Anna Christin Makowski

Estimated prevalence of mental disorders and the desire for social distance—Results from population surveys in two large German cities

The study is focused on two research questions: What are the publics estimates of the prevalence of depression, schizophrenia, bulimia nervosa and anorexia nervosa? What is the relationship between the estimated prevalence of the mental disorders and the publics desire for social distance? Analyses are based on a telephone survey in two large German cities (Hamburg and Munich, N=2014, response rate 51%). Vignettes with typical signs and symptoms suggestive of a depression, schizophrenia, bulimia nervosa and anorexia nervosa were presented. Respondents were asked about the lifetime prevalence of the mental disorders and their desire for social distance. Across all four disorders under study the respondents markedly overestimate the rates of lifetime prevalence. Increasing prevalence estimation is associated with a significant decrease in the desire for social distance in case of schizophrenia. As for depression, anorexia nervosa and bulimia nervosa there are no significant associations. Many campaigns aimed at reducing stigma emphasize the high prevalence of mental disorders. The assumption of these campaigns is that reduction of the perceived distinction leads to a decrease of the desire for social distance towards those afflicted. Our results indicate that this may not generally be an effective way to reduce stigma.

Changes in beliefs and attitudes toward people with depression and schizophrenia – results of a public campaign in Germany

We examined the impact of a mental health awareness campaign on public attitudes. The campaign was embedded in the project psychenet - Hamburg Network for Mental Health. Beliefs and attitudes were examined before and after specific awareness measures in Hamburg (intervention region) and Munich (control region). Analyses were based on representative surveys (2011: N=2014; 2014: N=2006). Vignettes with symptoms suggestive of depression respectively schizophrenia were presented, followed by questions on social distance, beliefs and emotional reactions. Analyses of variance tested variations between regions over time and differences between those aware of the campaign and those not aware. In 2014, 7.3% (n=74) of the Hamburg respondents were aware of the psychenet campaign. Regarding the total sample, there were minor changes in attitudes. Differentiated according to campaign awareness among Hamburg respondents, those who were aware showed less desire for social distance toward a person with depression. Moreover, respondents aware of the campaign stated less often that a person with schizophrenia is in need of help. The campaign had small impact on attitudes. A substantial change in ingrained attitudes toward persons with mental health problems is difficult to achieve with interventions targeting the general public.

Beliefs about depression--do affliction and treatment experience matter? Results of a population survey from Germany.

BACKGROUND There is not much known about the associations of beliefs about depression (depression literacy) with a history of depression and treatment experience. METHODS Analyses were based on a telephone survey in two large German cities (Hamburg and Munich). Written vignettes with typical signs and symptoms suggestive of a depression were presented to 1293 respondents. Respondents were then asked about beliefs about causes, symptoms, prevalence, and treatment using a standardized questionnaire. For the analysis respondents were divided into three groups: (1) people who never had a depression, (2) people who had a depression but were not treated and (3) people with treatment experience. RESULTS Respondents with experience in treatment for depression were more likely to correctly recognize the disorder, to positively evaluate treatability and to favor external factors (adverse conditions in childhood and psychosocial stress) as potential causes of depression compared to those who never were afflicted. There were no significant differences between these two groups regarding beliefs about the effectiveness of treatment options. There were only few significant differences in depression literacy between respondents who have a history of depression but have not sought help and those who never were afflicted. LIMITATIONS The three groups were constituted on the basis of respondents׳ self-reports, not medical diagnoses. CONCLUSIONS Our findings only partly support the general assumption that being afflicted and having sought help is associated with beliefs closer to those of professionals.

Changes in depression stigma after the Germanwings crash - Findings from German population surveys.

BACKGROUND Media coverage of the Germanwings plane crash intensely focused on the co-pilots mental illness and was criticized for potentially increasing depression stigma. We explored whether stigma beliefs towards persons with depression changed in April 2015 (about one month after the crash) compared to 2014. METHOD Telephone surveys among the adult population were conducted in Munich, Germany (N=650 in 2014 and N=601 in 2015). In both surveys, four components of stigma were assessed: (1) characteristics ascribed to persons with a depression, (2) belief in a continuum of symptoms from mental health to mental illness, (3) emotional reactions to people afflicted by depression (fear, anger, and pro-social reactions), and (4) desire for social distance. RESULTS Some stigmatizing attitudes have increased after the crash. More specifically, we found more pronounced changes in the attributes ascribed (stereotypes) and in the perceived separation from persons afflicted (continuum beliefs) than in the emotional reactions and the desire for social distance. However, overall increase in depression stigma was smaller than expected as changes were not statistically significant in the majority of the analyzed items. LIMITATIONS Due to the study design no causal interpretation of results is possible. Moreover, evidence presented is confined to a regional German sample. CONCLUSIONS A single devastating event and related media coverage seem to have a limited impact on public stigmatizing attitudes.

Differences in depression stigma towards ethnic and socio-economic groups in Germany – Exploring the hypothesis of double stigma

BACKGROUND Ethnic minorities and people with a low socio-economic status (SES) are often mentioned groups potentially affected by double stigma when faced with the burden of mental illness. Against this background we examine differences in public attitudes towards a) migrant vs. non-migrant persons with depression and b) low vs. high SES persons with depression. METHOD Analyses are based on data of a representative cross-sectional telephone survey among the adult population in Germany (N=2013). To compare the four groups, different depression vignettes were presented to the respondents. Three components of stigma were assessed in the survey: (1) characteristics ascribed to persons with a depression, (2) emotional reactions to people afflicted by depression, and (3) desire for social distance. RESULTS Respondents less often felt annoyed when the person in the depression vignette was a migrant coming from Turkey. However, differences are not statistically significant in the vast majority of the analyzed items. In terms of the comparison between high and low SES persons, analyses reveal small and inconsistent differences in public depression stigma. LIMITATIONS The study focusses on two deprived groups (ethnic minorities and people with a low SES) and is restricted to Germany. CONCLUSIONS Individuals with a low SES (compared to those with a high SES) and migrants (compared to non-migrants) with depression do not seem to be confronted with double public stigma in terms of stereotypes, emotional reactions, and desire for social distance.

Continuum beliefs in the stigma process regarding persons with schizophrenia and depression: results of path analyses

Background Individuals with mental illness often experience stigmatization and encounter stereotypes such as being dangerous or unpredictable. To further improve measures against psychiatric stigma, it is of importance to understand its components. In this study, we attend to the step of separation between “us” and “them” in the stigma process as conceptualized by Link and Phelan. In using the belief in continuity of mental illness symptoms as a proxy for separation, we explore its associations with stereotypes, emotional responses and desire for social distance in the stigma process. Methods Analyses are based on a representative survey in Germany. Vignettes with symptoms suggestive of schizophrenia (n = 1,338) or depression (n = 1,316) were presented to the respondents, followed by questions on continuum belief, stereotypes, emotional reactions and desire for social distance. To examine the relationship between these items, path models were computed. Results Respondents who endorsed the continuum belief tended to show greater prosocial reactions (schizophrenia: 0.07; p < 0.001, depression: 0.09; p < 0.001) and less desire for social distance (schizophrenia: −0.13; p < 0.001, depression: −0.14; p < 0.001) toward a person with mental illness. In both cases, agreement with the stereotypes of unpredictability and dangerousness was positively associated with feelings of anger and fear as well as desire for social distance. There were no statistically significant relations between stereotypes and continuum beliefs. Discussion Assumptions regarding continuum beliefs in the stigma process were only partially confirmed. However, there were associations of continuum beliefs with less stigmatizing attitudes toward persons affected by either schizophrenia or depression. Including information on continuity of symptoms, and thus oppose perceived separation, could prove helpful in future anti-stigma campaigns.

Was weiß und denkt die Bevölkerung über psychische Erkrankungen

Public knowledge about and attitudes towards mental illness were analyzed. Furthermore, changes in knowledge and attitudes after an information and awareness campaign were examined. The basis were two telephone surveys in 2011 (t0) and 2014 (t1) in Hamburg (intervention) and Munich (control). In 2011, the public was relatively well informed about mental disorders. Regarding the level of information of the public before the campaign and inconsistent results of previous evaluation studies the anticipated impact of the awareness campaign at t1 are moderate.

Benefit and Adherence of the Disease Management Program “Diabetes 2”: A Comparison of Turkish Immigrants and German Natives with Diabetes

There is an ongoing debate about equity and equality in health care, and whether immigrants benefit equally from services as the non-immigrant population. The study focuses on benefits from and adherence to the diabetes mellitus type 2 (DM 2) disease management program (DMP) among Turkish immigrants in Germany. So far, it has not been researched whether this group benefits from enrollment in the DMP as well as diabetics from the non-immigrant population. Data on the non-immigrant sample (N = 702) stem from a survey among members of a German health insurance, the Turkish immigrant sample (N = 102) was recruited in the area of Hamburg. Identical questions in both surveys enable comparing major components. Regarding process quality, Turkish diabetics do not differ from the non-immigrant sample; moreover, they have significantly more often received documentation and diabetes training. In terms of outcome quality however, results display a greater benefit on behalf of the non-immigrant sample (e.g., blood parameters and body mass index), and they also met more of the DMP criteria. This underlines the need of diabetics with Turkish background for further education and information in order to become the empowered patient as is intended by the DMP as well as to prevent comorbidities.

Public stigma towards individuals with somatic symptom disorders – Survey results from Germany

OBJECTIVE The study aims to investigate (1) the magnitude of public stigma towards individuals with somatic symptom disorder (SSD), (2) differences in public stigma between SSD and depression, and (3) predictors of social distance towards individuals with SSD. METHODS Analyses are based on a national telephone survey in Germany (N = 1004). Two vignettes with symptoms of SSD were used. Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Stigma was measured by stereotypes, negative emotional reactions, and desire for social distance. RESULTS There were no significant differences in public stigma regarding type of symptom and existence of an earlier somatic disease. Two of three components of public stigma under study (stereotypes and desire for social distance) showed higher values in case of depression compared to SSD (both vignettes pooled). Age and negative emotional reactions were positively associated with desire for social distance in case of both SSD vignettes, whereas associations with stereotypes and experience (own affliction and contact to persons afflicted) were inconsistent. Education was not associated with social distance towards people with SSD. CONCLUSIONS Results indicated public stigma towards people affected by SSD in Germany. Compared with depression, SSD stigma was lower in most components. Magnitude of SSD stigma was similar, irrespective of main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Reducing SSD stigma could help to improve illness behaviour and prevent chronification.

Depression stigma and migration – results of a survey from Germany

BackgroundThere are barely any studies focusing on migration in relation to mental illness stigma. We explore present attitudes regarding depression among migrants (either born in Germany or born abroad) and non-migrants in Germany, drawing upon three components of public stigma: stereotypes, emotional reactions and desire for social distance. Furthermore, differences in self-stigma of depression between the two groups are analyzed.MethodsAnalyses are based on a representative telephone survey (N = 2013) in Germany. Respondents were presented with a vignette depicting either someone from Turkey or from Germany affected by depression, followed by questions on stereotypes, emotional reactions and desire for social distance. The (anticipated) self-stigma of depression was also assessed. Analyses of variance tested for differences between migrant and non-migrant respondents, stratified by migrant status in the vignette.ResultsRegarding the depression vignette depicting a non-migrant, there were only few differences between subgroups. However, when presented with a vignette describing someone from Turkey, respondents with migrant background who were foreign-born expressed greater stigmatizing attitudes, e.g. when it comes to stereotypes or desire for social distance. Furthermore, this subsample displayed higher levels of self-stigma of depression, especially regarding the ascription of own responsibility.ConclusionsThe results underline the need to incorporate migration status/ethnicity in stigma research. Differences in attitudes as well as in (anticipated) self-stigma of depression identify foreign-born migrants in Germany as important target groups for tailored anti-stigma interventions, which need to consider diverse cultural backgrounds.