Francisco Bevilacqua Guarniero

O estigma atribuído pelos psiquiatras aos indivíduos com esquizofrenia

CONTEXTO: A literatura acerca da maneira como a populacao geral estigmatiza individuos com disturbios mentais aumentou consideravelmente nas ultimas decadas. Mas a duvida sobre se os psiquiatras tambem estigmatizam seus pacientes ainda permanece. OBJETIVO: O presente estudo visou avaliar as atitudes de psiquiatras brasileiros em relacao aos individuos com esquizofrenia. METODOS: Dos cerca de 6.000 participantes do Congresso Brasileiro de Psiquiatria em 2009, 1.414 psiquiatras concordaram em participar do estudo. Entrevistas face a face foram realizadas utilizando um questionario que avaliava o estigma em tres dimensoes: estereotipos, distância social e preconceito, todas relacionadas a alguem com esquizofrenia. Opiniao sobre medicacoes psicotropicas e tolerância aos efeitos colaterais tambem foram avaliadas. Dados sociodemograficos e profissionais foram coletados. RESULTADOS: Psiquiatras brasileiros tenderam a estereotipar negativamente pessoas com esquizofrenia. Estereotipos negativos correlacionaram-se com uma melhor opiniao sobre medicacoes psicotropicas e com maior tolerância a efeitos colaterais. Idade maior correlacionou-se com estereotipos positivos e com menor preconceito. CONCLUSAO: Os psiquiatras estigmatizam individuos com esquizofrenia e possivelmente tem certa dificuldade em admitir esse fato. Campanhas antiestigma para profissionais de saude mental devem ser promovidas.

Public stigmatization of different mental disorders: a comprehensive attitude survey

Dear Editor, Stigmatization of mental disorders is a key issue in the social sciences and one of the most important obstacles in the field of public mental health care. The literature indicates that stigmatization of persons with mental disorders is quite prevalent in the general population (Link et al. 1999; Crisp et al. 2005). Nevertheless, significant variation exists depending on the different components of stigma that have been applied (e.g., stereotypes, prejudice or discrimination; Corrigan, 2004). Recognition is the key element in the concept of ‘mental health literacy’ (Jorm, 2000) and a crucial strategy to reduce public stigma through education and the provision of pertinent information (Corrigan, 2004). However, recognition of mental disorders is rather low in the general public (Jorm, 2000) and several studies revealed that labelling a person as mentally ill is associated with increased stigma (Martin et al. 2000; Peluso & Blay, 2009). Furthermore, stigma is highly related to the disorder to which it is attributed. In this respect a growing body of evidence suggests that stigma is greater towards schizophrenia when compared with depression and that substance-use disorders are even more stigmatized than schizophrenia (Link et al. 1999; Crisp et al. 2005; Pescosolido et al. 2010). Thus, in this study we aimed at expanding the stigma literature by integrating the following three topics as discussed above: (1) different components and measures of stigma, (2) labelling of mental disorders and (3) different types of mental disorders.

Stigma toward schizophrenia: do all psychiatrists behave the same? Latent profile analysis of a national sample of psychiatrists in Brazil

BackgroundAn important issue concerning the worldwide fight against stigma is the evaluation of psychiatrists’ beliefs and attitudes toward schizophrenia and mental illness in general. However, there is as yet no consensus on this matter in the literature, and results vary according to the stigma dimension assessed and to the cultural background of the sample. The aim of this investigation was to search for profiles of stigmatizing beliefs related to schizophrenia in a national sample of psychiatrists in Brazil.MethodsA sample of 1414 psychiatrists were recruited from among those attending the 2009 Brazilian Congress of Psychiatry. A questionnaire was applied in face-to-face interviews. The questionnaire addressed four stigma dimensions, all in reference to individuals with schizophrenia: stereotypes, restrictions, perceived prejudice and social distance. Stigma item scores were included in latent profile analyses; the resulting profiles were entered into multinomial logistic regression models with sociodemographics, in order to identify significant correlates.ResultsThree profiles were identified. The “no stigma” subjects (n = 337) characterized individuals with schizophrenia in a positive light, disagreed with restrictions, and displayed a low level of social distance. The “unobtrusive stigma” subjects (n = 471) were significantly younger and displayed the lowest level of social distance, although most of them agreed with involuntary admission and demonstrated a high level of perceived prejudice. The “great stigma” subjects (n = 606) negatively stereotyped individuals with schizophrenia, agreed with restrictions and scored the highest on the perceived prejudice and social distance dimensions. In comparison with the first two profiles, this last profile comprised a significantly larger number of individuals who were in frequent contact with a family member suffering from a psychiatric disorder, as well as comprising more individuals who had no such family member.ConclusionsOur study not only provides additional data related to an under-researched area but also reveals that psychiatrists are a heterogeneous group regarding stigma toward schizophrenia. The presence of different stigma profiles should be evaluated in further studies; this could enable anti-stigma initiatives to be specifically designed to effectively target the stigmatizing group.

Patterns of stigma toward schizophrenia among the general population: A latent profile analysis

Objective: Our purpose was to assess stigma toward schizophrenia in a representative sample of the Brazilian general population. Methods: The sample consisted of 1015 individuals interviewed by telephone. A vignette describing someone with schizophrenia was read, and four stigma aspects regarding this hypothetical individual were assessed: stereotypes, restrictions, perceived prejudice and social distance. Latent profile analysis searched for stigma profiles among the sample. Multinomial logistic regression was used to find correlates of each class. Results: Four stigma profiles were found; ‘no stigma’ individuals (n = 251) mostly displayed positive opinions. ‘Labelers’ (n = 222) scored high on social distance; they more often had familial contact with mental illness and more often labeled the vignette’s disorder as schizophrenia. ‘Discriminators’, the group with the majority of individuals (n = 302), showed high levels of stigmatizing beliefs in all dimensions; discriminators were significantly older. ‘Unobtrusive stigma’ individuals (n = 240) seemed to demonstrate uncertainty or low commitment since they mostly answered items with the middle/impartial option. Conclusion: Some findings from the international literature were replicated; however, familial contact increased stigma, possibly denoting a locally modulated determinant. Hereby, our study also adds important cross-cultural data by showing that stigma toward schizophrenia is high in a Latin-American setting. We highlight the importance of analyzing the general population as a heterogeneous group, aiming to better elaborate anti-stigma campaigns.

Attitudes of mental health professionals towards persons with schizophrenia: a transcultural comparison between Switzerland and Brazil

Background: Stigmatization is an important issue in the treatment and course of schizophrenia. The maintenance of stigmatizing attitudes may be related to socio-cultural factors. Objectives: To compare stigmatizing attitudes of mental health professionals in the culturally diverse countries Brazil and Switzerland. Methods: We analyzed data of two broad stigmatization surveys from Switzerland and Brazil by focusing on the social distance and attitudes of mental health professionals towards the acceptance of side effects of psychopharmacological treatment. Results: Swiss mental health professionals showed significantly higher levels of social distance than their Brazilian counterparts. There was also a weak effect of age as well as an interaction effect between origin and age. With respect to the acceptance of side effects, the effect of origin was rather weak. With the exception of drug dependence, Swiss professionals’ acceptance of long-lasting side effects was significantly higher than for their counterparts in Brazil. Discussion: The strong association between origin and social distance may be related to the socio-cultural background of the mental health professionals. In comparison with Switzerland, Brazil is very heterogeneous in terms of ethnicity and socio-economic structure. The distinct acceptance of side effects may additionally be related to the more sophisticated medicaments (i.e. new generation of antipsychotic drugs) commonly used in Switzerland.

The schizophrenia stigma and mass media: a search for news published by wide circulation media in Brazil

Abstract Schizophrenia is the most common illness used today as a metaphor in the media and routinely appears associated with crime and violence with no medical or scientific rigor, reinforcing the stigma against this disorder. Evaluation of the presence of structural stigma in the Brazilian media by means of a survey of printed news and the Internet using the term schizophrenia and its correlates under three aspects: (a) medical and scientific uses, (b) assigning a diagnosis of schizophrenia to crime suspects with little or no medical or scientific rigor, and (c) the metaphorical use. The study was conducted in three stages: search for publications, classification of items found and analysis of the context in which they were published. The survey was conducted in two periods: 2008 and 2011, the first being restricted to the newspaper Folha de S. Paulo and the second extended to the homepage of the main Brazilian print media. We found 229 texts, distributed as follows: 89 (39%) records as science and health, with a tendency to impersonality; 62 (27%) records as crime and violence, in which the ‘diagnosis’ of schizophrenia is given by lay people and ‘supported’ by an archeology of the life of the suspect which enlists all sorts of non-standard behavior; and 78 (34%) records of metaphorical use, always with a negative meaning. Most of the texts found (a) does not give voice to people with schizophrenia and their suffering, (b) trivializes the use of this psychiatric illness out of context to describe contradictory or of dubious character political and economic decisions, and (c) reinforces the stigma that lays over the bearer of schizophrenia individualizing them only in rare violent cases with a supposed diagnosis.

Acquisition and retention of basic pathophysiological knowledge in psychiatry.

ObjectiveAn important and yet underexplored issue in medical education concerns the extent to which students retain early taught theoretical knowledge during subsequent stages of their academic schooling. This study aimed to assess the degree to which medical students retain basic pathophysiological knowledge on biological psychiatry across different stages of medical education.MethodsA cross-sectional investigation was conducted using a multiple choice questionnaire (MCQ) of objective pathophysiological knowledge taught in a course given to second-year students, supplemented by questions measuring subjective interest and attributed importance to the content taught. Comparisons (ANOVA with post hoc Tukey tests) were carried out among five groups (n = 417): baseline (freshmen), pre-intervention group (second-year students attending the first day of the course), immediate tested group (second-year students on the final day of the course), 1-year delayed tested group (third-year students), and 3-years delayed tested group (interns).ResultsIn comparison to the baseline and pre-intervention groups, the other three groups that received teaching displayed significantly better levels of knowledge (p < 0.0001). Differently, scores of interest and attributed importance were higher in the pre-intervention group relative to all other groups that were tested after having been given the course (p < 0.005). There were no significant associations between knowledge retention, attributed importance, and interest within pre-intervention or post-intervention groups.ConclusionsThe only modest loss of knowledge over time indicates that a large proportion of early taught content is retained throughout the later years of medical education. Nevertheless, retained knowledge does not seem to be associated with subjective interest and attributed importance to such early taught content.