Carlos Nordt

Factors influencing social distance toward people with mental illness

Background: When identifying ways to reduce stigmatization because of mental illness it is crucial to understand contributing factors. Social distance—the willingness to engage in relationships of varying intimacy with a person—is an indicator of public attitudes toward persons with mental illness. Methods: Multiple linear regression analysis of the results of a vignette-based opinion survey conducted on a representative population sample in Switzerland (n = 594). Results: The level of social distance increases if situations imply ‘social closeness.’ The vignette describing a person with schizophrenia, attitudes to general aspects of mental health (lay helping, community psychiatry), emotions toward those affected, and the attitude toward consequences of mental illness (medical treatment, medication side effects, negative sanctions, e.g. withdrawal of the driver license) were found to predict social distance. Demographic factors such as age, gender, and the cultural background influence social distance. The explained variance (R2) is 44.8%. Conclusions: Social distance is a multifaceted concept influenced by, e.g., socio-economic and cultural factors, but also by the respondents general attitude toward (mental) health issues. These results suggest that more knowledge about mental illnesses, especially schizophrenia, may increase social distance. The findings presented here may help to focus anti-stigma campaigns not only on transmission of knowledge, but on integrating different approaches.

Do people recognise mental illness? Factors influencing mental health literacy

Abstract.Background:Mental health literacy has been defined as the public’s knowledge and the beliefs about mental disorders enhancing the ability to recognise specific disorders.Aims:Firstly, to determine whether the public recognises a person depicted in a vignette as mentally ill or as experiencing a crisis. Secondly, to reveal the factors influencing the correct recognition.Methods:Multiple logistic regression analysis of an opinion survey conducted in a representative population sample in Switzerland (n=844).Results:The depression vignette was correctly recognised by 39.8% whereas 60.2% of the respondents considered the person depicted as having a ‘crisis.’ The schizophrenia vignette was correctly identified by 73.6% of the interviewees. A positive attitude to psychopharmacology positively influenced the recognition of the two vignettes whereas a positive attitude to community psychiatry had the inverse effect. Moreover, for the depression vignette previous contact to mentally ill people had a positive influence on the recognition. For the schizophrenia vignette instead, rigidity and interest in mass media had a negative influence, respectively.Conclusions:The low knowledge about mental disorders, particularly depression, confirms the importance and the need to increase mental health literacy. Furthermore, professionals must openly discuss illness models with their patients, especially emphasising the differences between illness and crisis.

Do mental health professionals stigmatize their patients

Objective:  Assessing stereotypes towards people with mental illness among mental health professionals, comparing their view to the Swiss general population and analysing the influence of demographic factors, profession and work place variables (type of ward, employment time and professional experience).

Lay recommendations on how to treat mental disorders

Background Beliefs about the helpfulness of interventions are influencing the individual help-seeking behavior in case of mental illnesses. It is important to identify these beliefs as professional helpers are asked to consider them in their treatment recommendations. Objective Assessing lay proposals for an appropriate treatment of mental illnesses. Methods We conducted a representative opinion survey in Switzerland. Eighteen treatment proposals were presented with respect to a vignette either depicting schizophrenia or depression. Respondents were asked to indicate the proposals considered to be helpful for treatment and those considered to be harmful, respectively. Results‘Psychologist,’‘general practitioner,’‘fresh air,’ and ‘psychiatrist’ were mostly proposed as being helpful. Among several psychiatric treatment approaches ‘psychotherapy’ was favored, while psychopharmacological treatment and electroconvulsive therapy were only proposed by less than one-fourth of the interviewees. Especially psychotropic drugs were considered to be harmful. Treatment by a psychiatrist was regarded as being more helpful for schizophrenic individuals than for depressive persons. For a person experiencing a life crisis, treatment by a psychiatrist and psychological treatment were viewed as being harmful, and non-medical interventions were preferred. However, for persons thought to be mentally ill, psychiatric and psychopharmacological treatments were recommended. Conclusion Mental health professionals are regarded as being helpful although their treatment methods are seen as being less helpful. A clear distinction is made between lay proposals for depression and schizophrenia. However, the perception of whether a condition is considered to be an illness or a life crisis has significantly more influence on lay treatment proposals than the cited diagnosis in the vignette.

Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis

BACKGROUND Switzerland has been criticised for its liberal drug policy, which could attract new users and lengthen periods of heroin addiction. We sought to estimate incidence trends and prevalence of problem heroin use in Switzerland. METHODS We obtained information about first year of regular heroin use from the case register of substitution treatments in the canton of Zurich for 7256 patients (76% of those treated between 1991 and March, 2005). We estimated the proportion of heroin users not yet in substitution treatment programmes using the conditional lag-time distribution. Cessation rate was the proportion of individuals leaving substitution treatment programmes and not re-entering within the subsequent 10 years. Overall prevalence of problematic heroin use was modelled as a function of incidence and cessation rate. FINDINGS Every second person began their first substitution treatment within 2 years of starting to use heroin regularly. Incidence of heroin use rose steeply, starting with about 80 people in 1975, culminating in 1990 with 850 new users, and declining substantially to about 150 users in 2002. Two-thirds of those who had left substitution treatment programmes re-entered within the next 10 years. The population of problematic heroin users declined by 4% a year. The cessation rate in Switzerland was low, and therefore, the prevalence rate declined slowly. Our prevalence model accords with data generated by different approaches. INTERPRETATION The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people. Our model could enable the study of incidence trends across different countries and thus urgently needed assessments of the effect of different drug policies.

Lay beliefs about causes of depression

Objective:  Assessing lay beliefs about causes of depressive behaviour and analysing the influence of labelling and demographic factors on causal attributions.

Public acceptance of restrictions on mentally ill people.

Objective: To assess the influence of demographic, psychological, sociological and cultural variables on the public acceptance of restrictions on mentally ill people.

Perceived stigmatization of mentally ill people and its consequences for the quality of life in a Swiss population.

The awareness of social conceptions of mental illness is essential in understanding the social realities of people with mental illness. Labeling due to psychiatric hospitalization can have a powerful influence on people’s life chances. Little is known about subjective perceptions of stigmatization and discrimination and the influence of these beliefs on the quality of life of mentally ill people. We used a psychiatric inpatient sample and a community sample to analyze and compare perception of stigmatization and discrimination. Both patients and community members believed that most people rejected former mental patients. Thus, attitudes toward mental illness have their source in the socialization of the individual and his or her cultural context rather than in the currently pathological state of those affected. In a multiple regression analysis, we showed that even if controlled for demographic and clinical factors, perceived devaluation and discrimination had a significant negative effect on the quality of life of the mentally ill people. For planning and implementing psychiatric treatment programs, it is important to be aware of social conceptions of mental disorder.

Public attitude to compulsory admission of mentally ill people

Objective: Assessing the public attitude to compulsory admission of mentally ill in Switzerland and analyzing the influence of demographic, psychological, and sociological factors.

Patterns of inpatient care for immigrants in Switzerland: a case control study.

BackgroundMigration has become a major political and social concern in West European societies.MethodsA case–control method was used to analyse the utilisation of inpatient mental health services by immigrants from a catchment area in Switzerland over a 7-year period.ResultsCompared to natives, immigrants had fewer psychiatric hospitalisations, but more emergency and compulsory admissions. During inpatient treatment, they received less psycho-, ergo- and physiotherapy. Other therapies as well as compulsory measures were at comparable rates, as was the frequency of irregular discharge. They spent shorter periods as inpatients and the rate of psychiatric readmissions was significantly lower. Comparison of different countries of origin revealed that only patients from West and North Europe were comparable to natives regarding type of referral, inpatient treatment, and longitudinal measures of service utilisation. Even after accounting for effects of social class, immigrants from South Europe, former Yugoslavia, Turkey, East Europe and more distant countries spent significantly shorter time in inpatient treatment, compared to Swiss control patients.ConclusionsResults of this study clearly point to an underutilisation of inpatient facilities among immigrants with mental disorders, and to disadvantages in psychiatric inpatient care. This, however, does not pertain to all foreign patients to the same extent: inequalities of mental health service use are particularly pronounced in immigrants from more distant countries.