Vignette Character Research Articles

Spontaneous labelling and stigma associated with clinical characteristics of peers ‘at‐risk’ for psychosis

The public health benefits of utilizing an 'at-risk for psychosis' designation are tempered by concerns about stigma. It is therefore of interest to examine whether symptoms associated with this designation might spontaneously induce labels associated with a psychotic disorder, other non-psychotic disorders or non-psychiatric labels. This pilot study explored the labels associated with characteristics of 'high risk for psychosis' and the corresponding stigma level. A vignette describing an identical character, followed by a series of questions about stigmatizing attitudes towards the vignette character, was administered in the present investigation. The results indicated that even though most young people (59%) did not spontaneously label the vignette character with psychotic-like diagnostic labels, the single most frequent label provided was 'paranoid/a'. When such labelling, that is, strongly tied to psychosis, occurred, respondents exhibited stronger stigmatizing attributions of fear compared to those indicating non-psychiatric labels (e.g. 'weird'). These results suggest that the majority of respondents did not endorse diagnostic labels spontaneously, thus signaling that stigma in the majority of cases would not naturalistically be elicited. However, a segment of respondents evidenced stigma simply from behavioural changes manifested by individuals exhibiting signs of psychosis, independent of diagnosis. Implications for reducing any stigma associated with an 'at-risk for psychosis' designation are discussed.

Effect of Cheating Experience on Attitudes toward Infidelity

The present study investigated how cheating experience influences perception of others’ infidelity. Using vignette characters, we explored the hypothesis that a participant’s experience cheating on a partner and gender of vignette character moderate gender-differentiated perceptions of infidelity (i.e., men reporting more accepting attitudes toward infidelity than women). Participants (N = 320) were asked a series of questions evaluating both how ‘acceptable’ and ‘forgivable’ was a vignette character’s infidelity. Men and women with prior experience cheating found the cheating vignette character of their same gender significantly more acceptable and forgivable than the unfaithful character of the other gender. Participants who reported no history of infidelity found infidelity as generally unacceptable, regardless of character gender.

A comparison of the illness perceptions of North Indian and white British women

BackgroundTreatment seeking by South Asians for depression has been shown to be lower than for white British people.AimsThis study compared illness perceptions about depression and the help-seeking behaviour of white British (n = 70) and North Indian women (n = 70) living in the UK. Previous studies have used interviews to elicit illness perceptions but have been time-consuming. The shorter Brief Illness Perception Questionnaire (BIPQ) was used instead.MethodA cross-sectional survey design was used. Participants were asked to evaluate problems of a vignette character using the BIPQ.ResultsCompared with the British group, Indian participants believed treatment would be less beneficial; felt they had less of an understanding of the character's difficulties and that the character's difficulties had less of an effect on her emotionally. Significantly fewer of the Indian sample suggested the character should go to her general practitioner (GP). Consistent with previous findings, Indian women reported themselves to be feeling more distressed when compared with British women. No differences in perceived causes of the vignette character's difficulties were found between the groups which is slightly discrepant with previous studies.ConclusionsEthnic differences were found in illness perceptions which could help explain the lower rate of GP consultation amongst Indian women.

Psychiatric labels and other influences on young people's stigmatizing attitudes: Findings from an Australian national survey

BackgroundStigma is a major impediment to help seeking for mental disorders by young people. To reduce stigma and improve help seeking, a better understanding of the influences on different components of stigma for different disorders is required. MethodsIn 2011, a telephone interview was conducted with a national sample of 2522 Australians aged 15–25 years. Participants were presented with a vignette of a young person portraying either depression, depression with suicidal thoughts, social phobia, post-traumatic stress disorder or psychosis. They were then asked what they thought was wrong with the person, exposure to mental health problems in themselves and in family or friends, stigmatizing attitudes, and their awareness of beyondblue. ResultsAccurate psychiatric labeling of the mental disorder presented in the vignette and beyondblue awareness were the best predictors of less stigmatizing attitudes, followed closely by exposure to family or friends with mental health problems. Across vignettes, the personally held stigmatizing perception of mental health problems as a weakness rather than an illness was most strongly associated with these predictors. LimitationsStigma and labeling were assessed with reference to a vignette character and may not reflect actual experience or behaviors. Other limitations include the cross-sectional design and potential for social desirability bias in the stigma measure. ConclusionsFindings suggest that community awareness campaigns (such as those by beyondblue) that encourage appropriate close contact with others affected by mental health problems and improved accurate psychiatric label use may have potential to counter various aspects of stigma, especially personal beliefs that mental illness is a weakness.

Attributions of Autonomy and Competence of Older and Younger Homeless Mentally Ill

This study investigated attributions of autonomy and competence. Respondents completed items following one of four vignettes in which a character was identified as an older male, younger male, older female, or younger female with a history of hallucinations, substance abuse, and living on the street. Respondents viewed the vignette character as suffering from malnutrition, alcoholism, depression, and likely to commit suicide. A General Linear Model revealed harsher perceptions toward the older vignette characters. When controlling for educational exposure to aging and psychopathology, there were significant differences in eight of 37 items (F = 116.270, df = 37, p < .001).

Vignette development and administration: a framework for protecting research participants

This paper is a discussion regarding vignette development and administration as a means of protecting research participants in social research. Health and social care researchers investigate a plethora of issues that may be sensitive or upsetting, for example, abuse or bereavement. This exposes participants to potential emotional harm caused by revisiting the original trauma. Using research methods that offer a protective layer is important. Evidence suggests that vignettes provide protection for research participants by placing distance between their experience and that of the vignette character. However, there are few methodological papers regarding vignette use. Utilising examples from our own research, we engage in a critical discussion regarding vignette development and administration. The paper offers a new framework to support researchers – particularly those in health and social care – in the development and administration of vignettes. We contend that the framework supports best practice in vignette use, particularly when researching sensitive issues.

Where would young people seek help for mental disorders and what stops them? Findings from an Australian national survey

BackgroundIn order to improve help seeking by young people for mental illness, a better understanding is required of their help-seeking intentions and barriers to their help seeking from various different sources and for different disorders. MethodsYoung people's help-seeking intentions and perceived barriers to help seeking were assessed by a national telephone survey of 3021 youths aged 15–25 years. Respondents were presented with a vignette of a young person portraying depression, depression with suicidal thoughts, depression with alcohol abuse, post-traumatic stress disorder, social phobia, or psychosis. ResultsEmbarrassment or shyness was the most frequently mentioned barrier to seeking help from most sources. However, different barriers featured prominently depending on the disorder and the helper. Age, sex, and knowing a family member or friend who had received professional help for mental illness predicted some barriers. LimitationsHelp-seeking intentions and barriers were assessed with reference to a vignette character and may not reflect actual experience or behaviors. ConclusionsFindings can facilitate the targeting of future efforts to improve young people's help seeking for mental disorders by highlighting the barriers that are more relevant for specific disorders, sources of help and personal characteristics.

The Peer Informant: Characteristics Related to the Perceptions of Peer Behavior Problems

Victimization and rejection by peers leads to and exacerbates behavior problems in children and adolescents. Given the implications of problematic peer relations for adolescents who experience behavior problems, the present study examined factors that may be related to how adolescents perceive peers who exhibit such problems. Specifically, the present study examined the relationship of adolescent informants’ socioeconomic status, their prior exposure to psychological symptoms, their perceived social acceptance, and their own behavior problems to their perceptions of peers’ internalizing and externalizing behavior problems, their liking and disliking of peers who exhibit such problems, and their attributions for the etiology of such problems when portrayed by fictitious peers of the same age. In particular, adolescents were asked to rate a set of vignettes portraying internalizing and externalizing behavior problems that are seen commonly in peers and to complete a set of brief questionnaires. Results revealed that adolescents were able to perceive the presence of both internalizing and externalizing behavior problems in vignette characters. Additionally, vignette characters who did not exhibit behavior problems were most likely to be approached and liked, whereas those vignette characters who displayed externalizing behavior problems were more likely to be disliked and ignored. Finally, although adolescents endorsed both internal and external etiological factors, ratings were related to the sex of the depicted vignette character and the nature of the portrayed behavior problems. Overall, this study provided additional evidence that, although adolescents can serve as valuable informants, they also tended to be rejecting of peers who display behavior problems.

A qualitative exploration into young children’s perspectives and understandings of emotional difficulties in other children

Research into children's perspectives and understandings of emotional difficulties is limited and methodologically varied. In this paper we explore young children's perspectives and understandings of emotional difficulties in their peers. We conducted five focus groups involving a total of 25 children. The children, aged eight and nine, were presented with vignettes representing peers experiencing emotional difficulties, and invited to discuss their perspectives on possible causes. We also explored their emotional and behavioural reactions to the vignette characters. Using interpretative phenomenological analysis we identified three themes: Searching for an Explanation; Empathy versus Blame; and Consequences and Solutions. The children drew on their own emotional experiences in their sense-making, and the extent to which they held the character responsible for their behaviour was particularly important in influencing their responses towards the characters.

Young people's mental health first aid intentions and beliefs prospectively predict their actions: Findings from an Australian National Survey of Youth

Little is known about whether mental health first aid knowledge and beliefs of young people actually translate into actual behavior. This study examined whether young people's first aid intentions and beliefs predicted the actions they later took to help a close friend or family member with a mental health problem. Participants in a 2006 national survey of Australian youth (aged 12–25years) reported on their first aid intentions and beliefs based on one of four vignettes: depression, depression with alcohol misuse, psychosis, and social phobia. At a two-year follow-up interview, they reported on actions they had taken to help any family member or close friend with a problem similar to the vignette character since the initial interview. Of the 2005 participants interviewed at follow-up, 608 reported knowing someone with a similar problem. Overall, young people's first aid intentions and beliefs about the helpfulness of particular first aid actions predicted the actions they actually took to assist a close other. However, the belief in and intention to encourage professional help did not predict subsequent action. Findings suggest that young people's mental health first aid intentions and beliefs may be valid indicators of their subsequent actions.

We All Want It, but We Don't Know What It Is: Toward a Standard of Affordability for Health Insurance Premiums

The 2010 Patient Protection and Affordable Care Act (P.L. 111-148), or ACA, requires that U.S. citizens either purchase health insurance or pay a fine. To offset the financial burden for lower-income households, it also provides subsidies to ensure that health insurance premiums are affordable. However, relatively little work has been done on how such affordability standards should be set. The existing literature on affordability is not grounded in social norms and has methodological and theoretical flaws. To address these issues, we developed a series of hypothetical vignettes in which individual and household sociodemographic characteristics were varied. We then convened a panel of eighteen experts with extensive experience in affordability standards to evaluate the extent to which each vignette character could afford to pay for one of two health insurance plans. The panel varied with respect to political ideology and discipline. We find that there was considerable disagreement about how affordability is defined. There was also disagreement about what might be included in an affordability standard, with substantive debate surrounding whether savings, debt, education, or single parenthood is relevant. There was also substantial variation in experts' assessed affordability scores. Nevertheless, median expert affordability assessments were not far from those of ACA.

Culture, Development, and Zero-Sum Thought

Zero-sum thought is believed to vary across collectivist and individualist cultures. In two studies, we test a model of the origins of cross-cultural differences in zero-sum thought. We examine individuals at four age groups (preschool, early elementary, late elementary, adults) in a collectivist culture, Singapore, and an individualist culture, the United States. Participants predict one vignette character’s state on either the basis of a different character or the same character at a different time. Results indicate early- emerging differences in zero-sum thought that are consistent with previous findings on cultural differences in emotional suppression. Results are discussed in terms of cultural differences in suppression and practical implications.

Predictors of children’s prosocial lie-telling: Motivation, socialization variables, and moral understanding

Children tell prosocial lies for self- and other-oriented reasons. However, it is unclear how motivational and socialization factors affect their lying. Furthermore, it is unclear whether children’s moral understanding and evaluations of prosocial lie scenarios (including perceptions of vignette characters’ feelings) predict their actual prosocial behaviors. These were explored in two studies. In Study 1, 72 children (36 second graders and 36 fourth graders) participated in a disappointing gift paradigm in either a high-cost condition (lost a good gift for a disappointing one) or a low-cost condition (received a disappointing gift). More children lied in the low-cost condition (94%) than in the high-cost condition (72%), with no age difference. In Study 2, 117 children (42 preschoolers, 41 early elementary school age, and 34 late elementary school age) participated in either a high- or low-cost disappointing gift paradigm and responded to prosocial vignette scenarios. Parents reported on their parenting practices and family emotional expressivity. Again, more children lied in the low-cost condition (68%) than in the high-cost condition (40%); however, there was an age effect among children in the high-cost condition. Preschoolers were less likely than older children to lie when there was a high personal cost. In addition, compared with truth-tellers, prosocial liars had parents who were more authoritative but expressed less positive emotion within the family. Finally, there was an interaction between children’s prosocial lie-telling behavior and their evaluations of the protagonist’s and recipient’s feelings. Findings contribute to understanding the trajectory of children’s prosocial lie-telling, their reasons for telling such lies, and their knowledge about interpersonal communication.

The influence of stigma on first aid actions taken by young people for mental health problems in a close friend or family member: Findings from an Australian national survey of youth

Young people are an important source of first aid for mental health problems in people they are close to, but their first aid skills remain inadequate. Research into the factors that influence mental health first aid skills are required to reveal targets for improving these skills. This study examined the influence of stigma on first aid actions taken by young people to help someone close to them with a mental health problem. Participants in a national telephone survey of Australian youth (aged 12-25 years) reported on their stigmatising attitudes based on one of three disorders in vignettes: depression, depression with alcohol misuse, and social phobia. At a two-year follow-up interview, they were asked if they knew a family member or close friend with a problem similar to the vignette character since the initial interview, and those who did reported on the actions taken to help the person. Of the 1520 participants interviewed at follow up, 507 reported knowing someone with a similar problem. Young people's stigmatising attitudes (weak-not-sick, social distance and dangerousness/unpredictability) influenced their first aid actions. Social desirability could have affected the assessment of stigma, we could not assess the severity of the first aid recipient's problem or the benefit derived from the first aid provided, and the proportion of variance explained was modest. Reducing stigma may help to improve the first aid that people with mental health problems can receive from young people who are close to them.

Stigma in America: Has Anything Changed?

Data from the 1996 and 2006 General Social Survey were analyzed to examine the relationship between the desire for social distance from individuals with mental illness and a number of factors that were thought to contribute to it, including perceptions of mental illness and dangerousness. Random samples of participants were assigned to one of four experimental conditions, in which they were read a vignette describing a character who presented with alcoholism, depression, schizophrenia, or minor problems. The desire for social distance from characters whose presenting problems were alcoholism or depression was significantly lower in 2006 than in 1996. The participants' perceptions that the character was mentally ill and/or dangerous to others partially mediated the association between presenting problem and social distance. Participants who were younger, white, better educated, and attended religious services more often required less social distance from the vignette characters than did their counterparts.

First aid actions taken by young people for mental health problems in a close friend or family member: Findings from an Australian national survey of youth

This study examined the first aid actions taken by young people to help someone they know and care about who was experiencing a mental health problem and the characteristics of the first aid provider (respondent) and recipient which influence these first aid actions. Participants in a national survey of Australian youth (aged 12–25years) completed a two-year follow-up phone interview based on one of the following disorders in vignettes: depression, depression with alcohol misuse, social phobia and psychosis. Participants were asked if they knew a family member or close friend who had experienced a similar problem to the vignette character since the initial interview and those who did reported on any actions taken to help the person. Of the 2005 participants interviewed, 609 (30%) reported knowing someone with a similar problem, with depression (with or without alcohol misuse) being the most common problem. Respondent age and gender, recipient gender, and type of mental health problem, all influenced first aid actions. Findings indicate that peers are a major source of support for young people with mental health problems and underscore some important areas and subgroups of young people to target for interventions to improve young people's mental health first aid skills.

The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help

In this study, we examined whether young people's help-seeking intentions and beliefs about the helpfulness of various sources of help are influenced by their own, and their parents' stigmatising attitudes towards young people with mental disorders. A national telephone survey was conducted with 3,746 Australians aged 12-25 years and 2,005 of their parents. Stigmatising attitudes, help-seeking intentions, and perceived helpfulness of various sources of help were assessed in relation to four vignettes of a young person with a mental disorder (psychosis, depression, depression with alcohol misuse or social phobia). Unlike 'stigma perceived in others', the 'weak-not-sick', 'social distance' and 'dangerous/unpredictable' dimensions of young people's stigma were associated with both help-seeking intentions and helpfulness beliefs about various sources of help. Attributing mental disorder to a personal weakness rather than an illness was associated with less intention to seek help from a doctor and less positive beliefs about professional sources (including doctors, counsellors, and psychologists). In contrast, young adults aged 18-25 years who perceived the vignette character as more dangerous or unpredictable had greater intention to seek help from a psychiatrist and a helpline, and more positive beliefs about psychiatrists. Greater social distance was associated with less intention to seek help from informal sources and less positive beliefs about these sources. No consistent pattern of associations was found for parent stigma. The findings suggest that different dimensions of youth stigma differentially influence help-seeking intentions and beliefs about the helpfulness of different sources of help.

Perceptions of Students about Younger and Older Men and Women who May Be Homeless

ABSTRACT Future human service providers will interact with homeless persons in health, mental health, and social service practice contexts. This study investigated the perceptions of students enrolled in social work courses who are pursuing degrees in human service programs toward older and younger female and male homeless individuals. Respondents (N = 207) were given one of four vignettes in which a character was identified as an older male, a younger male, an older female, or a younger female who was frequently seen near an interstate highway, talking to him/herself and appearing unkempt, thin, and frail. Most respondents perceived the vignette character as mentally ill, neglectful of health, likely to have HIV, tuberculosis, hepatitis A and/or hepatitis B and/or hepatitis C, likely to experience suicidal thoughts/ideation, and to have head lice/scabies/body lice. Older men were more likely to be perceived as military veterans with a history of mental illness and substance abuse. Older women were least likely to be perceived as having a history of substance abuse or using a handout to purchase ethanol. Older women were perceived to be homeless because they could not afford other living accommodations. A general linear model revealed significant differences in 7 of 41 items that respondents answered based on the gender and age of the vignette characters. These perceptual differences between male and female homeless persons will require additional investigation.

Adolescents’ beliefs about sources of help for ADHD and depression

The peer group begins to become a source of support during late childhood and adolescence making it important to understand what type of help young people might suggest to a friend with an emotional or behavioral problem. Three groups of young people participated in the study with average ages of 12 (N = 107), 14 (N = 153) and 16 years (N = 133). All participants were presented with vignettes describing fictional peers, two of whom had symptoms of clinical problems (ADHD and depression) and a third comparison peer without symptoms. Results indicate that all participants distinguished between clinical and comparison vignette characters and they believed that the characters with clinical symptoms needed help. The 16-year-olds were more likely to differentiate between the two clinical vignettes in terms of the type of help suggested. The results are discussed in light of previous research on adolescents’ understanding of sources of help for mental health problems.

Healthy minds for country youth: Help‐seeking for depression among rural adolescents

To assess depression recognition, barriers to accessing help from health professionals and potential sources of help for depression among rural adolescents. Cross-sectional survey. Two rural secondary schools in south-east South Australia. Seventy-four secondary school students aged 14 to 16 years. Depression recognition was measured using a depression vignette. Helpfulness of professionals, barriers to seeking help and help-seeking behaviours for depression were assessed by self-report questionnaire. Depression was identified in the vignette by 73% (n = 54) of participants. Participants indicated that it would be more helpful for the vignette character to see other health professionals (98.6%, 95% CI, 92.0-100.0%) than a doctor (82.4%, 72.1-89.6%). Barriers to seeking help from doctors and other health professionals were categorised into logistical and personal barriers. Participants agreed more strongly to personal (mean = 2.86) than logistical barriers (mean = 2.67, P < 0.05) for seeing a doctor. Boys and girls responded differently overall, and to personal barriers to seeing an other health professional. Sources of help were divided into three categories: formal, informal and external. Informal sources of help (mean = 4.02) were identified as more helpful than both formal (mean = 3.66) and external sources (mean = 3.72, P < 0.001). Gender differences were observed within and between the three sources of help categories. Recognising symptoms of depression was demonstrated in this study. Helpfulness of professionals, barriers to seeking help and potential sources of help for depression were identified. More work is required for improving depression literacy and providing effective interventions specifically for rural adolescents.