Anita Holzinger

The Stigma of Alcohol Dependence Compared with Other Mental Disorders: A Review of Population Studies

AIMS Stigma is likely to aggravate the severe medical and social consequences of alcohol dependence. We aim to explore the characteristics of the alcohol dependence stigma by comparing it with the stigma of other conditions. METHODS On the basis of a systematic literature search, we identified 17 representative population studies published before July 2010 that examine aspects of the stigma of alcoholism and simultaneously of other mental, medical or social conditions. Seven surveys were located in Europe, five in North America, three in New Zealand and one each in Brazil and Ethiopia, respectively. RESULTS Compared with people suffering from other, substance-unrelated mental disorders, alcohol-dependent persons are less frequently regarded as mentally ill, are held much more responsible for their condition, provoke more social rejection and more negative emotions, and they are at particular risk for structural discrimination. Only with regard to being a danger, they are perceived to be at a similarly negative level to that of people suffering from schizophrenia. CONCLUSION Alcoholism is a particularly severely stigmatized mental disorder. Cultural differences are likely, but under-researched. We discuss possible reasons for the differences between the stigma of alcoholism and of other mental diseases and the consequences for targeted anti-stigma initiatives.

Biogenetic explanations and public acceptance of mental illness: systematic review of population studies

BACKGROUND Biological or genetic models of mental illness are commonly expected to increase tolerance towards people with mental illness, by reducing notions of responsibility and blame. AIMS To investigate whether biogenetic causal attributions of mental illness among the general public are associated with more tolerant attitudes, whether such attributions are related to lower perceptions of guilt and responsibility, to what extent notions of responsibility are associated with rejection of people who are mentally ill, and how prevalent notions of responsibility are among the general public with regard to different mental disorders. METHOD A systematic review was conducted of representative population studies examining attitudes towards people with mental illness and beliefs about such disorders. RESULTS We identified 33 studies relevant to this review. Generally, biogenetic causal attributions were not associated with more tolerant attitudes; they were related to stronger rejection in most studies examining schizophrenia. No published study reported on associations of biogenetic causal attributions and perceived responsibility. The stereotype of self-responsibility was unrelated to rejection in most studies. Public images of mental disorder are generally dominated by the stereotypes of unpredictability and dangerousness, whereas responsibility is less relevant. CONCLUSIONS Biogenetic causal models are an inappropriate means of reducing rejection of people with mental illness.

Depression and Quality of Life: Results of a Follow-Up Study

Background: Although there is sufficient evidence that the quality of life of people suffering from depression is reduced hardly anything is known about their quality of life after the remission of a depressive episode. Aims: We therefore set out to study the quality of life of patients with depression (ICD-10 F32, F33) one, four and seven months after discharge from hospital. For comparison, a random sample of the general population was studied in addition. Method: Quality of life was assessed by means of the WHOQOL-100, a self-administered questionnaire developed by WHO. Results: Although, shortly after discharge, quality of life of patients whose depression remitted was better than that of patients with persisting depression it was still slightly worse than that of the general population. During the subsequent six months, there was no further improvement of quality of life, i.e. even at the end of the follow-up period there was a slight lack of quality of life, especially as concerns the level of independence, spirituality/religion/personal beliefs and physical health. Conclusions: Thus, what already had been reported based on the objective assessment of quality of life, namely that depression implies a persisting impairment of social functioning and living conditions, can be replicated to some extent from the point of view of the patients themselves.

Personality disorder and social anxiety predict delayed response in drug and behavioral treatment of panic disorder

BACKGROUND The aim of this study was to analyze the impact of pretreatment characteristics and personality disorders on the onset of response in the treatment of panic disorder. METHODS The data of 73 out-patients with panic disorder who had completed at least 6 weeks of a randomized trial of 24 weeks of either paroxetine only or paroxetine combined with cognitive group-therapy were analyzed in a Cox proportional hazards model. RESULTS The likelihood of having responded to treatment (defined by a CGI rating of improvement) was more than twice as high for patients without a personality disorder or social phobia than for Patients with a personality disorder or social phobia. CONCLUSIONS We suggest that patients with these characteristics do benefit from prolonged treatment, and they may profit from an additional treatment focused on social anxiety.

Public Attitudes Towards Alcohol Dependence

OBJECTIVE Although among the most prevalent psychiatric conditions, alcoholism seems to be neglected within the current debate on mental illness stigma. We establish the state of current research on public attitudes towards alcohol dependent people. METHODS In an extensive search of the literature, we identified 49 population studies on this topic between 1948 and 2008. 27 studies contained relevant information from Western countries and were included in this review. RESULTS Although most people regard alcoholism as an illness, there is a strong tendency to blame those affected for their condition. Psycho-social causal attributions prevail over biologic explanations. Most people regard alcohol dependent persons as unpredictable and dangerous. The desire for social distance is stronger towards alcohol dependent persons than towards those with other psychiatric diagnoses such as depression or schizophrenia; only those addicted to illegal drugs suffer stronger rejection. Preferences of the public for resource allocation within the health care system put alcohol dependent patients at a potential disadvantage. CONCLUSIONS Alcoholism is a severely stigmatized condition. In order to change the stigma of alcoholism, studies exploring theoretical models and mechanisms of stigmatization seem necessary.

[Evaluation of target-group oriented interventions aimed at reducing the stigma surrounding mental illness].

OBJECTIVE To provide a systematic review of target-group oriented interventions aimed at reducing the stigma surrounding mental illness. METHODS An electronic literature search was carried out based on PubMed. In addition, the reference lists of included studies were examined and other sources like the internet were used. RESULTS 51 studies could be identified, over half of them being targeted at school students. There was a large variation in the format of the various interventions. One half of interventions were based exclusively on education, the other half on a combination of education with contact with someone with a mental disorder. The vast majority of studies reported positive intervention effects. However, in several studies the effect did not persist over a time period of a few months. It appears easier to improve knowledge or to change misconceptions of mental disorders than to reduce the tendency to distance oneself from people with mental illness. When directly comparing the effect of interventions based exclusively on education with those combining education with facilitating contact with people with mental disorders, the latter proved more effective. CONCLUSION A remarkable number of targeted interventions aimed at reducing the stigma attached to mental illness have been carried out. However, due to methodological limitations no definite assessment of the effect of these interventions is possible at the present time. There is a pressing need for research that adheres more closely to the methodological standards of evaluation research.Dem Problem der Stigmatisierung psychisch Kranker wurde in den letzten Jahren vermehrt Aufmerksamkeit geschenkt. Die Tatsache, dass psychisch Kranke auch heutzutage vielfältigen Diskriminierungen ausgesetzt sind, rückte im− mer stärker in das Bewusstsein der Öffentlichkeit und der Fachwelt [1,2]. In Reaktion darauf wur− den weltweit zahlreiche Programme initiiert, die das Ziel verfolgen, das Stigma, das psychischen Krankheiten anhaftet, zu reduzieren. Am bekann− testen ist das Programm der WPA 1Open the doors“, an dem zurzeit 20 Länder, darunter auch Österreich, Deutschland und die Schweiz, betei− ligt sind (WPA Homepage 1Open the Doors“). In− zwischen wurde eine Vielzahl von ganz unter− schiedlichen Antistigma−Interventionen durch− geführt. Prinzipiell kann man zwischen Interven− tionen, die sich an die breite Öffentlichkeit rich− ten (z. B. [3]), und solchen, die sich an bestimmte Zielgruppen (z. B. Schüler) wenden, unterschei− den. Um letztere geht es in der vorliegenden Arbeit. Wir wollen uns mit der Frage beschäfti− gen, inwieweit mittels zielgruppenorientierter Antistigma−Interventionen eine Reduzierung der Stigmatisierung und Diskriminierung psychisch kranker Menschen erreicht werden kann. Methode !

What to do about depression? Self-help recommendations of the public

Background: While help-seeking and treatment preferences for depression have been assessed in a number of population studies, little is known about the public’s self-help beliefs. Aims: To explore public beliefs about self-help actions to be taken in case of depression. Methods: In spring 2009, a population-based survey was conducted by telephone in the city of Vienna. A fully structured interview was carried out, which began with the presentation of a vignette describing a case of depression. Subsequently, respondents were asked to indicate to what extent they would recommend various self-help actions. Results: Among the self-help options proposed, confiding in a close friend or someone in the family were most frequently recommended. Apart from that, a variety of interpersonal actions (socializing with others, joining a self-help group), psychological methods (thinking positively), lifestyle changes (engaging in sport, listening to music, going on vacation, reading a good book) and dietary methods (eating healthy food) were endorsed by over half of respondents. While women were more ready to recommend self-help actions, the better educated were less enthusiastic about them. Conclusions: As only some of the self-help measures endorsed by the public are evidence based, more research is needed before promulgating their use.

[Associations to psychoanalysis--results of a population based survey in Vienna].

OBJECTIVE To investigate the associations and connotations of the general public to psychoanalysis. METHODS A representative telephone survey was conducted in the city of Vienna. 1,205 people over 16 years of age were interviewed. As part of a fully structured interview associations to psychoanalysis were investigated by an open question. Results were subsequently further analyzed by means of content analysis. RESULTS Psychoanalysis is widely known in the general public. But associations are rather limited. Besides the name of Sigmund Freud, people do not have many associations to psychoanalysis. The picture of psychoanalysis is rather orientated towards the past. CONCLUSIONS Despite its high profile, a rather undifferentiated and one-dimensional image of psychoanalysis is prevalent among the general public.

Gruppenpsychotherapie bei Panikstörung

Seit die Panikstorung im Diagnosticai and Statistical Manual of Mental Disorders (DSM-III) des Amerikanischen Psychiaterverbandes (APA 1980) definiert wurde, ist eine grose Zahl von pharmakotherapeutischen Studien erschienen. Dabei haben sich die alten trizyklischen und die neuen selektiv serotonergen Antidepressiva wie auch die Monoaminooxidase-Hemmkorper bei Anwendung uber 8 bis 12 Wochen als wirksam erwiesen; es kommt durch diese Medikamente zu einer deutlichen Reduktion der Panikattacken und der agoraphoben Symptomatik sowie der damit einhergehenden Behinderungen (Katschnig 1996). Auch aus dem psychotherapeutischen Bereich kamen nach und nach Studien, in denen belegt werden konnte, das bei Panikattacken zumindest kognitive Therapie auserst wirksam ist (Margraf et al. 1993). Bis heute gibt es nur wenige randomisierte Vergleichsstudien, die Pharmakotherapie und Psychotherapie miteinander vergleichen. In einer der am besten geplanten Untersuchungen, der von Clark und Mitarbeitern (1994), zeigte sich, das sowohl medikamentose als auch kognitive Therapie wirksam ist, nach Ende der Therapie kognitive Therapie jedoch einen persistierenderen Effekt als eine abgesetzte Pharmakotherapie aufweist.

The diffusion of the diagnostic term bipolar disorder among the German public

In 2005, 15 years after the introduction of the diagnosis in DSM-III, a telephone survey in Germany revealed that the public was still unfamiliar with the term bipolar disorder. Only 5.3% of those questioned knew at the time that it denotes a mental illness. In the meantime, efforts have been made to spread the concept among the public. In the media there has been increasing mention of the disorder. Another telephone survey in 2017 showed that familiarity with the diagnostic term has grown substantially. 54.0% of respondents now connected the term bipolar disorder with a mental illness.