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Changes in stigma and population mental health literacy before and after the Covid-19 pandemic: Analyses of repeated cross-sectional studies
... Notably, the additive genetic component specific to mothers increased during the post-pandemic period compared to baseline, which points to the emergence of "real" unique perspectives on the child's wellbeing. A potential explanation is the increased attention to and awareness of mental health and wellbeing as a result of the pandemic coverage (Penninx et al. 2022;Winkler et al. 2024), but it can also indicate unique behavior observed only by mothers. This increase in the rater-specific additive genetic component was more pronounced in mothers than fathers, supporting the narrative of a change in the proportion and/or context of childcare duties between mothers and fathers as a result of the pandemic (Augustine and Prickett 2022; Yerkes et al. 2024). ...
The impact of the COVID-19 pandemic on the wellbeing of 26,555 Dutch children and adolescents (ages 8–18, 50% female, 89% with parents born in the Netherlands) was investigated using three cohorts: a general population twin sample (NTR), a general population sample (KLIK), and a clinical sample (DREAMS). Data were collected in seven waves between 2020 and 2023. Linear mixed models were employed to examine changes in wellbeing, twin models were used to estimate genetic and environmental contributions, and a psychometric model was employed to explore potential rater bias. A 6.5% drop in wellbeing was observed at the onset of the pandemic in the NTR sample, followed by partial recovery but not a return to pre-pandemic levels. Mean wellbeing scores were consistently lower in the clinical cohort (DREAMS), which also showed different effects of age, gender, and parental educational attainment compared to the two general population samples (NTR and KLIK). Increased disagreement between fathers’ and mothers’ ratings during lockdown was also identified. Genetic factors were found to account for 26–28% of the variance in wellbeing during the pandemic, and 34–35% before and after. Shared environmental factors were higher during the lockdown period (60–62%) compared to before and after the lockdown (45–49%), indicating the key role of family and home environment in that period. Multi-rater analyses suggested that part of this increase in shared environmental variance likely reflects rater bias rather than true environmental influences. These findings highlight that children in psychiatric care may face additional challenges compared to their peers and emphasize the importance of multi-rater assessments. Results suggest that both genetic predispositions and environmental disruptions should be considered when developing strategies to support child wellbeing during crises.
This study investigated the Czech adults’ mental health following the COVID-19 pandemic and the potential influence of data collection methodology on prevalence estimates. Separately, it investigated changes in help-seeking and associated barriers. Data from representative surveys on Czech adults, conducted in November 2017 (n = 3,306), in May (n = 3,021) and November 2020 (n = 3,000), and in November and December 2022 (n = 7,311), were used. Current mental disorders were assessed by the Mini International Neuropsychiatric Interview, and the treatment gap was established in individuals scoring positively. In help-seeking individuals, encountering barriers was investigated. In 2017 and 2022, 20.02 % and 27.22 % of individuals had at least one mental disorder, respectively. The 2022 panel sampling and online and telephone interviewing estimates (34.29 % and 26.7 %) were substantially higher than those from household sampling and personal interviewing (19.9 %). Prevalence rates based on household sampling and personal interviewing were broadly consistent in 2017 and 2022. The treatment gap was around 80 % from 2017 to 2022. More than 50 % of individuals encountered structural barriers in help-seeking in 2022. This study showed that prevalence rates were still elevated in 2022, but suggests that data collection methodology influenced the estimates. Separately, the treatment gap remained consistently very high, and encountering structural barriers in help-seeking was common.
Although improving the mental health of children and adolescents has become a global priority, resources outlining developmentally appropriate content for improving mental health literacy (MHL) across school-aged children are scarce. A comprehensive, life-course approach to building MHL is needed to address the evolving competencies, needs, capacities, and risk factors for mental health, especially to establish school-based interventions that can be equitably and sustainably implemented. We conducted a theoretical review highlighting the relation of research and practice in building MHL through developmentally appropriate knowledge and competencies for children and adolescents. A two-pronged review of the literature was conducted to provide an overview of (1) research with a focus on neurobiological, psychological, cognitive, and social developmental milestones of school-aged children relevant for building MHL and (2) evidence-based and theory-driven content for the development of universal MHL interventions for children and adolescents considering the four components of MHL. A map of relevant key milestones highlights the range of development that occurs and ample opportunity for increasing universal MHL during these sensitive years primed for learning. We reflect on current understandings and global considerations for MHL interventions with an emphasis on applying developmental science to the future strengthening of intervention development, uptake, adaptation, implementation, evaluation, and scale-up.
Public perceptions of the determinants of mental illness have important implications for attitudes and stigma, but minimal previous research has explored how causal attributions are spontaneously invoked in everyday public discourse. This study investigated how causal explanations for mental illness are disseminated in popular Irish news media, in the two years before and after the onset of the COVID-19 pandemic. Keyword searches of a news media database identified 1,892 articles published between March 2018 to March 2022 that mentioned one of six categories of mental disorders: anxiety disorders, mood disorders, substance-related disorders, personality disorders, eating disorders, and psychotic disorders. Overall, 25% of the identified articles contained a causal explanation for mental illness. Inductive content analysis revealed the content and prevalence of eight types of causal explanations for mental disorders. Overall, attributions to life events/experiences, the cultural/societal environment, interpersonal relations, and health and lifestyle factors occurred more frequently than attributions to biological or psychological determinants. Life events/experiences were the most common explanation for anxiety and personality disorders, cultural/societal environment for eating disorders, and health/lifestyle factors for mood and psychotic disorders. Interpersonal factors in mental illness aetiology became more salient following the COVID-19 pandemic. The findings emphasise the need for theory and research on lay explanations of mental disorders to account for diversity, both in the range of attributions invoked, and in how attributional patterns shift across time and mental disorders category.
Background
Anxiety disorder has become a major clinical and public health problem, causing a significant economic burden worldwide. Public attitudes toward anxiety can impact the psychological state, help-seeking behavior, and social activities of people with anxiety disorder.
Objective
The purpose of this study was to explore public attitudes toward anxiety disorders and the changing trends of these attitudes by analyzing the posts related to anxiety disorders on Sina Weibo, a Chinese social media platform that has about 582 million users, as well as the psycholinguistic and topical features in the text content of the posts.
Methods
From April 2018 to March 2022, 325,807 Sina Weibo posts with the keyword “anxiety disorder” were collected and analyzed. First, we analyzed the changing trends in the number and total length of posts every month. Second, a Chinese Linguistic Psychological Text Analysis System (TextMind) was used to analyze the changing trends in the language features of the posts, in which 20 linguistic features were selected and presented. Third, a topic model (biterm topic model) was used for semantic content analysis to identify specific themes in Weibo users’ attitudes toward anxiety.
ResultsThe changing trends in the number and the total length of posts indicated that anxiety-related posts significantly increased from April 2018 to March 2022 (R2=0.6512; P
The COVID-19 pandemic has had negative consequences on the mental health of the population, which has been documented. Marginalised groups that are at risk of poor mental health overall have been particularly impacted. The purpose of this review is to describe the mental health impact of the COVID-19 pandemic on marginalised group (i.e. persons who are socio-economically disadvantaged, migrants and members of ethno-racial minorities, experience homelessness) and identified interventions which could be well-suited to prevent and address mental health difficulties. We conducted a literature review of systematic reviews on mental health difficulties since the beginning of the COVID-19 epidemic and appropriate interventions among marginalised groups published from January 1, 2020 to May 2, 2022, using Google Scholar and PubMed (MEDLINE). Among 792 studies on mental health difficulties among members of marginalised groups identified by keywords, 17 studies met our eligibility criteria. Twelve systematic reviews examining mental health difficulties in one or several marginalised groups during the COVID-19 pandemic and five systematic reviews on interventions that can mitigate the mental health impact of the COVID-19 pandemic were retained in our literature review. The mental health of marginalised groups was severely affected during the COVID-19 pandemic. Most frequently reported mental health difficulties included symptoms of anxiety and depression. Additionally, there are interventions that appear effective and well-suited for marginalised populations, which should be disseminated on a large scale to mitigate the psychiatric burden in these groups and at the population level.
Background
Large efforts have been made to erase the stigma of mental illness, but it is unclear whether they have succeeded on a population level. We examine how attitudes toward people with depression or schizophrenia have evolved in Germany since 1990, and whether there are different developments for both disorders.
Methods
Using data from the three decades, four wave repeated cross-sectional representative population study in the “old” (western) states in Germany with surveys in 1990 ( n = 2,044), 2001 ( n = 4,005), 2011 ( n = 1,984), and 2020 ( n = 2,449), we calculate time-trends for social distance and emotional reactions toward someone with major depression or acute schizophrenia.
Results
Social distance worsened in six out of seven situations for schizophrenia, whereas improving in two out of seven situations for depression. Emotions related to fear and uneasiness increased for schizophrenia, whereas tending to decrease for depression. Pro-social reactions like the desire to help increased for depression, but decreased for schizophrenia. Initially observed differences, favoring depression over schizophrenia, widened over the 30-year study period. For schizophrenia, the biggest negative changes occurred between 1990 and 2001, whereas some improvements with regard to depression occurred more recently.
Conclusion
Contrary to expectations, stigma has become more severe regarding acute schizophrenia in Germany over the last 30 years, whereas only slightly improving for depression. The apparent normalization of mental health problems seems not to directly translate into improving attitudes toward people with severe mental illness. Re-focusing of anti-stigma efforts on people with severe mental illness seems necessary.
Background
Hospital staff is at high risk of developing mental health issues during the coronavirus (COVID-19) pandemic. However, the literature lacks an overall and inclusive picture of mental health problems with comprehensive analysis among hospital staff during the COVID-19 pandemic.
Objectives
To ascertain the prevalence of anxiety, depression and other mental health outcomes as reported in original articles among hospital staff during the COVID-19 pandemic.
Design
A PRISMA 2020 and MOOSE 2000 compliant umbrella review of published meta-analyses of observational studies evaluating the prevalence of mental health problems in hospital staff during the pandemic.
Review methods
Systematic searches were conducted in PubMed/Medline, CINAHL, EMBASE, and PsycINFO from December 1st, 2019, until August 13th 2021. The random effects model was used for the meta-analysis, and the I² index was employed to assess between-study heterogeneity. Publication bias using Egger test and LFK index was examined. Data was analyzed using STATA 17.0 software. AMSTAR-2 was applied for the quality assessment of systematic reviews, while we used GRADE to rate the quality of evidence.
Results
Forty-four meta-analyses from 1298 individual studies were included in the final analysis, encompassing the prevalence of 16 mental health symptoms. One-third of hospital workers reported anxiety (Prevalence: 29.9%, 95% CI:27.1% to 32.7%) and depression (Prevalence:28.4%, 95% CI:25.5% to 31.3%) symptomatology, while about 40% (95% CI: 36.9% to 42.0%) suffered from sleeping disorders. Fear-related symptoms, reduced well-being, poor quality of life, and acute stress symptoms had the highest prevalence among hospital staff. However, the quality of evidence in these areas varied from low to very low. Nurses suffered more often from sleep problems and symptoms of anxiety and depression than doctors, whereas doctors reported a higher prevalence of acute stress and post-traumatic disorders. The burden of anxiety, depression, and sleep disorders was higher among female employees than their male counterparts. Remarkably, acute stress and insomnia affected more than half of first-line medical staff.
Conclusions
The prevalence of mental health problems among hospital staff during the COVID-19 pandemic is generally high, with anxiety, depression and insomnia symptoms representing the most robust evidence based on a large dataset of prevalence meta-analyses. However, there is no strong confidence in the body of evidence for each outcome assessed.
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Tweetable abstract
The COVID-19 pandemic is having a major impact on the mental health of hospital staff. The need for support must be different for nurses and doctors @eldi12345.
Importance
Stigma, the prejudice and discrimination attached to mental illness, has been persistent, interfering with help-seeking, recovery, treatment resources, workforce development, and societal productivity in individuals with mental illness. However, studies assessing changes in public perceptions of mental illness have been limited.
Objective
To evaluate the nature, direction, and magnitude of population-based changes in US mental illness stigma over 22 years.
Design, Setting, and Participants
This survey study used data collected from the US National Stigma Studies, face-to-face interviews conducted as 1996, 2006, and 2018 General Social Survey modules of community-dwelling adults, based on nationally representative, multistage sampling techniques. Individuals aged 18 years or older, including Spanish-speaking respondents, living in noninstitutionalized settings were interviewed in 1996 (n = 1438), 2006 (n = 1520), and 2018 (n = 1171). The present study was conducted from July 2019 to January 2021.
Main Outcomes and Measures
Respondents reacted to 1 of 3 vignettes (schizophrenia, depression, alcohol dependence) meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria or a control case (daily troubles). Measures included beliefs about underlying causes (attributions), perceptions of likely violence (danger to others), and rejection (desire for social distance).
Results
Of the 4129 individuals interviewed in the surveys, 2255 were women (54.6%); mean (SD) age was 44.6 (16.9) years. In the earlier period (1996-2006), respondents endorsing scientific attributions (eg, genetics) for schizophrenia (11.8%), depression (13.0%), and alcohol dependence (10.9%) increased. In the later period (2006-2018), the desire for social distance decreased for depression in work (18.1%), socializing (16.7%), friendship (9.7%), family marriage (14.3%), and group home (10.4%). Inconsistent, sometimes regressive change was observed, particularly regarding dangerousness for schizophrenia (1996-2018: 15.7% increase, P = .001) and bad character for alcohol dependence (1996-2018: 18.2% increase, P = .001). Subgroup differences, defined by race and ethnicity, sex, and educational level, were few and inconsistent. Change appeared to be consistent with age and generational shifts among 2 birth cohorts (1937-1946 and 1987-2000).
Conclusions and Relevance
To date, this survey study found the first evidence of significant decreases in public stigma toward depression. The findings of this study suggest that individuals’ age was a conservatizing factor whereas being in the pre–World War II or millennial birth cohorts was a progressive factor. However, stagnant stigma levels for other disorders and increasing public perceptions of likely violence among persons with schizophrenia call for rethinking stigma and retooling reduction strategies to increase service use, improve treatment resources, and advance population health.
Coronavirus disease 2019 (COVID-19) was first recognised in December 2019. The subsequent pandemic has caused 4.3 million deaths and affected the lives of billions. It has increased psychosocial risk factors for mental illness including fear, social isolation and financial insecurity and is likely to lead to an economic recession. COVID-19 is associated with a high rate of neuropsychiatric sequelae. The long-term effects of the pandemic on mental health remain uncertain but could be marked, with some predicting an increased demand for psychiatric services for years to come. COVID-19 has turned a spotlight on mental health for politicians, policy makers and the public and provides an opportunity to make mental health a higher public health priority. We review longstanding reasons for prioritising mental health and the urgency brought by the COVID-19 pandemic, and highlight strategies to improve mental health and reduce the psychiatric fallout of the pandemic.
COVID-19 was declared a pandemic in March 2020, resulting in many countries worldwide calling for lockdowns. This study aimed to review the existing literature on the effects of the lockdown measures established as a response to the COVID-19 pandemic on the mental health of children and adolescents. Embase, Ovid, Global Health, PsycINFO, Web of Science, and pre-print databases were searched in this PRISMA-compliant systematic review (PROSPERO: CRD42021225604). We included individual studies reporting on a wide range of mental health outcomes, including risk and protective factors, conducted in children and adolescents (aged ≤ 19 years), exposed to COVID-19 lockdown. Data extraction and quality appraisal were conducted by independent researchers, and results were synthesised by core themes. 61 articles with 54,999 children and adolescents were included (mean age = 11.3 years, 49.7% female). Anxiety symptoms and depression symptoms were common in the included studies and ranged 1.8–49.5% and 2.2–63.8%, respectively. Irritability (range = 16.7–73.2%) and anger (range = 30.0–51.3%), were also frequently reported by children and adolescents. Special needs and the presence of mental disorders before the lockdown, alongside excessive media exposure, were significant risk factors for anxiety. Parent–child communication was protective for anxiety and depression. The COVID-19 lockdown has resulted in psychological distress and highlighted vulnerable groups such as those with previous or current mental health difficulties. Supporting the mental health needs of children and adolescents at risk is key. Clinical guidelines to alleviate the negative effects of COVID-19 lockdown and public health strategies to support this population need to be developed.
Background
We aimed to assess the changes in public stigma towards people with mental health problems in Czechia; and to investigate the association between these and the exposure to the ongoing mental health care reform and one of its implementation projects focused on reducing stigma.
Methods
We analyzed data from three cross-sectional surveys representative of the Czech adult population. We used linear regression models to compare population attitudes and desire for future contact with people with mental health problems between the 2013/2014 baseline and the 2019 follow-up. In our 2019 sample, we employed linear regression models to assess the relationship between exposure to mental health care reform and nation-wide anti-stigma campaign, and population stigmatizing attitudes and intended behavior. We utilized a propensity score matching procedure to mitigate potential bias.
Results
The 2013, 2014, and 2019 datasets consisted of 1797, 1810, and 1077 participants, respectively. Population attitudes improved significantly between 2014 and 2019 ( B = 0.99, 95% CI = 0.06; 1.93), but we did not detect a change in population desire for future contact with people with mental health problems. Exposure to the nationwide anti-stigma campaign or mental health care reform was associated with more favorable attitudes ( B = 4.25, 95% CI = 2.07; 6.42 and B = 7.66, 95% CI = 3.91; 11.42), but not with higher desire for future contact with people with mental health problems.
Conclusions
Mental health care reform and its nation-wide anti-stigma project seems to have a positive impact on population attitudes, but not on desire for future contact with people with mental health problems.
COVID-19 and its countermeasures have negatively impacted the mental health of populations worldwide. The current paper considers whether the rising incidence of psychiatric symptoms during the pandemic may affect lay beliefs about the cause and course of mental illness. Laypeople’s causal attributions and expectations regarding the trajectory of mental illness have important implications for societal stigma and therapeutic orientations. Two online experimental studies investigated whether reading about fictional cases of mental illness that were explicitly situated during the COVID-19 pandemic, compared with reading about the same cases without any pandemic-related contextualisation, affected attributions and expectations about Generalised Anxiety Disorder (Study 1) and Major Depressive Disorder (Study 2). Study 1 (n = 137) results showed that highlighting the onset of anxiety symptoms during the COVID-19 pandemic weakened attributions to biological causes and reduced the anticipated duration of symptoms. However, Study 2 (n = 129) revealed no effects of COVID-19 contextualisation on beliefs about the cause or course of depression. The research provides preliminary evidence that the increased incidence of mental illness during the pandemic may reshape public beliefs about certain mental illnesses. Given the importance of public understandings for the lived experience of mentally unwell persons in society, further evidence of the range and extent of the pandemic’s effects on lay beliefs is important to inform clinical, public health and stigma-reduction initiatives.
Aims
The United Nations warned of COVID-19 related mental health crisis; however, it is unknown whether there is an increase in prevalence of mental disorders as existing studies lack a reliable baseline analysis or they did not use a diagnostic measure. We aimed to analyse trends in the prevalence of mental disorders prior to and during the COVID-19 pandemic.
Methods
We analysed data from repeated cross-sectional surveys on a representative sample of non-institutionalized Czech adults (18+ years) from both November 2017 (n=3306; 54% females) and May 2020 (n=3021; 52% females). We used Mini International Neuropsychiatric Interview (MINI) as the main screening instrument. We calculated descriptive statistics and compared the prevalence of current mood and anxiety disorders, suicide risk, and alcohol related disorders at baseline and right after the first peak of COVID-19 when related lockdown was still in place in CZ. In addition, using logistic regression, we assessed the association between COVID-19-related worries and the presence of mental disorders.
Results
We found an increased proportion of those experiencing symptoms of at least one current mental disorder during the COVID-19 pandemic by more than 10 % when compared to the baseline in November 2017 (20.02, 95% CI = 18.64; 21.39 in 2017 vs 29.63, 95% CI = 27.9; 31.37 in 2020). The prevalence of both major depressive disorder (3.96, 95% CI = 3.28; 4.62 vs 11.77, 95% CI = 10.56; 12.99); and suicide risk (3.88, 95% CI = 3.21; 4.52 vs 11.88, 95% CI = 10.64; 13.07) tripled and current anxiety disorders almost doubled (7.79, 95% CI = 6.87; 8.7 vs 12.84, 95% CI = 11.6; 14.05). The prevalence of alcohol use disorders in 2020 was approximately the same as in 2017 (10.84, 95% CI = 9.78; 11.89 vs 9.88, 95% CI = 8.74; 10.98); however, there was a significant increase in weekly binge drinking behaviors (4.07% vs 6.39%). Strong worries about both, health or economic consequences of COVID-19, were associated with an increased odds of having a mental disorder (1.63, 95% CI = 1.4; 1.89 and 1.42, 95% CI = 1.23; 1.63 respectively).
Conclusions
This study provides evidence matching concerns that COVID-19 related mental health problems is a real concern and poses a major threat to populations, particularly considering the barriers in service provision posed during lockdown. This finding emphasizes an urgent need to scale up mental health promotion and prevention globally.
Mental health literacy (MHL) is considered a prerequisite for early recognition and intervention in mental disorders, and for this reason, it has become a focus of research over the past few decades. Assessing this construct is relevant for identifying knowledge gaps and erroneous beliefs concerning mental health issues, to inform the development of interventions aimed at promoting mental health literacy as well as the evaluation of these interventions. Recently, we developed a new self-reporting measure (MHLq) for assessing mental health literacy in young people (12⁻14 years-old), meeting the need to assess MHL from a comprehensive perspective of the construct instead of focusing on a restricted number of mental disorders or specific dimensions (e.g., knowledge concerning specific disorders; stigma). The present study aimed to adapt the MHLq for the young adult population and to examine its psychometric properties, according to the following steps: (1) item adaptation, using a think aloud procedure (n = 5); (2) data collection (n = 356, aged between 18 and 25 years old; and (3) psychometric analyses (exploratory factor analysis and internal consistency analysis). The final version of the questionnaire included 29 items (total scale α = 0.84), organized by four dimensions: (1) knowledge of mental health problems (α = 0.74); (2) erroneous beliefs/stereotypes (α = 0.72); (3) help-seeking and first aid skills (α = 0.71); and (4) self-help strategies (α = 0.60). The results suggest that the MHLq-adult form is a practical, valid, and reliable screening tool for identifying gaps in knowledge, beliefs, and behavioral intentions related to mental health and mental disorders, planning promotion programs, and evaluating intervention effectiveness.
It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need predicted intention (GP: beta 0.45, p < 0.001; MHP: beta 0.38, p < 0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p < 0.01; GP: beta 0.17, p = 0.093). More knowledge was associated with more self-identification (beta 0.21, p < 0.01), while support for discrimination was associated with lower self-identification (beta − 0.14, p < 0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta − 0.16, p < 0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Recognizing one’s own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.
Background
Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigma-related influences on pathways to care in the early stages of psychotic disorders have not been systematically examined.
Method
This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results.
Results
The meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: ‘sense of difference’, ‘characterizing difference negatively’, ‘negative reactions (anticipated and experienced)’, ‘strategies’, ‘lack of knowledge and understanding’, and ‘service-related factors’. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups.
Conclusions
Our findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care.
Objective:
Public stigma of mental illness is still a major problem where numerous population studies during the last decade have mainly shown no improvements. A Swedish national antistigma campaign has been running 2010-2014. The aim of this study was to investigate changes in public stigma during this period as compared to baseline in 2009.
Methods:
Yearly population surveys were made between 2009 and 2014 including assessments of mental health literacy, attitudes, and intended future behaviour. Two surveys were made, one including a nationally representative sample and one including a representative sample from three original campaign regions. Multiple regression analyses, also including age, gender, education, and familiarity with mental illness were made to investigate yearly changes in public stigma compared to baseline.
Results:
Mental health literacy improved significantly in the campaign regions between 2009 and 2014, as did intended future behaviour. Attitudes toward mental illness also improved significantly. Improvements were also shown in the national population surveys, but the time pattern of these compared to that of the original campaign regions indicated that these changes took place mainly after the campaign had been extended to a further five Swedish regions.
Conclusion:
The results of our surveys suggest that a campaign primarily based on social contact theory and involving people with lived experience of mental illness may, even in a rather short-term perspective, have a significant positive impact on mental health literacy, attitudes, and intentions of social contact with people with mental illness.
Purpose
Stigma among health care professionals is detrimental to the life of those with mental health problems. In the region of post-communist Europe, the level of stigma among health care providers remains understudied. We aimed to compare attitudes towards people with mental illness between Czech medical doctors and the general population.
Methods
The Community Attitudes towards Mentally Ill (CAMI) scale was used to measure stigmatizing attitudes among a nationally representative sample of (1) adults residing in the Czech Republic (n = 1810) and (2) Czech medical doctors (n = 1200). Descriptive statistics and multivariable linear regression were used to assess differences between both samples.
Results
Compared to the general adult population in the Czech Republic, Czech medical doctors demonstrated less stigmatizing attitudes toward people with mental illness in 26 of the 27 CAMI items as well as in the total CAMI score. Medical doctors, however, were more likely to consider mental hospitals as an up-to-date method of treating people with mental illness.
Conclusions
Our findings demonstrate more favorable attitudes towards people with mental illness among Czech medical doctors when compared to the Czech general population. Stigma, however, is high among both these groups.
Understanding trends and effective mechanisms that are likely to reduce public stigma and discrimination towards people with mental illness is important. We aimed to assess changes in public stigma in England after the introduction of the Time to Change anti-stigma campaign.
Methods
We used data from the 2003 and 2007–13 national Attitudes to Mental Illness surveys to investigate 10-year trends in public attitudes across England before and during the Time to Change anti-stigma campaign. We present annual mean scores for attitude items related to prejudice and exclusion, and tolerance and support for community care. We also present an extrapolated linear trend line for the years 2009–13 and estimate population attitude scores without the campaign. We present unadjusted and adjusted linear regression models. In addition, we used multivariable linear regression models fitted to data aggregated by region to investigate whether a dose-effect response exists between campaign awareness and regional outcomes related to knowledge, attitudes, and intended behaviour.
Findings
About 1700 respondents were surveyed each year. Significant increases in positive attitudes related to prejudice and exclusion occurred after the Time to Change campaign. In the multivariable analysis, we noted a significant increase in positive attitudes in relation to prejudice and exclusion after the launch of Time to Change (reverse-coded Z score 0·02, 95% CI 0·01 to 0·05; p=0·01), but not for tolerance and support for community care (Z score 0·01, −0·01 to 0·03; p=0·27). We also found evidence for a dose–effect relation between campaign awareness and regional improvement in knowledge (p=0·004) and attitudes (tolerance and support p
For major physical diseases, it is widely accepted that members of the public will benefit by knowing what actions they can take for prevention, early intervention, and treatment. However, this type of public knowledge about mental disorders (mental health literacy) has received much less attention. There is evidence from surveys in several countries for deficiencies in (a) the public's knowledge of how to prevent mental disorders, (b) recognition of when a disorder is developing, (c) knowledge of help-seeking options and treatments available, (d) knowledge of effective self-help strategies for milder problems, and (e) first aid skills to support others affected by mental health problems. Nevertheless, there is evidence that a range of interventions can improve mental health literacy, including whole-of-community campaigns, interventions in educational settings, Mental Health First Aid training, and information websites. There is also evidence for historical improvements in mental health literacy in some countries. Increasing the community's mental health literacy needs to be a focus for national policy and population monitoring so that the whole community is empowered to take action for better mental health.
Although stigma in relation to mental health has been defined as including components of knowledge, attitudes and behaviour, no psychometrically tested instrument to assess behavioural discrimination at the population level has been developed. This paper presents details of the development and psychometric properties of the Reported and Intended Behaviour Scale (RIBS), an instrument based on the Star Social Distance Scale, to assess reported (past and current) and intended (future) behavioural discrimination among the general public against people with mental health problems.
Three studies were carried out to evaluate psychometric properties of the RIBS (Study 1, n = 92; Study 2, n = 37; Study 3, n = 403). Adults aged 25-45 in socio-economic groups: B, C1 and C2 (middle-income groups) took part in development and testing of the RIBS.
Internal consistency and test-retest reliability is moderate/substantial. Strong consensus validity was found, as rated by service users/consumers and international experts in stigma research.
Use of a behavioural outcome may be important to evaluate the effectiveness of interventions intended to reduce stigma and/or discrimination related to mental illness. The RIBS was found to be a brief, feasible and psychometrically robust measure for assessing mental health-related reported and intended behavioural discrimination.
The measurement of public attitudes toward the mentally ill has taken on new significance since the introduction of community-based mental health care. Previous attitude scales have been constructed and applied primarily in a professional context. This article discusses the development and application of a new set of four scales explicitly designed to measure community attitudes toward the mentally ill. The scales represent dimensions included in previous instruments, specifically, authoritarianism, benevolence, social restrictiveness, and community mental health ideology, but are expressed in terms of an almost completely new set of items that emphasize community contact with the mentally ill and mental health facilities. Data from a study of community attitudes about neighborhood mental health facilities in Toronto are used to test the internal and external validity of the scales. Results of the analysis provide strong support for the validity of the scales and demonstrate their usefulness as explanatory and predictive variables for studying community response to mental health facilities.
To give an overview of the volume of alcohol consumption, beverage preference, and patterns of drinking among adults (people 15 years and older) in central and eastern Europe (Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, and Slovenia) and to compare it to southern and western Europe, Russia and Ukraine.
Secondary data analysis. Consumption and preferred beverage type data for the year 2002 were taken from the WHO Global Status Report on Alcohol and the WHO Global Alcohol Database.
Average consumption in central and eastern Europe is high with a relatively large proportion of unrecorded consumption ranging from one litre in Czech Republic and Estonia to 10.5 l in Ukraine. The proportion of heavy alcohol consumption (more than 40 g of pure alcohol per day) among men was the lowest in Bulgaria (25.8%) and the highest in Czech Republic (59.4%). Among women, the lowest proportion of heavy alcohol consumption was registered in Estonia (4.0%) and the highest in Hungary (16.0%). Patterns of drinking are detrimental with a high proportion of binge drinking, especially in the group of countries traditionally drinking vodka. In most countries, beer is now the most prevalent alcoholic beverage.
Other studies suggest that the population drinking levels found in central and eastern Europe are linked with higher levels of detrimental health outcomes. Known effective and cost-effective programs to reduce levels of risky drinking should, therefore, be implemented, which may, in turn, lead to a reduction of alcohol-attributable burden of disease.
People with alcohol related liver disease (ALD) experience stigma and discrimination. This review summarizes the evidence on ALD stigma in healthcare and its implications for people with ALD, drawing from the literature on mental illness stigma and specifically the stigma of alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to increased illness burden of ALD, failure or delay of seeking help, inferior healthcare, and negative health outcomes. Stigma can be experienced, but also anticipated and avoided, which all negatively impacts ALD healthcare. Blaming people with ALD for their condition is central to ALD stigma. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigma of ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low and middle income countries and in countries with restrictive drinking norms. Interventions to reduce ALD stigma and facilitate early help-seeking need to be developed and evaluated.
Clinical trial number
N.a.
Objectives
To assess the prevalence of mental disorders during the second wave of COVID-19 pandemic in comparison with both, baseline and the first wave of the pandemic, and to identify disproportionally affected non-clinical subgroups.
Material and methods
We used data from three nationally representative cross-sectional studies and compared the prevalence of current mood and anxiety disorders, and alcohol-use disorders at baseline (November 2017, n=3306), immediately after the first peak (May 2020, n=3021), and during the second peak (November 2020, n=3000) of COVID-19 in Czechia. We used the Mini International Neuropsychiatric Interview (M.I.N.I.) as a screening instrument, and calculated weighted prevalence (%) with 95% weighted confidence intervals (95% CIs). Additionally, we examined the prevalence of these disorders across different non-clinical population sub-groups during the second wave of the pandemic.
Results
The proportion of individuals experiencing at least one mental disorder was highest during the second wave of the pandemic (32.94%, 95% CI = 31.14%; 34.77%), when compared to both the baseline in November 2017 (20.02%, 95% CI = 18.64%; 21.39%), and the first wave in May 2020 (29.63%, 95% CI = 27.9%; 31.37%). Younger adults, students, those having lost a job or on forced leave, and those with only elementary education displayed disproportionally high prevalence of mental disorders.
Conclusions
Our findings suggest that population mental health has not returned to pre-COVID-19 levels. It seems that mental health of some population subgroups, such as young adults or those worse off economically, might have been affected disproportionately by the COVID-19 situation, and future studies identifying high-risk groups are warranted.
The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.
Conceptualizing own symptoms as potential signs of a mental illness is an important, yet under-researched step towards appropriate help. Few validated measures address recognition and identification of own mental illness. Aim of this study is to investigate performance and correlates of the 'self-Identification as Having a Mental Illness’ scale (SELF-I) in a group of 229 currently untreated individuals with mental health problems, predominantly depression. Measures included: self-identification with having a mental illness (SELF-I), depressive and somatic symptom severity (PHQ-9 and PHQ-15), illness perceptions (B-IPQ-R-C), and sociodemographic variables. Principal-component analysis revealed in a unidimensional factor structure. The SELF-I showed good reliability in terms of internal consistency (Cronbach's alpha, 0.85–0.87) and re-test reliability over three months (Intraclass correlation coefficient, 0.74). Associations with depressive symptoms, previous treatment experiences and self-labelling demonstrated construct and criterion validity. Low associations with somatic symptoms and with illness-perceptions as measured by the B-IPQ-R-C indicated discriminant validity. We did not observe any floor or ceiling effects. The SELF-I scale is a brief, unidimensional and reliable measure of self-identification as having a mental illness that offers useful research perspectives.
Objectives
The CZEch Mental health Study (CZEMS) was launched to inform the ongoing mental health care reform. This paper describes rationale, methods, and the plan for the future analyses of this project.
Methods
A cross‐sectional survey on a representative sample of the general adult noninstitutionalized population of the Czech Republic was conducted. Two‐stage sampling was utilized and respondents were interviewed by centrally trained staff using a paper and pencil interviewing. The presence of mental disorders was assessed by The Mini‐International Neuropsychiatric Interview. The study also collected information about disability, self‐identification of having a mental illness, medical history, and help‐seeking behaviour.
Results
This survey had a 75% response rate, and the final sample consisted of 3,306 persons aged from 18 to 96 years (mean age 49 years old, 54% women) that were interviewed in their homes. The final sample is representative for the Czech Republic in terms of age, gender, education, and region.
Conclusions
CZEMS will provide up‐to‐date evidence about a prevalence of mental disorders in the Czech Republic, associated disability, and treatment gap. This will help informed decision‐making about the current mental health care reform and future mental health care development in the Czech Republic.
Background:
Mental disorders create high individual and societal costs and burden, partly because help-seeking is often delayed or completely avoided. Stigma related to mental disorders or mental health services is regarded as a main reason for insufficient help-seeking.
Aims:
To estimate the impact of four stigma types (help-seeking attitudes and personal, self and perceived public stigma) on active help-seeking in the general population.
Method:
A systematic review of three electronic databases was followed by random effect meta-analyses according to the stigma types.
Results:
Twenty-seven studies fulfilled eligibility criteria. Participants' own negative attitudes towards mental health help-seeking (OR = 0.80, 95% CI 0.73-0.88) and their stigmatising attitudes towards people with a mental illness (OR = 0.82, 95% CI 0.69-0.98) were associated with less active help-seeking. Self-stigma showed insignificant association (OR = 0.88, 95% CI 0.76-1.03), whereas perceived public stigma was not associated.
Conclusions:
Personal attitudes towards mental illness or help-seeking are associated with active help-seeking for mental problems. Campaigns promoting help-seeking and fighting mental illness-related stigma should target these personal attitudes rather than broad public opinion.
Video is considered to be an effective, easy to use tool employed in anti-stigma interventions among young people. Mass media has been shown to be effective for reducing stigma; however, there is insufficient evidence to determine the destigmatization effects of videos specifically. This article systematically reviews the effectiveness of video intervention in reducing stigma among young people between 13 and 25 years. We searched 13 electronic databases including randomized controlled trials, cluster randomized controlled trials, and controlled before and after studies. Of the 1426 abstracts identified, 23 studies (reported in 22 papers) met the inclusion criteria. Video interventions led to improvements in stigmatising attitudes. Video was found to be more effective than other interventions, such as classical face-to-face educational sessions or simulation of hallucinations. According to results of two studies, social contact delivered via video achieved similar destigmatization effect to that delivered via a live intervention. Although the quality of studies as well as the form of video interventions varied, the findings suggest that video is a promising destigmatization tool among young people; however, more studies in this area are needed. There was a lack of evidence for interventions outside of school environments, in low- and middle-income countries, and studies, which looked at long-term outcomes or measured impact on actual behaviour and implicit attitudes. The review generates recommendations for video interventions targeted at young people.
Reducing public stigma could improve patients' access to care, recovery and social integration. The aim of the study was to evaluate a mass media intervention, which aimed to reduce the mental health, related stigma among the general population in Catalonia (Spain). We conducted a cross-sectional population-based survey of a representative sample of the Catalan non-institutionalized adult population (n=1019). We assessed campaign awareness, attitudes to people with mental illness (CAMI) and intended behaviour (RIBS). To evaluate the association between campaign awareness and stigma, multivariable regression models were used. Over 20% of respondents recognized the campaign when prompted, and 11% when unprompted. Campaign aware individuals had better attitudes on the benevolence subscale of the CAMI than unaware individuals (P=0.009). No significant differences in authoritarianism and support for community mental health care attitudes subscales were observed. The campaign aware group had better intended behaviour than the unaware group (P<0.01). The OBERTAMENT anti-stigma campaign had a positive impact to improve the attitudes and intended behaviour towards people with mental illness of the Catalan population. The impact on stigma was limited to attitudes related to benevolence. A wider range of anti-stigma messages could produce a stronger impact on attitudes and intended behaviour.
Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user's perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma.
This is one of the first studies, which compares the level of stigmatizing behaviour in countries that used to be on the opposite sides of the Iron Curtain. The aim was to identify the prevalence of reported and intended stigmatizing behaviour towards those with mental health problems in the Czech Republic and to compare these findings with the findings from England. The 8-item Reported and Intended Behaviour Scale (RIBS) was used to assess stigmatising behaviour among a representative sample of the Czech population (n=1797). Results were compared with the findings of an analogous survey from England (n=1720), which also used the RIBS. The extent of reported behaviour (i.e., past and present experiences with those with mental health problems) was lower in the Czech Republic than in England. While 12.7% of Czechs reported that they lived, 12.9% that they worked, and 15.3% that they were acquainted with someone who had mental health problems, the respective numbers for England were 18.5%, 26.3% and 32.5% (P<0.001 in each of these items). On the other hand, the extent of intended stigmatizing behaviour towards those with mental health problems is considerably higher in the Czech Republic. Out of maximum 20 points attached to possible responses to the RIBS items 5-8, Czechs had a lower total score (x=11.0, SD=4.0) compared to English respondents (x=16.1, SD=3.6), indicating lower willingness to accept a person with mental health problems (P<0.001). The prevalence of stigmatizing behaviour in the Czech Republic is worrying. Both, further research and evidence based anti-stigma interventions, should be pursued in order to better understand and decrease stigmatizing behaviour in the Czech Republic and possibly across the post-communist countries in Central and Eastern Europe.
Copyright © 2015. Published by Elsevier Masson SAS.
Objective:
To evaluate whether a campaign to increase public knowledge about depression (beyondblue: the national depression initiative) has influenced the Australian public's ability to recognize depression and their beliefs about treatments.
Method:
Data from national surveys of mental health literacy in 1995 and 2003-04 were analysed to see if states and territories which funded beyondblue (the high exposure states) had greater change than those that did not (the low exposure states). In both surveys, participants were asked what was wrong with a person in a depression case vignette and to give opinions about the likely helpfulness for this person of a range of treatments. In the 2003-04 survey participants were also asked questions to assess awareness of beyondblue.
Results:
Awareness of beyondblue in the states that provided funding was found to be around twice the level of those that did not. Using the low-exposure states as a control, the high-exposure states had greater change in beliefs about some treatments, particularly counselling and medication, and about the benefits of help-seeking in general. Recognition of depression improved greatly at a national level, but slightly more so in the high-exposure states.
Conclusions:
The data are consistent with beyondblue having had a positive effect on some beliefs about depression treatment.
Background:
Public stigma against people with mental health problems is damaging to individuals with mental illness and is associated with substantial societal burden.
Aims:
To investigate whether public knowledge, attitudes and behaviour in relation to people with mental health problems have improved among the English population since the inception of the Time To Change programme in 2009.
Method:
We analysed longitudinal trends in public knowledge, attitudes and behaviour between 2009 and 2012 among a nationally representative sample of English adults.
Results:
There were improvements in intended behaviour (0.07 standard deviation units, 95% CI 0.01-0.14) and a non-significant trend for improvement in attitudes (P = 0.08) among the English population. There was, however, no significant improvement in knowledge or reported behaviour.
Conclusions:
The findings provide support for effectiveness of the national Time to Change programme against stigma and discrimination in improving attitudes and intended behaviour, but not knowledge, among the public in England.
Tackling the mental health impact of the COVID-19 crisis: An integrated, whole-of-society response
- E Hewlett
- S Takino
- Y Nishina
- C Prinz
Hewlett, E., S. Takino, Y. Nishina and C. Prinz (2021). "Tackling the mental health impact of the COVID-19
crisis: An integrated, whole-of-society response." Organisation for Economic Co-operation and
Development (OECD).
COVID-19-related mental health challenges and opportunities perceived by mental health providers in the Philippines
- Bollettino
COVID-19-related Mental Health Challenges and Opportunities Perceived by Mental Health Providers in the Philippines
- V Bollettino
- C Y Foo
- H Stoddard
- M Daza
- A C Sison
- M Teng-Calleja
- P Vinck
Bollettino, V, C. Y. Foo, H. Stoddard, M. Daza, A. C. Sison, M. Teng-Calleja and P. Vinck (2023). "COVID-19-related Mental Health Challenges and Opportunities Perceived by Mental Health Providers in the
Philippines." Asian Journal of Psychiatry: 103578.
Mental health literacy: empowering the community to take action for better mental health
- Jorm