Eva Mnich

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.

The Impact of Sociodemographic Factors on the Utilisation of Support Services for Family Caregivers of Elderly Dependents – Results from the German Sample of the EUROFAMCARE Study

Objectives: As in nearly all European countries, demographic developments in Germany have led to both a relative and an absolute increase in the country’s elderly population. The care and support needed by these people is primarily provided by relatives or friends and close acquaintances within the home environment. The major challenges for society are to sustain, promote and support these informal resources. In order to achieve this, it is crucial that family caregivers are provided with situation-specific services that support them and relieve their burden of care. The major challenges for society are therefore to sustain, promote and support informal resources and to provide the opportunity for the use of services aimed at assisting and relieving the burden of family caregivers. Methods: In the context of the EUROFAMCARE study, 1,003 family caregivers from Germany were interviewed at home about their experiences using a standardized questionnaire. Included in the study were primary caregivers providing at least four hours of personal care or support per week to a relative aged 65 years or older. Subjects solely providing financial support were excluded. In this paper, a linear regression analysis has been conducted to analyse impact of sociodemographic factors on the utilisation of support services. Results: The family caregivers were 54 years on average (SD=13.4), 76% of them were female. The dependent elderly were 80 years on average (SD=8.3), and 69% of them were women. 60% of them were receiving long-term care insurance benefits. Use of support services aimed directly at family caregivers is very low. After including certain services aimed primarily at those in need of care but also often serving as a source of relief for family caregivers, the percentage of caregivers using support services increased slightly. Among sociodemographic characteristics, caregivers’ gender and education level have the greatest influence on services use. Other influential factors are caregivers’ perception of their caregiving burden and their assessment of the dependent family member’s need for assistance and support.

The relationship between biogenetic attributions and desire for social distance from persons with schizophrenia and major depression revisited

AIMS Previous population-based studies did not support the view that biological and genetic causal models help increase social acceptance of people with mental illness. However, practically all these studies used un-labelled vignettes depicting symptoms of the disorders of interest. Thus, in these studies the publics reactions to pathological behaviour had been assessed rather than reactions to psychiatric disorders that had explicitly been labelled as such. The question arises as to whether results would have been similar if respondents had been confronted with vignettes with explicit mention of the respective diagnosis. METHODS Analyses are based on data of a telephone survey in two German metropolises conducted in 2011. Case-vignettes with typical symptoms suggestive of depression or schizophrenia were presented to the respondents. After presentation of the vignette respondents were informed about the diagnosis. RESULTS We found a statistically significant association of the endorsement of brain disease as a cause with greater desire for social distance from persons with schizophrenia. In major depression, this relation was absent. With both disorders, there was no statistically significant association between the endorsement of hereditary factors as a cause and social distance. CONCLUSIONS Irrespective of whether unlabelled or labelled vignettes are employed, the ascription to biological or genetic causes seems not to be associated with a reduction of the publics desire for social distance from people with schizophrenia or depression. Our results corroborate the notion that promulgating biological and genetic causal models may not help decrease the stigma surrounding these illnesses.

Erfahrungen von pflegenden angehörigen älterer menschen in Europa bei der inanspruchnahme von unterstützungsleistungen: Ausgewählte ergebnisse des projektes EUROFAMCARE

ZusammenfassungIn diesem Beitrag werden ausgewählte Ergebnisse der EUROFAMCARE-Studie zur Nutzung und Erreichbarkeit unterstützender Angebote für pflegende Angehörige präsentiert. Die Untersuchung wurde in sechs europäischen Ländern (Deutschland, Griechenland, Italien, Polen, Schweden und Großbritannien), die unterschiedliche Typen von Wohlfahrtsstaaten repräsentieren, durchgeführt. Mit Hilfe eines gemeinsam entwickelten Erhebungsinstrumentes und gemeinsamer Rekrutierungsstrategien wurden in allen sechs Ländern jeweils rund 1000 pflegende Angehörige älterer Menschen persönlich interviewt. Die dargestellten Ergebnisse zeigen die unterschiedliche Nutzung von Diensten/Angeboten und die Verfügbarkeit von finanziellen Unterstützungsmöglichkeiten in den verschiedenen Ländern. Weiter werden die Erfahrungen der pflegenden Angehörigen, insbesondere hinsichtlich der Kosten von Unterstützungsleistungen und die größten Hilfen bzw. Hindernisse bei der Inanspruchnahme, dargestellt. Schließlich werden die Gründe für eine Nichtinanspruchnahme bestimmter Unterstützungsleistungen, als auch für eine Aufgabe von Unterstützungsleistungen, die eigentlich noch benötigt werden, aufgezeigt. Insbesondere in den nordeuropäischen Ländern zeigt sich einerseits zwar eine höhere Verfügbarkeit von Diensten/Angeboten, die aber andererseits aufgrund ihrer geringe Flexibilität bei deren Anpassung an die Bedürfnisse der Pflegenden und ihrer betreuten Angehörigen z.T. nicht genutzt werden.SummaryThis article presents selected findings of the EUROFAMCARE research project, reporting up-to-date information on the use and accessibility of support services for family carers of older people in six European countries representing different typologies of welfare systems (Germany, Greece, Italy, Poland, Sweden and the UK). Data were collected by means of face-to-face interviews to national samples of about 1000 family carers per country (i.e. 6000 in total), based on a common recruitment and data collection protocol. The reported findings reveal the crossnational usage of different support services – subdivided for comparative reasons in the categories of socio-emotional support, information, respite care, training and assessment services – as well as of available care allowances. The analysis includes the perceived experience of carers in using them, in terms of costs sustained, factors affecting service accessibility – i.e. main obstacles and greatest helps in accessing them – as well as reasons for not using (needed) services or for stopping using (still needed) services. Cross-national differences are relevant, showing a greater availability in Northern European countries, where however higher refusal rates by potential users of available services are recorded, possibly in connection to their lack of flexibility and low customisation.

Erfahrungen von pflegenden Angehörigen älterer Menschen in Europa bei der Inanspruchnahme von Unterstützungsleistungen

ZusammenfassungIn diesem Beitrag werden ausgewählte Ergebnisse der EUROFAMCARE-Studie zur Nutzung und Erreichbarkeit unterstützender Angebote für pflegende Angehörige präsentiert. Die Untersuchung wurde in sechs europäischen Ländern (Deutschland, Griechenland, Italien, Polen, Schweden und Großbritannien), die unterschiedliche Typen von Wohlfahrtsstaaten repräsentieren, durchgeführt. Mit Hilfe eines gemeinsam entwickelten Erhebungsinstrumentes und gemeinsamer Rekrutierungsstrategien wurden in allen sechs Ländern jeweils rund 1000 pflegende Angehörige älterer Menschen persönlich interviewt. Die dargestellten Ergebnisse zeigen die unterschiedliche Nutzung von Diensten/Angeboten und die Verfügbarkeit von finanziellen Unterstützungsmöglichkeiten in den verschiedenen Ländern. Weiter werden die Erfahrungen der pflegenden Angehörigen, insbesondere hinsichtlich der Kosten von Unterstützungsleistungen und die größten Hilfen bzw. Hindernisse bei der Inanspruchnahme, dargestellt. Schließlich werden die Gründe für eine Nichtinanspruchnahme bestimmter Unterstützungsleistungen, als auch für eine Aufgabe von Unterstützungsleistungen, die eigentlich noch benötigt werden, aufgezeigt. Insbesondere in den nordeuropäischen Ländern zeigt sich einerseits zwar eine höhere Verfügbarkeit von Diensten/Angeboten, die aber andererseits aufgrund ihrer geringe Flexibilität bei deren Anpassung an die Bedürfnisse der Pflegenden und ihrer betreuten Angehörigen z.T. nicht genutzt werden.SummaryThis article presents selected findings of the EUROFAMCARE research project, reporting up-to-date information on the use and accessibility of support services for family carers of older people in six European countries representing different typologies of welfare systems (Germany, Greece, Italy, Poland, Sweden and the UK). Data were collected by means of face-to-face interviews to national samples of about 1000 family carers per country (i.e. 6000 in total), based on a common recruitment and data collection protocol. The reported findings reveal the crossnational usage of different support services – subdivided for comparative reasons in the categories of socio-emotional support, information, respite care, training and assessment services – as well as of available care allowances. The analysis includes the perceived experience of carers in using them, in terms of costs sustained, factors affecting service accessibility – i.e. main obstacles and greatest helps in accessing them – as well as reasons for not using (needed) services or for stopping using (still needed) services. Cross-national differences are relevant, showing a greater availability in Northern European countries, where however higher refusal rates by potential users of available services are recorded, possibly in connection to their lack of flexibility and low customisation.

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.

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.

Quality of life of Turkish type 2 diabetics in Germany and Turkey – a comparison between Hamburg and Istanbul

Objectives. The analyses address the following research questions: (1) Do Turkish diabetics in Germany and Turkey differ in terms of quality of life? (2) If yes, can these differences (in part) be explained by social factors (age, gender, education, household size), functional limitations and availability of support? (3) Are social factors, functional limitations and availability of support differently associated with quality of life among Turkish diabetics in Germany and Turkey? Design. For this comparative cross-sectional study, 111 patients with type 2 diabetes were personally interviewed in Istanbul (Turkey) and 294 Turkish patients in Hamburg (Germany). For quality of life measurement we have used the Turkish version of the WHOQOL-Bref-26. Sociodemographics included age, sex, education and household-size. Health related functional limitations were assessed on the basis of an index of (instrumental) activities of daily living including the availability of help. Statistical analyses were conducted on group comparisons with Chi-square- and T-tests as well as linear regressions. Results. There are no significant differences between Turkish diabetics in Germany and Turkey in the physical and the psychological dimensions of the WHOQOL-Bref. However, in the WHOQOL-domains ‘social QoL’ and ‘environmental QoL’ Turkish diabetics living in Hamburg have a significantly better quality of life than their counterparts in Istanbul. These differences cannot be explained by individual sociodemographic factors, functional limitations and availability of support. Furthermore, we found much stronger positive associations between education and quality of life in Istanbul than in Hamburg. Conclusion. Beyond strong similarities between the two samples in sociodemographics, physical and mental health the social and environmental quality of life was significantly assessed better by the Turkish diabetics living in Hamburg. This is most likely an effect of public investment in social security, infrastructure and health care which is also influencing the decision as to where to spend life in retirement.