Stigma Attitudes Research Articles

Online interventions to reduce stigma towards population groups affected by blood borne viruses in Australia.

Stigmatising attitudes and behaviours by others can have a range of negative effects for population groups and individual people affected by blood borne viruses. The reduction of stigma is a major goal within current Australian national health strategies, however, there is a lack of evidence regarding effective interventions to achieve this goal. Drawing on Allport's (1954) intergroup contact theory, this study aimed to evaluate the effectiveness of an online stigma reduction intervention implemented with the Australian public. The study was conducted between February and May 2020. Australian adults recruited via Facebook advertising were randomly allocated to a control group (n=316) or one of five intervention groups: people living with HIV (n=320), people living with hepatitis C (n=347), people living with hepatitis B (n=333), people who inject drugs (n=316), or sex workers (n=296). Participants viewed a short video depicting lived experiences of their assigned group. Participants completed attitudinal measures about the group before and immediately after the video, and then at three-month follow-up. These measures related to overall attitudes towards the group, controllability of the stigmatised condition/behaviour, desire to maintain personal distance from the group, and opinions regarding treatment of the group in health care and public policy. Longitudinal changes in attitudes were analysed using a mixed effects regression model with maximum likelihood estimation. Across each of the intervention groups, reductions in negative attitudes were found immediately after watching the videos on almost all outcome measures. By three-month follow-up, the HIV intervention group demonstrated long-term improvements in relation to personal distance compared to the control group, and the hepatitis B intervention group demonstrated long-term improvements in relation to attitudes and personal distance compared to the control group. Across intervention and control groups, long-term reductions in negative attitudes were found in relation to HIV controllability, hepatitis B controllability and opinions, hepatitis C controllability and opinions, and injecting drug use attitudes and opinions. Brief online videos depicting priority populations groups demonstrated positive results in terms of reducing some stigmatising attitudes towards those groups amongst members of the Australian public. Online contact interventions have the potential to be scaled up and rolled out across jurisdictions at national and international levels. These findings suggest that these interventions could be an effective way to contribute to the reduction of stigma and discrimination towards populations affected by blood borne viruses.

AIDS fighter health defense: protocol for a randomized controlled trial to test a game-based intervention to improve adolescents\u2019 AIDS prevention ability

BackgroundAlthough great progress has been made in the prevention and treatment of AIDS, there are still a considerable number of new infections annually, especially in adolescents. With the advance of technology, game-based education has gradually become an important tool for changing healthy behaviors among youth.MethodsA protocol for conducting a randomized controlled trial to evaluate the “AIDS Fighter · Health Defense”, a game-based AIDS education project aimed at improving the ability of adolescents to prevent AIDS. During the four-week intervention, participants will receive: 1) A virus combat game; 2) Goal setting to eliminate HIV; 3) Questions to be answered to be resurrected in the game; 4) Points ranking; 5) Recognition and Rewards. The primary outcomes include changes in participants’ knowledge, stigma attitude, and risk behaviors attitude related to AIDS after four weeks of intervention. The secondary outcomes are the participants’ AIDS-related risk behaviors three and six months after the intervention.DiscussionAIDS Fighter· Health Defense may be an innovative approach to help adolescents improve AIDS prevention capabilities, fill the gap in game-based AIDS prevention education in China, and gain experience of AIDS management.Trial registrationChinese Clinical Trial Registry: ChiCTR2000040195. Registered 25 November 2020.

Exploring first responders' perceptions of medication for addiction treatment: Does stigma influence attitudes?

Researchers have suggested that provider-based stigma of persons who suffer from opioid use disorder (OUD) in the criminal justice system serves as a barrier to fully implementing harm reduction strategies, such as the use of naloxone and medication for addiction treatment (MAT). While scholars have begun to explore the relationships between stigma and first responders' attitudes toward naloxone, little work has been done to assess first responders' attitudes toward other forms of harm reduction, including MAT. The goal of the current exploratory study was to help fill this gap in the literature by assessing first responders' (N = 282) attitudes toward MAT, as well as the correlates of these attitudes. The study specifically focused on examining the relationship between provider-based stigma and attitudes toward MAT. Results show that, in the aggregate, first responders held slightly negative attitudes toward the use of MAT. Moreover, the study found that certain dimensions of stigma (i.e., dangerousness and fatalism) to exhibit a negative relationship with attitudes toward MAT, while support for the disease model of addiction was associated with positive perceptions. Policy implications based on these findings are discussed within.

Effects of a psychiatric diagnosis vs a clinical formulation on lay attitudes to people with psychosis

ABSTRACT Background: Limited research has investigated whether replacing psychiatric diagnosis with psychological formulation-based approaches has implications for lay attitudes to mental health. The present study investigates experimentally whether presenting psychosis in terms of a schizophrenia diagnosis vs. formulation narrative affects stigma and treatment attitudes in the general public. Method: The study employed a between-groups experimental vignette design, with data collected online. 351 participants (64.1% female, aged 18–66,) read a vignette about a person experiencing psychosis, defined with either a diagnosis of schizophrenia or a narrative-based formulation. Participants completed a battery of scales measuring their attitudes to the vignette character (social distance, attribution, recommended treatment options, mental help-seeking attitudes). Results: Desired social distance was significantly greater in participants exposed to the diagnostic label of schizophrenia. The schizophrenia label led participants to rate medical care as significantly more helpful relative to the formulation condition but did not affect ratings of specialist or community care or mental help-seeking attitudes. Conclusions: These findings suggest that a psychological formulation approach may slightly lessen stigma-related attitudes, relative to traditional diagnostic systems. Popularisation of formulation models need not compromise general orientations to help-seeking or perceived helpfulness of specialist care but may lead to less medicalised treatment preferences.

The influence of contact with mental health services on carers’ help-seeking attitudes: contribution of stigma and affective state

Background Carers who experience stigma and aversion to help-seeking could have a detrimental impact on consumers of mental health services (MHS). Aim This study aimed to investigate the relationship between carers’ experiences with MHS, stigma, affective state and help-seeking attitudes. Methods Fifty-seven carers of people with a mental illness completed an online survey including demographics about the carer and consumer, carers’ experience with MHS, Days’ mental illness stigma scale, the inventory of attitudes towards seeking mental health services and the depression–happiness scale. Results Carer responses evenly reflected positive and negative experiences with MHS. There were significant correlations between experiences of MHS and stigma, attitudes towards help-seeking, and affective state. Carers who reported negative experiences of MHS demonstrated reduced help-seeking attitudes. Both stigma and affective state independently reduced the association between positive experiences of MHS and more positive help-seeking attitudes. When all three variables were included in the regression model, stigma was the only significant predictor of reduced help-seeking attitudes. Conclusions MHS must establish positive engagement with carers, as this is associated with positive help-seeking attitudes. Negative experiences of MHS exacerbate carer stigma. Positive interactions between MHS and carers likely facilitate better access to care for consumers and improve clinical outcomes.

Evaluating Social Marketing Messages in New Zealand’s Like Minds Campaign and Its Effect on Stigma

Background: A key objective of government and social marketers is to remove the institutionalized stigma of mental illness, increasing mental health service uptake. While research has evaluated past campaigns based on changes in attitudes and beliefs, very little research has examined the communication messages used in social marketing campaigns. Focus of the Article: This impact evaluation research identifies the institutionalized cultural-moral norms incorporated into New Zealand’s Like Minds mental health advertisements and examines how attitudes and beliefs changed over time in response to these norms. Importance to the Social Marketing Field: This research offers a new approach to social marketing evaluation and demonstrates the importance of consistent incorporation of cultural-moral institutional norms in social marketing campaigns. Method: Using macro-social marketing theory, thematic analysis is used to identify the cultural-moral institutional norms in the Like Minds campaign advertisements over a 10-year period (2002–2012). Results: The Like Minds campaign was found to have multiple cultural-moral institutional norms, such as Mental illness as a villain, Personal responsibility, and Inherent human dignity, as well as utilizing two different institutionalization processes of Socialization and Identity Formation. However, these norms were inconsistently and sometimes contradictorily presented and as a result, not all changes in mental health stigma beliefs and attitudes show long term change. Rates for service uptake also had mixed results during the campaign duration, though overall an increase in uptake was found. Recommendations for Research and Practice: The research highlights the importance of understanding the underlying institutionalized cultural-moral norms presented in communications and aligning those with the overall objectives of a social marketing campaign. Limitations: Like Minds campaign phases 2 to 5 are analyzed, phase 1 was inaccessible for analysis and advertisements after 2012 are not analyzed.

Mental Health Literacy, Stigma, and Access to Services among Young Adults in Tunisia

Background: There is limited research on mental health literacy and stigmatization attitudes towards mental illness in Tunisia, despite the increasing need for such research to better understand its complexity in a specific country context. Using an exploratory mixed-method approach this study attempted to assess the needs and perceptions about mental health within a population of Tunis-based young adults.
 Methods: A sample of 80 participants completed an online survey on different aspects of mental health attitudes, mental illness literacy and stigma, with a subset of survey participants participating in one-on-one interviews.
 Results: Survey results show that 77% of respondents completely agreed or somewhat agreed that they would like to learn more about mental health. This study also found that 68% of the sample reported a lack of accessibility to mental healthcare services resulting in 49% reporting their preference to search their symptoms on the internet instead of informing someone. Throughout the interviews phase, the main factors identified to have a crucial impact on young adults' choice to openly communicate feelings and thoughts with each other and to seek professional help are: culture, gender roles, sexual orientation, and family approval.
 Conclusion: This study suggests a great desire among young adults to learn more about mental health, and highlights the cultural complexities regarding mental health stigmatization in Tunisia. It also highlights the need for culturally relevant approaches raising awareness about mental health.

European study on the attitude of psychiatrists towards their patients

IntroductionMany people think that people with mental disorders might be dangerous or unpredictable. These patients face various sources of disadvantages and experience discrimination in job interviews, in education, and housing. Mental health-related stigma occurs not only within the public community, it is a growing issue among professionals as well. Our study is the first that investigates the stigmatising attitude of psychiatrists across Europe.ObjectivesWe designed a cross-sectional, observational, multi-centre, international study of 33 European countries to investigate the attitude towards patients among medical specialists and trainees in the field of general adult and child and adolescent psychiatry.MethodsAn internet-based, anonymous survey will measure the stigmatising attitude by using the local version of the Opening Minds Stigma Scale for Health Care Providers. Data gathering started in July this year and will continue until December 2020.ResultsThis study will be the first to describe the stigmatising attitude of psychiatric practitioners across Europe from their perspectives.ConclusionsThe study will contribute to knowledge of gaps in stigmatising attitude towards people with mental health problems and will provide with new directions in anti-stigma interventions.DisclosureNo significant relationships.

Stigmatization attitudes of medical staff toward people with respiratory syndromes during COVID-19 pandemic

IntroductionThe health care workers have extremely high risks of adverse psychological reactions from COVID-19 pandemic. On the other hand, patients with respiratory syndromes face stigmatization due to their possible contagiousness of SARS-Cov-2.ObjectivesTo study the association of behavior, psychological distress in health care workers, and their stigmatization attitudes to the patients.MethodsThe online-survey of 1800 health care workers performed during different lockdown periods in Russia: the first week and the last (30/Mar-5/Apr/20 and 4-10/May/20). The Psychological stress scale (PSM-25), modified Perceived devaluation-discrimination scale (Cronbach’s α=0.74) were used. Dispersion analysis with p-value=0.05 and Cohen’s d, Cramer’s V calculation (ES) performed.ResultsIn the 2nd phase medical stuff more often wore masks (64% vs. 89%; χ2=98.7, p=0.000, df=1; ES=0.23) and gloves (30% vs. 57%; χ2=57.6, p=0.000, df=1; ES=0.18), continued perform hand hygiene (94-95%) and physical distancing (73-74%), but was restricted in most effective protective measure: self-isolation (49% vs. 36%; χ2=16.0, p=0.000, df=1; ES=1.0). The psychological stress levels decreased in the 2nd phase (ES=0.13), while the stigma levels (ES=0.33) increased. Physicians experienced more stress compared with nurses and paramedical personnel (ES=0.34; 0.64) but were less likely to stigmatize SARS-CoV-2 infected individuals (ES=0.43; 0.41). The highest rates of contacts with COVID-19 patients (83%) were reported by physicians (χ2=123.0; p = 0.00, df=4; ES=0.28).ConclusionsDirect contact with SARS-Cov-2 is associated with a significant increase in stress among medical personnel. However, the stigmatizing reactions are not directly associated with the risks of infection and are most prevalent among nurses and paramedical personnel.

Validation of the Self Stigma of Seeking Help (SSOSH) scale in a population of Colombian medical students

ObjectiveValidate the Self Stigma Of Seeking Help (SSOSH) scale in a population of students of a medical school for its use in Colombia. MethodsWe included 384 medical students from the city of Medellín. Initially, two direct translations were made, two back translation and one pilot test. The internal consistency, test-retest repeatability and structural, convergent, divergent and discriminative construct validity were then evaluated. ResultsA easy-to-understand and to fill out Spanish version was obtained. The internal consistency of the scale was adequate (Cronbach’s alpha = .80; 95%CI, .77–.83) as well as the test-retest repeatability (CCI = .77; 95%CI, .63–.86). The Confirmatory Factor Analysis showed a good fit with the one-dimensional structure (RMSEA = .073; IC90%, .056–.089; CFI = .968; TLI = .977; WRMR = .844). The convergent validity was supported by the correlation with the Public Stigma scales (ρ = .39) and Attitudes towards Seeking Help (ρ = –0.50) and the divergent validity with the Social Desirability scale (ρ = –0,05). When examining the discriminative validity, differences were found between the scores of those who would be willing to seek professional help when having a mental health problem and those who probably would not (Difference of means = 4.9; 95%CI, 2.99–6.83). ConclusionsThe Colombian version of the SSOSH is valid, reliable and useful for the measurement of the Self-stigma associated with seeking professional help in the university population of the Colombian health sector. Its psychometric properties must be investigated in populations of other programs and outside universities.

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.

Time to end weight stigma in healthcare.

Weight stigma and discrimination is experienced by people living with obesity (PLWO) on almost a daily basis, across many settings. Counterintuitively, given that healthcare settings should be a safe space that is free of judgement, empirical evidence has demonstrated that weight stigma in healthcare settings is pervasive, where PLWO are stigmatised, disrespected, and in some instances discriminated against through lack of equitable access to care [1]. The conscious and unconscious stigmatising attitudes held by healthcare professionals is a reflection of (1) exposure to consistent and widespread weight stigma, and (2) the lack of training and education for healthcare professionals about the complexity of obesity as well as how to avoid bias and stigmatising attitudes that may impact care for PLWO.

Ethical and culturally competent care of transgender patients: A scoping review.

Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care. No formal ethical approval was required. To synthesize the literature and identify gaps about approaches to the provision of ethical and culturally competent care to transgender populations. A Scoping Review. Literature was searched within CINAHL, Science Direct, PubMed, Google Scholar, EMBASE, and Scopus databases using indexed keywords such as "transgender," "gender non-conforming," "ethically sensitive care," and "culturally sensitive care." In total, 30 articles, which included transgender patients and their families and nurses, doctors, and health professionals who provided care to transgender patients, were selected for review. Data were extracted and synthesized using tabular and narrative summaries and thematic synthesis. Of 30 articles, 23 were discussion papers, 5 research articles, and 1 each case study and an integrative review. This indicates an apparent dearth of literature about ethical and culturally sensitive care of transgender individuals. The review identified that healthcare professionals should educate themselves about sensitive issues, become more self-aware, put transgender individual in charge during care interactions, and adhere to the principles of advocacy, confidentiality, autonomy, respect, and disclosure. The review identified broad approaches for the provision of ethical and culturally competent care. The identified approaches could be used as the baseline, and further research is warranted to develop and assess organizational and individual-level approaches.

Psychiatric-mental health education with integrated role-play and real-world contact can reduce the stigma of nursing students towards people with mental illness

Stigma and negative attitudes towards people with mental illness are frequently found among nursing students. Interventions targeting mental illness stigma are the critical elements in altering the status. The aim of the present study was to examine the effects of the psychiatric-mental health education with role-play and real-world contact on stigma of nursing students towards people with mental illness in China. A single group pretest and posttest study design was adopted and total 373 students were recruited whilst 343 completed the course. We integrated the role-play and contact with patients in the routine psychiatric-mental health education. After the education was completed, the students' stigma towards people with mental illness were positively changed (pretest mean score of stigma: 53.77, posttest mean score of stigma: 49.01, 95% CI: 2.63–6.87) and their willingness to care for the people with mental illness was also significantly increased (pretest mean score of willingness: 5.45, posttest mean score of willingness: 7.38, 95% CI: −2.22–−1.65). The psychiatric-mental health education especially with integrated role-play and real-world contact is an effective way to reduce nursing students’ stigma and negative attitudes towards people with mental illness and increases their willingness to care for people with mental illness.

Establishment of the Trends of Access to Basic Education by Primary School Children with Disabilities in Busia County, Kenya

The introduction of Universal Primary Education, accompanied by establishment of Educational Assessment and Resource Centers in the county, was expected that pupils with disabilities would meaningfully access quality integrated education. However, this objective has not been realized as planned due to institutional factors that bar them from obtaining an adequate education and opportunity for full social life. The purpose of the study was to establish the trends of access to basic education by primary school children with disabilities in Busia county. The study adopted the Ex-post facto research design. The survey covered more than 14,000 households in a total of 600 clusters (436 rural and 164 urban). A sample 200 subjects was drawn composed of 155 pupils 2 head teachers, 2 special needs teachers and 41 pupils with physical disabilities. The research adopted a methodology that comprised of mainly literature review and participatory data collection methodologies namely key informant interviews (KII) and focus group discussions (FGDs). A total of 22 KIIs and 10 FGDs were employed in the collection of data across the two counties and at the national level. Descriptive statistics which include frequencies and percentages was used to present the study findings. The study not only establishes international standards and guidelines for the promotion of these rights, but also receives comprehensive domestication at continental, regional and national levels. Attempts have also been made to extend the domestication of these rights further down to the sub national level, although there is not much evidence as yet of county governments in Kenya activating their legislative, executive and policy mandates in response to the basic educational needs of children with disabilities. There are a series of social and community factors that make access to basic education for children with disabilities difficult. These include social stigma and negative parental attitudes to disability which may arise out of religious and cultural beliefs for example where disability may be seen as punishment. Parental resistance to inclusive education for special groups may also be a barrier. Based on the assessment findings, the teachers in the special institutions experience several challenges. To begin with, the teacher/student ratio gap is widening on an annual basis, while there is lack of adequate modern learning and teaching materials in the institutions. Secondly, there are low levels of awareness on parents’ side on education for the children with disabilities. Thirdly, there is lack of funds to facilitate education for children with disabilities at various institutions.

Mental health stigma and professional help-seeking attitudes a comparison between Cuba and Germany.

Globally the burden due to mental disorders is continuously increasing. Still, professional help-seeking behavior is not fully understood. To conceive cultural determinants of help-seeking is crucial to reduce personal and social costs of (untreated) mental disorders. The current study investigates mental health stigma and help-seeking attitudes in a Cuban (n = 195) and a German (n = 165) sample. In a questionnaire survey we asked for attitudes towards mental illness and professional help-seeking in the general Cuban and German populations. The cultural context was associated with mental health stigma and professional help-seeking attitudes. Interestingly, Cuban participants reported stronger mental health stigma and more willingness to seek help. In multiple hierarchical regression analyses, community attitudes towards the mentally ill significantly predicted help-seeking attitudes, especially in the Cuban sample. Only in the German sample, more negative individual beliefs about mental illness predicted more self-stigma on help-seeking. Beyond that, cultural context moderated the association between mental health stigma and help-seeking attitudes with a stronger association between the measures in the German sample. However, gender did not predict help-seeking attitudes and self-stigma on help-seeking and no interactions between community attitudes, cultural context, and gender were found in the prediction of help-seeking attitudes. Similarities and differences between the samples are discussed in the light of the cultural contexts and peculiarities of the current samples. Concluding, implications of the current findings are reviewed.

Opioid Use Disorder Stigma, Discrimination, and Policy Attitudes in a National Sample of U.S. Young Adults

PurposeA small fraction of people with opioid use disorder (OUD) receives appropriate care. Public opinion about addiction contributes to the availability and accessibility of effective treatment services. Little is known about such attitudes toward OUD among young adults, a population at heightened risk for OUD onset. The current study examined endorsement of social stigma, discrimination, and policy attitudes about OUD and hypothesized correlates of such attitudes (familiarity with OUD, criminal justice involvement, respondent demographic characteristics). MethodsA national sample of 190 young adults (weighted n = 408; 69% female, 42% White, non-Hispanic) aged 19–29 years completed web and telephone surveys covering opioid social stigma, discrimination, policy attitudes, personal experience with opioids, and criminal justice, and participant characteristics (age, sex, race, education, employment, income). Linear regressions were performed to examine associations between respondent characteristics and attitudes. ResultsYoung adults, on average, endorsed moderate levels of stigma and discrimination toward people with OUD and support for treatment-oriented policies. Stigma was positively associated with discrimination and negatively associated with support for policies favorable to people with OUD. Regression results revealed that more negative attitudes toward OUD were endorsed as a function of older age and less personal experience or familiarity with OUD. ConclusionsHeterogeneity in young adults’ attitudes about OUD may be explained, in part, by personal characteristics and familiarity with OUD. Adolescence may be an opportune developmental period to prevent or reduce public stigma related to OUD and MOUD and increase public attitudes in support of expanded access to effective OUD treatments.

Efficacy of an Intervention to Reduce Stigma Beliefs and Attitudes among Primary Care and Mental Health Professionals: Two Cluster Randomised-Controlled Trials.

Although it may seem paradoxical, primary care and mental health professionals develop prejudices and discriminatory attitudes towards people with mental health problems in a very similar way to the rest of the population. The main objective of this project was to design, implement and evaluate two awareness-raising interventions respectively tailored to reduce stigmatising beliefs and attitudes towards persons with a mental health diagnosis among primary care (PC) and mental health (MH) professionals. These interventions were developed by Obertament, the Catalan alliance against stigma and discrimination in mental health. Activists from this organisation with lived experience of mental health diagnosis carried out awareness-raising interventions in PC and MH health centres. The Targeted, Local, Credible, Continuous Contact (TLC3) methodology was adapted to the Catalan healthcare context. The efficacy of these interventions was evaluated using two prospective double-blind cluster-randomised-controlled trials. Stigmatizing beliefs and behaviours were measured with the Opening Minds Stigma Scale for Health Care Providers in PC centres and with the Beliefs and Attitudes towards Mental Health Service users’ rights in MH centres. Reductions in both PC and MH professionals’ stigmatising beliefs and attitudes were found in the 1-month follow-up, although a ‘rebound effect’ at the 3-month follow up was detected. This emphasizes the importance of the continuity of the presence of anti-stigma activities and messages. Attrition rates were high, which can hamper the reliability of the results. Further follow-up studies should enquiry effects of long-term interventions aimed at reducing stigmatising beliefs and attitudes among primary care and mental health professionals using assessment systems that include the measurement of knowledge acquired and actual behavioural change.

Does a comprehensive service user-led education programme effect more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress in medical students? A comparative cohort study.

This study sought to investigate the impact of a service user-led anti-stigma and discrimination education programme, encompassing numerous interventions focused on facilitating multiple forms of social contact, the promotion of recovery, and respect for human rights, on medical student attitudes. A comparison cohort study was used to compare the attitudes of two cohorts of medical students who received this programme as part of their fifth (the fifth-year cohort) or sixth (the sixth-year cohort) year psychological medical education attachment (programme cohorts) with two cohorts of equivalent students who received a standard psychological medical attachment (control cohorts). Attitudes to recovery (using the Recovery Attitudes Questionnaire) and stigma (using the Opening Minds Scale for Healthcare Providers) were measured at the beginning and end of the attachments for each year and compared both within and between the cohorts using Wilcoxon signed-rank or Wilcoxon rank-sum tests. With sample sizes ranging from 46 to 70 across all cohorts, after their psychological medicine attachment both the programme and control cohorts showed more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress. Significant differences between the programme cohorts and the control cohorts were found for recovery attitudes (median difference of 2, p < 0.05 in both fifth and sixth year), with particularly large differences being found for the 'recovery is possible and needs faith' subdomain of the Recovery Attitudes Questionnaire. There were no significant between cohort differences in terms of stigmatising attitudes as measured by the Opening Minds Scale for Healthcare Providers. The introduction of a comprehensive service user-led anti-stigma and education programme resulted in significant improvements in recovery attitudes compared to a control cohort. However, it was not found to be similarly superior in facilitating less stigmatising attitudes. Various possible reasons for this are discussed.

Mental health literacy in Arab states of the Gulf Cooperation Council: A systematic review.

Mental health literacy (MHL) has been relatively neglected, despite the increase of mental health illnesses worldwide, as well as within the Middle East region. A low level of MHL may hinder public acceptance of evidence-based mental health care. This systematic review aims to identify and appraise existing research, focusing on MHL among adults in the Gulf Cooperation Council (GCC) countries. A systematic search of electronic databases (PubMed, PsychInfo, and Medline) was carried out from database inception to July 2019, in order to identify peer-reviewed journal articles that investigated MHL in the GCC countries. Studies were eligible for inclusion if they were: cross-sectional studies, reported in English, targeted adults (aged 18 and above), conducted in any of the GCC countries, include at least one outcome measure of the main components of MHL: knowledge of mental illnesses and their treatment, stigmatizing attitudes towards mental illnesses, and seeking help for self and offering help. A total of 27 studies (16,391 participants) were included. The outcome across studies varied due to disparity in the tested populations. Findings show that limited MHL was observed among participants, even health care professionals. Results also show a high cumulative level of stigma and negative attitude towards mental health illness in the public. Negative beliefs and inappropriate practices are common, as well. The majority of studies yielded a moderate to high risk of bias. This work indicates that research on MHL must be tackled through well-designed large-scale studies of the public. Campaigns to promote early identification and treatment of mental illness is also encouraged to improve overall level of MHL in the general population of the GCC region. Registration number: PROSPERO 2018 CRD42018104492.