Harald Zäske

The relationship between mental illness severity and stigma

Objective:  To investigate influencing factors for lay perception of mental illness severity and their effects on the stigma of mental illness.

Suicidal behavior—symptom or disorder?

This article examines the diagnostic status of suicidal ideation with and without additional signs of defined or subthreshold mental disorders. Data from the World Health Organization (WHO) study on Psychological Problems in General Health Care (PPGHC) show that 8.8% of all general practice patients report that they recently had a wish to be dead. Among patients with acute depressive episodes, the rate is 34.5%, as compared with 1.3% in persons without any sign of mental disorder. Rates of suicidal ideation in persons with subthreshold disorders (10.4%) are similar to the rate in persons with other, nondepressed forms of mental disorders (12.9%). Still, 30.1% of all persons with suicidal ideation do not have a defined mental disorder, and 21.5% do not even have subthreshold disorders. But in these persons also, suicidal ideation is associated with an increased rate of depressive complaints. Suicidal ideation therefore, in any case, can be seen as an indicator of mental problems. But it seems impossible to lower the thresholds of defined mental disorders so that all forms of suicidal ideation will be covered. Instead, suicidal thoughts must be regarded as a symptom with the status of a disorder itself which should be handled as a comorbid condition if other mental disorders co-occur.

Measuring the stigma of psychiatry and psychiatrists: development of a questionnaire

The stigma of mental illness is a severe burden for people suffering from mental illness both in private and public life, also affecting their relatives, their close social network, and the mental health care system in terms of disciplines, providers, and institutions. Interventions against the stigma of mental illness employ complementary strategies (e.g., protest, education, and contact) and address different target groups (e.g., school children and teachers, journalists, stakeholders). Within this framework, the World Psychiatric Association has adopted an Action Plan with the goal to improve the image of psychiatry and to reduce potential stigmatizing attitudes toward psychiatry and psychiatrists. To evaluate such interventions, a questionnaire has been developed that assesses opinions and attitudes toward psychiatrists and psychiatry in different samples of medical specialists (psychiatrists and general practitioners). The questionnaire comprises scales about perceived stigma in terms of the perception of societal stereotypes, self-stigma in terms of stereotype agreement, perceived stigma in terms of structural discriminations, discrimination experiences, stigma outcomes, and attitudes toward a second medical discipline. It is available in several languages (Arab, English, German, Japanese, Polish, and Spanish) and can easily be adapted for utilization in other medical specialties.

Erleben von Stigma und Diskriminierung bei ersterkrankten Schizophreniepatienten

BACKGROUND Patients with mental illnesses, especially with schizophrenia, suffer from stigma and discrimination. In addition, the stigma is a barrier to recognising and treating patients with first-episode psychosis; however, a self-rating instrument that assesses the general burden due to stigma experiences is still lacking. MATERIAL AND METHODS A total of N = 48 patients with first-episode schizophrenia who were participants in the multicenter first-episode (long-term) study within the German Research Network on Schizophrenia, completed a newly developed self-rating questionnaire to assess the burden due to stigma experiences (B-STE). The following variables were analyzed as possible correlates: psychopathology (CGI, PANSS, CDSS and HAM-D), global functioning (GAF), social adjustment (SAS), self-esteem (FSKN), as well as quality of life (LQLP), subjective well-being under neuroleptic treatment (SWN) and anticipated stigma (PDDQ). RESULTS Of the participants 25 % showed an increased burden due to stigma experiences, which correlated with a lower quality of life, lower subjective well-being under neuroleptic treatment, lower self-esteem and higher anticipated stigma. The results indicate that patients rated higher on the CGI scale who are at the same time better socially adjusted (SAS), are more intensely affected by the burden due to stigma experiences. CONCLUSION The short self-rating instrument burden due to stigma experiences (B-STE) can help to identify patients who might benefit from therapeutic or educational interventions to support coping with stigma experiences.ZusammenfassungHintergrundPatienten mit psychischen Erkrankungen, insbesondere mit Schizophrenie, sind von Stigmatisierung und Diskriminierung betroffen. Bei ersterkrankten Patienten stellt das Stigma häufig ein zusätzliches Hindernis für die Erkennung und Behandlung dar. Bislang existieren noch keine Selbstbeurteilungsinstrumente, um die allgemeine Belastung durch Erlebnisse von Stigma und Diskriminierung zu erheben.Material und MethodenBei 48 ersterkrankten Schizophreniepatienten (Teilnehmer der multizentrischen „Ersterkrankten-Langzeitstudie“ des Kompetenznetz Schizophrenie) wurde ein neu entwickelter Selbstbeurteilungsfragebogen zur Erfassung der Belastung durch stigmatisierende Erlebnisse (B-STE) erhoben. Als mögliche Korrelate wurden Psychopathologie (CGI, PANSS, CDSS, HAM-D), Funktionsfähigkeit (GAF), soziale Anpassung (SAS), Selbstwert (FSKN) sowie Lebensqualität (LQLP), subjektives Wohlbefinden unter Neuroleptika (SWN) und antizipiertes Stigma (PDDQ) untersucht.ErgebnisseVon den Befragten wiesen 25 % eine erhöhte Belastung durch stigmatisierende Erlebnisse auf, was mit reduzierter Lebensqualität und Wohlbefinden, reduziertem Selbstwert und antizipiertem Stigma korreliert. Es gibt Hinweise darauf, dass im klinischen Globalurteil (CGI) schwerer erkrankt eingeschätzte Patienten, die gleichzeitig jedoch über eine relativ gute soziale Funktionsfähigkeit (SAS) verfügen, besonders stark durch stigmatisierende Erlebnisse belastet sind.SchlussfolgerungDer hier vorgestellte Kurzfragebogen „Belastung durch stigmatisierende Erlebnisse“ (B-STE) kann bei der Klärung der Frage helfen, ob im Einzelfall für die Bewältigung von Stigmatisierungserlebnissen therapeutische und psychoedukative Maßnahmen sinnvoll sind.SummaryBackgroundPatients with mental illnesses, especially with schizophrenia, suffer from stigma and discrimination. In addition, the stigma is a barrier to recognising and treating patients with first-episode psychosis; however, a self-rating instrument that assesses the general burden due to stigma experiences is still lacking.Material and methodsA total of N = 48 patients with first-episode schizophrenia who were participants in the multicenter first-episode (long-term) study within the German Research Network on Schizophrenia, completed a newly developed self-rating questionnaire to assess the burden due to stigma experiences (B-STE). The following variables were analyzed as possible correlates: psychopathology (CGI, PANSS, CDSS and HAM-D), global functioning (GAF), social adjustment (SAS), self-esteem (FSKN), as well as quality of life (LQLP), subjective well-being under neuroleptic treatment (SWN) and anticipated stigma (PDDQ).ResultsOf the participants 25 % showed an increased burden due to stigma experiences, which correlated with a lower quality of life, lower subjective well-being under neuroleptic treatment, lower self-esteem and higher anticipated stigma. The results indicate that patients rated higher on the CGI scale who are at the same time better socially adjusted (SAS), are more intensely affected by the burden due to stigma experiences.ConclusionThe short self-rating instrument burden due to stigma experiences (B-STE) can help to identify patients who might benefit from therapeutic or educational interventions to support coping with stigma experiences.

Association of lay beliefs about causes of depression with social distance.

The aim of this study was to examine the association of lay attributions about causes of depression with attitudes and prejudiced behaviour towards people with depression.

[Experiences of stigma and discrimination in patients with first-episode schizophrenia].

BACKGROUND Patients with mental illnesses, especially with schizophrenia, suffer from stigma and discrimination. In addition, the stigma is a barrier to recognising and treating patients with first-episode psychosis; however, a self-rating instrument that assesses the general burden due to stigma experiences is still lacking. MATERIAL AND METHODS A total of N = 48 patients with first-episode schizophrenia who were participants in the multicenter first-episode (long-term) study within the German Research Network on Schizophrenia, completed a newly developed self-rating questionnaire to assess the burden due to stigma experiences (B-STE). The following variables were analyzed as possible correlates: psychopathology (CGI, PANSS, CDSS and HAM-D), global functioning (GAF), social adjustment (SAS), self-esteem (FSKN), as well as quality of life (LQLP), subjective well-being under neuroleptic treatment (SWN) and anticipated stigma (PDDQ). RESULTS Of the participants 25 % showed an increased burden due to stigma experiences, which correlated with a lower quality of life, lower subjective well-being under neuroleptic treatment, lower self-esteem and higher anticipated stigma. The results indicate that patients rated higher on the CGI scale who are at the same time better socially adjusted (SAS), are more intensely affected by the burden due to stigma experiences. CONCLUSION The short self-rating instrument burden due to stigma experiences (B-STE) can help to identify patients who might benefit from therapeutic or educational interventions to support coping with stigma experiences.ZusammenfassungHintergrundPatienten mit psychischen Erkrankungen, insbesondere mit Schizophrenie, sind von Stigmatisierung und Diskriminierung betroffen. Bei ersterkrankten Patienten stellt das Stigma häufig ein zusätzliches Hindernis für die Erkennung und Behandlung dar. Bislang existieren noch keine Selbstbeurteilungsinstrumente, um die allgemeine Belastung durch Erlebnisse von Stigma und Diskriminierung zu erheben.Material und MethodenBei 48 ersterkrankten Schizophreniepatienten (Teilnehmer der multizentrischen „Ersterkrankten-Langzeitstudie“ des Kompetenznetz Schizophrenie) wurde ein neu entwickelter Selbstbeurteilungsfragebogen zur Erfassung der Belastung durch stigmatisierende Erlebnisse (B-STE) erhoben. Als mögliche Korrelate wurden Psychopathologie (CGI, PANSS, CDSS, HAM-D), Funktionsfähigkeit (GAF), soziale Anpassung (SAS), Selbstwert (FSKN) sowie Lebensqualität (LQLP), subjektives Wohlbefinden unter Neuroleptika (SWN) und antizipiertes Stigma (PDDQ) untersucht.ErgebnisseVon den Befragten wiesen 25 % eine erhöhte Belastung durch stigmatisierende Erlebnisse auf, was mit reduzierter Lebensqualität und Wohlbefinden, reduziertem Selbstwert und antizipiertem Stigma korreliert. Es gibt Hinweise darauf, dass im klinischen Globalurteil (CGI) schwerer erkrankt eingeschätzte Patienten, die gleichzeitig jedoch über eine relativ gute soziale Funktionsfähigkeit (SAS) verfügen, besonders stark durch stigmatisierende Erlebnisse belastet sind.SchlussfolgerungDer hier vorgestellte Kurzfragebogen „Belastung durch stigmatisierende Erlebnisse“ (B-STE) kann bei der Klärung der Frage helfen, ob im Einzelfall für die Bewältigung von Stigmatisierungserlebnissen therapeutische und psychoedukative Maßnahmen sinnvoll sind.SummaryBackgroundPatients with mental illnesses, especially with schizophrenia, suffer from stigma and discrimination. In addition, the stigma is a barrier to recognising and treating patients with first-episode psychosis; however, a self-rating instrument that assesses the general burden due to stigma experiences is still lacking.Material and methodsA total of N = 48 patients with first-episode schizophrenia who were participants in the multicenter first-episode (long-term) study within the German Research Network on Schizophrenia, completed a newly developed self-rating questionnaire to assess the burden due to stigma experiences (B-STE). The following variables were analyzed as possible correlates: psychopathology (CGI, PANSS, CDSS and HAM-D), global functioning (GAF), social adjustment (SAS), self-esteem (FSKN), as well as quality of life (LQLP), subjective well-being under neuroleptic treatment (SWN) and anticipated stigma (PDDQ).ResultsOf the participants 25 % showed an increased burden due to stigma experiences, which correlated with a lower quality of life, lower subjective well-being under neuroleptic treatment, lower self-esteem and higher anticipated stigma. The results indicate that patients rated higher on the CGI scale who are at the same time better socially adjusted (SAS), are more intensely affected by the burden due to stigma experiences.ConclusionThe short self-rating instrument burden due to stigma experiences (B-STE) can help to identify patients who might benefit from therapeutic or educational interventions to support coping with stigma experiences.

Veränderungen in der sozialen Distanz der Bevölkerung gegenüber schizophren Erkrankten in 6 deutschen Großstädten

ZusammenfassungHintergrundIn Deutschland wurden in den vergangenen Jahren in mehreren Städten Programme und Maßnahmen initiiert, mittels derer das Stigma psychischer Erkrankungen und insbesondere der Schizophrenie bekämpft werden soll. Erkenntnisse über die Wirksamkeit dieser Maßnahmen liegen für Einzelinterventionen in bestimmten Zielgruppen vor, jedoch bislang noch nicht bezogen auf die Allgemeinbevölkerung.Material und MethodenIn den Jahren 2001 und 2004 wurden in 6 Städten Deutschlands, in denen zum Teil Antistigma-Initiativen tätig sind, repräsentative Telefonbefragungen im Messwiederholungsdesign an der gleichen Kohorte durchgeführt (n=7225/4622). Erhoben wurden die soziale Distanz gegenüber schizophren Erkrankten und die Bekanntheit von Antistigma-Initiativen.ErgebnisseIm Erhebungszeitraum reduzierte sich die soziale Distanz insgesamt. Signifikante, wenn auch kleine Effekte zeigten sich insbesondere bei Befragten, die Antistigma-Initiativen kannten und in Städten, in denen Antistigma-Maßnahmen durchgeführt werden.SchlussfolgerungErstmals konnte gezeigt werden, dass Antistigma-Programme und -Initiativen auf Bevölkerungsebene nachweisbare Effekte erzielen.SummaryBackgroundIn several German cities various programmes and initiatives have been conducted during recent years aimed at reducing the stigma attached to mental illness, especially schizophrenia. So far only single interventions in specific target groups have been evaluated but not their effectiveness in the general population.MethodsTwo representative telephone surveys with repeated measurements were conducted in six German cities (n 7,225/4,622). Social distance towards people with schizophrenia and knowledge of antistigma projects were assessed.ResultsBetween 2001 and 2004 the social distance toward persons with schizophrenia decreased in the general population. Persons familiar with antistigma projects or who lived in cities with such projects showed lower social distance.ConclusionsFor the first time evidence has been found that antistigma interventions are successful in reducing the stigma attached to schizophrenia in the general population.

Gesellschaftsrelevante Ansätze zur Überwindung von Stigma und Diskriminierung

Personen, die an einer psychischen Erkrankung leiden, werden nicht nur durch die Symptome ihrer Erkrankung beeintrachtigt, hinzu kommt die Belastung durch die gesellschaftliche Stigmatisierung und Diskriminierung aufgrund der Erkrankung. In Kap. 66 werden Definitionen von »Stigmatisierung« und »Diskriminierung« vorgestellt und Stigmakonzepte, wie sie Programmen und Kampagnen zur Bekampfung dieser Stigmatisierung zugrunde liegen, beschrieben. In diesem Kapitel wird der Zusammenhang zwischen Erkrankung, Stigma und psychiatrisch-psychotherapeutischer Versorgung unter besonderer Berucksichtigung der Rehabilitation psychisch Kranker dargestellt und Strategien, Stigmatisierung zu begegnen, vorgestellt und diskutiert. Internationale und nationale Programme und Kampagnen zur Bekampfung der Stigmatisierung aufgrund von psychischer Erkrankung werden vorgestellt und Methoden und Ergebnisse von Messungen ihrer Effekte und ihrer Effektivitat thematisiert.

The Influence of Stigma on the Course of Illness

This chapter is about the impact of the stigma of mental illness on the illness course. Three different stages of the illness are examined: the time between illness onset and recognition, the first episode, and the long-term course. Generally, long-term panel studies are scarce. Best evidence is given for the long-term course of illness basing on several studies referring to Link’s modified labelling approach. These studies indicate that personal stigma (comprising perceived, experienced, and self stigma) is associated in the long run with impaired quality of life, decreased self esteem, and higher burden due to depression and further illness symptoms. Even though personal stigma is related to the illness course, it is not simply part of it, because the burden due to illness and symptoms usually improves over time while the burden due to stigma remains high.

[Changes in the public's social distance toward individuals with schizophrenia in six German cities. Results of representative pre- and postinterventional telephone surveys from 2001 to 2004].

ZusammenfassungHintergrundIn Deutschland wurden in den vergangenen Jahren in mehreren Städten Programme und Maßnahmen initiiert, mittels derer das Stigma psychischer Erkrankungen und insbesondere der Schizophrenie bekämpft werden soll. Erkenntnisse über die Wirksamkeit dieser Maßnahmen liegen für Einzelinterventionen in bestimmten Zielgruppen vor, jedoch bislang noch nicht bezogen auf die Allgemeinbevölkerung.Material und MethodenIn den Jahren 2001 und 2004 wurden in 6 Städten Deutschlands, in denen zum Teil Antistigma-Initiativen tätig sind, repräsentative Telefonbefragungen im Messwiederholungsdesign an der gleichen Kohorte durchgeführt (n=7225/4622). Erhoben wurden die soziale Distanz gegenüber schizophren Erkrankten und die Bekanntheit von Antistigma-Initiativen.ErgebnisseIm Erhebungszeitraum reduzierte sich die soziale Distanz insgesamt. Signifikante, wenn auch kleine Effekte zeigten sich insbesondere bei Befragten, die Antistigma-Initiativen kannten und in Städten, in denen Antistigma-Maßnahmen durchgeführt werden.SchlussfolgerungErstmals konnte gezeigt werden, dass Antistigma-Programme und -Initiativen auf Bevölkerungsebene nachweisbare Effekte erzielen.SummaryBackgroundIn several German cities various programmes and initiatives have been conducted during recent years aimed at reducing the stigma attached to mental illness, especially schizophrenia. So far only single interventions in specific target groups have been evaluated but not their effectiveness in the general population.MethodsTwo representative telephone surveys with repeated measurements were conducted in six German cities (n 7,225/4,622). Social distance towards people with schizophrenia and knowledge of antistigma projects were assessed.ResultsBetween 2001 and 2004 the social distance toward persons with schizophrenia decreased in the general population. Persons familiar with antistigma projects or who lived in cities with such projects showed lower social distance.ConclusionsFor the first time evidence has been found that antistigma interventions are successful in reducing the stigma attached to schizophrenia in the general population.