Emotion-focused, defensive and palliative coping are more prevalent in women, while problem-focused coping is higher in men. Women seek more social support, the lack of it being the most consistent predictor of negative outcome of trauma. Women have been shown to benefit more from psychotherapy then men in the reduction of PTSD symptoms.Psychobiological reactions and effects of oxytocin: Although only 2% of psychobiological research has been conducted in females (mainly rats), sex differences have been shown. Women appear to have a more sensitized hypothalamus–pituitary–axis than men, while men appear to have a sensitized physiological hyperarousal system. PTSD has consistently been associated with amygdala hyperactivity, ventromedial prefrontal cortex (vmPFC) hypoactivity and reduced communication (functional connectivity) between the vmPFC and amygdala, with the lower PFC control over the amygdala providing an explanation for the excessive fear response in PTSD. We hypothesized that the oxytocin system, which is associated with social support, fear and stress responses, was likely to play a sex-specific role in the stress response. In recently traumatized patients, we found that the effects of administration of oxytocin on amygdala reactivity to emotional stimuli depend on stimulus valence and sex (Frijling, 2017). In PTSD patients, we showed sex-specific routes for the effects of single oxytocin administration on the potential to diminish anxiety (fear learning) and fear expression by the amygdala: increased inhibitory control of the vmPFC over the centromedial nucleus in men and fewer excitatory dorsal anterior cingulate cortex projections to the basolateral nucleus in women. So, while our findings add to accumulating evidence that oxytocin administration could potentially enhance treatment response in PTSD, the routes in men and women differ (Frijling, 2017).Gender policy: In summary, all of these sex and gender differences in brain and behaviour together may explain why PTSD is more prevalent in women than in men. Clearly, we should not simplify. There are no male or female stereotypes, but some features are more common in women and others in men. To fully understand the differences, we need more gender- and sex-sensitive research as well as reporting (e.g. see the gender policy of the European Association of Science Editors). In 2016, the European Journal of Psychotraumatology was the first to implement a gender policy (Olff, 2016), i.e. authors are asked to: report the sex of research subjects, justify single-sex studies, discriminate between sex and gender (mostly for human research), analyse how sex or gender impact the results, and discuss sex and gender issues when relevant. This should not only apply to the field of psychotrauma, but deserves a much broader implementation. In doing so, we hope to obtain information that will improve sex- and gender-specific approaches to helping those affected by psychotrauma.

Sex Differences in Binge Eating: Gonadal Hormone Effects Across Development.

Eating disorders are highly sexually differentiated disorders that exhibit a female predominance in risk. Most theories focus on psychosocial explanations to the exclusion of biological/genetic influences. The purpose of this descriptive review is to evaluate evidence from animal and human studies in support of gonadal hormone effects on sex differences in binge eating. Although research is in its nascent stages, findings suggest that increased prenatal testosterone exposure in males appears to protect against binge eating. Although pubertal testosterone may exert additional protective effects, the prenatal period is likely critical for the decreased risk observed in males. By contrast, studies indicate that, in females, it is the lack of prenatal testosterone coupled with the organizational effects of pubertal ovarian hormones that may lead to increased binge eating. Finally, twin data suggest that changes in genetic risk may underlie these hormone influences on sex differences across development.

Empirical Evidence on the Use of Credit Scoring for Predicting Insurance Losses with Psycho-social and Biochemical Explanations

An important development in personal lines of insurance in the United States is the use of credit history data for insurance risk classification to predict losses. This research presents the results of collaboration with industry conducted by a university at the request of its state legislature. The purpose was to see the viability and validity of the use of credit scoring to predict insurance losses given its controversial nature and criticism as redundant of other predictive variables currently used. Working with industry and government, this study analyzed more than 175,000 policyholders’ information for the relationship between credit score and claims. Credit scores were significantly related to incurred losses, evidencing both statistical and practical significance. We investigate whether the revealed relationship between credit score and incurred losses was explainable by overlap with existing underwriting variables or whether the credit score adds new information about losses not contained in existing underwriting variables. The results show that credit scores contain significant information not already incorporated into other traditional rating variables (e.g., age, sex, driving history). We discuss how sensation seeking and self-control theory provide a partial explanation of why credit scoring works (the psycho-social perspective). This article also presents an overview of biological and chemical correlates of risk taking that helps explain why knowing risk-taking behavior in one realm (e.g., risky financial behavior and poor credit history) transits to predicting risk-taking behavior in other realms (e.g., automobile insurance incurred losses). Additional research is needed to advance new nontraditional loss prediction variables from social media consumer information to using information provided by technological advances. The evolving and dynamic nature of the insurance marketplace makes it imperative that professionals continue to evolve predictive variables and for academics to assist with understanding the whys of the relationships through theory development.

Associations between Beliefs about the Causes of Mental Disorders and Stigmatizing Attitudes: Results of a Mental Health Literacy and Stigma Survey of the Japanese Public

:This study aimed to examine the associations between beliefs about the causes of depression and schizophrenia and stigmatizing attitudes towards people with these disorders. In 2013, a web-based survey was carried out with 1,000 Japanese adults. Participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia, or chronic schizophrenia and asked about their beliefs about the causes of these disorders and also about their personally-held stigmatizing attitudes, stigmatizing attitudes perceived in others, and the desire for social distance from the person described in the vignette. The results suggested that perceived stigma was significantly associated with several biogenetic, psychosocial, and personality explanations for both depression and schizophrenia. When respondents believed that psychosocial factors caused depression, they were less likely to perceive them as weak rather than sick. Believing that depression and schizophrenia were caused by personality characteristics was associated with stronger personal beliefs about the ill person’s dangerousness and unpredictability. Future research could aim to examine the influence of personality-based causes of mental illnesses in greater detail.

Social Support: A Role for Social Work in the Treatment and Prevention of Hypertension

Researchers have long noticed an association between social relationships and health. More recently, a vast and growing literature has developed, linking various forms of social support to hypertension, often even suggestive of a causal relationship. A detailed survey of this literature is presented, followed by a review of possible psychosocial and physiological explanations for the phenomena. Implications for social workers in various settings are emphasized.

The contradictions of gender: women, men and violence in mental health research-policy, law and human rights

ABSTRACTSince the 1960s significant differences in the mental health profile of men and women have been observed, but not adequately explained. The accepted pattern is that women are more likely to be diagnosed with high prevalence disorders and men are more likely to be diagnosed with serious low prevalence disorders. Clinical research has pursued physiological or psychosocial explanations for women’s mental health problems, while feminist perspectives have emphasised the pathologisation of women’s experiences. Recent research has refocused attention on the distinct mental health needs of women and men related to the experience of violence. The emphasis on violence in new mental health research, however, is matched by a curious silence in mental health law and policy with respect to the mental health impact of violence. This article recognises the need for a robust response to the experience of violence for both men and women. With respect to the experience of women, it calls for the adoption of a women centred, trauma informed approach to the development of law, policy and service provision in mental health. Such approaches should engage with the emerging recognition of intersectionality in the research literature, the aspirations of the consumer movement and human rights frameworks.

Why does Income Relate to Depressive Symptoms? Testing the Income Rank Hypothesis Longitudinally.

This paper reports a test of the relative income rank hypothesis of depression, according to which it is the rank position of an individual’s income amongst a comparison group, rather than the individual’s absolute income, that will be associated with depressive symptoms. A new methodology is developed to test between psychosocial and material explanations of why income relates to well-being. This method was used to test the income rank hypothesis as applied to depressive symptoms. We used data from a cohort of 10,317 individuals living in Wisconsin who completed surveys in 1992 and 2003. The utility assumed to arise from income was represented with a constant relative risk aversion function to overcome limitations of previous work in which inadequate specification of the relationship between absolute income and well-being may have inappropriately favoured relative income specifications. We compared models in which current and future depressive symptoms were predicted from: (a) income utility alone, (b) income rank alone, (c) the transformed difference between the individual’s income and the mean income of a comparison group and (d) income utility, income rank and distance from the mean jointly. Model comparison overcomes problems involving multi-collinearity amongst the predictors. A rank-only model was consistently supported. Similar results were obtained for the association between depressive symptoms and wealth and rank of wealth in a cohort of 32,900 British individuals who completed surveys in 2002 and 2008. We conclude that it is the rank of a person’s income or wealth within a social comparison group, rather than income or wealth themselves or their deviations from the mean within a reference group, that is more strongly associated with depressive symptoms.

Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours.

The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.

Behavioural outcomes at 3 years of age among late preterm infants admitted to neonatal intensive care: a cohort study

ObjectiveExamine the behavioural outcomes at age 3 years of late preterm infants (LPIs) who were admitted to neonatal intensive care (NIC) in comparison with LPIs who were not admitted.MethodThis cohort...

Associations between beliefs about the causes of mental disorders and stigmatising attitudes: Results of a national survey of the Australian public

To examine the associations between beliefs about the causes of depression, schizophrenia, social phobia and post-traumatic stress disorder (PTSD) and stigmatising attitudes towards people with these disorders. In 2011, telephone interviews were carried out with 6019 Australians aged 15 or over. Participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia or PTSD. Participants were asked about their beliefs about the causes of these disorders and about their personally held stigmatising attitudes, stigmatising attitudes perceived in others and the desire for social distance from the person described in the vignette. Belief in a weak or nervous personality as the cause of mental disorders was most consistently associated with personal stigma, perceived stigma and desire for social distance across vignettes. Belief in biogenetic causes was associated with a decreased belief in mental disorders as due to weakness rather than sickness, but was not linked to either a decreased or increased belief in dangerousness and unpredictability or desire for social distance. Belief in physical causes was associated with an increased belief in mental disorders as due to weakness rather than sickness. Belief in psychosocial causes had no consistent associations with stigma. Explaining mental disorders as due to personality characteristics is a more important factor in stigma than either biogenetic or psychosocial explanations.

No matter of etiology: Biogenetic, psychosocial and vulnerability-stress causal explanations fail to improve attitudes towards schizophrenia

Many anti-stigma campaigns emphasize biogenetic causes to convey that schizophrenia is an “illness like others”. A growing body of studies shows that although biogenetic explanations reduce blame, they tend to reinforce prognostic pessimism and harsher treatment of people with schizophrenia. In contrast, psychosocial explanations attenuate prognostic pessimism and perceived otherness, but seem less suitable to reduce blame. We hypothesized that a vulnerability-stress model that combines biogenetic and psychosocial explanations would yield clearer stigma-reducing effects than the mono-causal models. In an online-experiment, 416 participants from the general population randomly received either a vulnerability-stress, biogenetic, psychosocial or control-intervention, which consisted of information text and video presentation of a case-example. Causal beliefs, stereotypes and desired social distance were assessed by self-report. Baseline causal beliefs were weakly associated with stereotypes. The vulnerability-stress intervention did not reduce stigma more effectively than the biogenetic or psychosocial intervention and was less effective in reducing perceived blame than the biogenetic intervention. Compared to the control-intervention, no intervention showed significant stigma-reducing effects, but the psychosocial and vulnerability-stress conditions both increased blame. We found no evidence for vulnerability-stress explanations as a mean to reduce stigma. We propose further research to identify more effective ways to tackle stigma.