Julio Arboleda-Flórez

Community attitudes toward people with schizophrenia.

Objective: We surveyed public attitudes toward people with schizophrenia as part of a pilot project for the World Psychiatric Associations Global Campaign to Fight Stigma and Discrimination Because of Schizophrenia. Methods: We conducted random-digit telephone surveys with 1653 respondents (aged 15 years or over) residing in 2 adjacent rural and urban health regions (71.9% response rate). A brief interview collected information on experiences with people with a mental illness or schizophrenia, knowledge of causes and treatments for schizophrenia, and levels of social distance felt toward people with schizophrenia. Results: One-half of the sample had known someone treated for schizophrenia or another mental illness. Of those able to identify a cause of schizophrenia (two-thirds), most identified a biological cause, usually a brain disease. Social distance increased with the level of intimacy required. One in 5 respondents thought they would be unable to maintain a friendship with, one-half would be unable to room with, and three-quarters would be unable to marry, someone with schizophrenia. Those over 60 were least knowledgeable or enlightened and the most socially distancing. Greater knowledge was associated with less-distancing attitudes. When other factors were controlled, exposure to the mentally ill was not correlated with knowledge or attitudes, even among those who had worked in agencies providing services to the mentally ill. Conclusions: Most respondents were relatively well informed and progressive in their reported understanding of schizophrenia and its treatment. Clear subgroup differences were apparent with respect to age and knowledge. Knowledge of schizophrenia, not exposure to the mentally ill, was a central modifiable correlate of stigma.

Attitudes about schizophrenia from the pilot site of the WPA worldwide campaign against the stigma of schizophrenia

Background: A series of surveys were conducted to assess the attitudes of the public, and other groups, toward those with schizophrenia. The aim of these surveys was to aid in the planning and evaluation of the WPA anti-stigma initiative in Alberta, Canada. Method: A questionnaire was devised and administered via telephone to over 1,200 individuals in three Alberta cities, and in paper and pencil format to 40 members of the Schizophrenia Society of Alberta and 67 medical students. Results: In contrast to some earlier findings, “loss of mind” was rated to be more disabling than any other handicapping condition. In general, respondents showed a relatively sophisticated understanding of schizophrenia and a higher level of acceptance than might have been predicted. Nonetheless, this acceptance was not as high for situations where closer personal contact was likely, and fears of dangerousness continue to be associated with schizophrenia. The majority of respondents, however, felt that treatment aided those with schizophrenia, expressed support for progressive programmes for the mentally ill, and stated that they would be willing to pay higher taxes so that programming could be improved. Conclusions The results do not support the utility of a broad approach for an anti-stigma campaign, but rather suggest a more specific focus, such as perceived dangerousness.

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Forces findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.

Association between physical illness and suicide among the elderly

Background Only a few small studies have explored the association between various physical illnesses and suicide in the elderly and they have produced inconsistent results. Thus, we undertook this larger study to more definitively assess the association between elderly suicide and physical illness. Methods This case-control study compared the proportion with physical illnesses among 822 cases who committed suicide with that among 944 controls who died due to motor vehicle accident at age 55 years or over in Alberta, Canada. Results Compared to the motor vehicle accident deaths, the elderly who committed suicide were more likely to have cancer, ischemic heart disease, chronic pulmonary disease, peptic ulcer, prostatic disorder, depression and other psychiatric illnesses. There was no significant difference in the proportion of cerebrovascular disease and diabetes mellitus between the case and control groups before adjustment of demographic and clinical characteristics. After adjustment of these variables, the elderly with any of the following illnesses were more likely to die by suicide than those without the illness: cancer (adjusted odds ratio [95 % confidence interval]: 1.73 [1.16–2.58]), prostatic disorder (excluding prostatic cancer, 1.70 [1.16–2.49]), chronic pulmonary disease among the married (1.86 [1.22–2.83]), depression (6.70 [4.72–9.50]) or other psychiatric illness (2.16 [1.68–2.76]). There was no evidence that ischemic heart disease, cerebrovascular disease, peptic ulcer and diabetes mellitus might be associated with suicide in the elderly. Conclusions Cancer, prostatic disorder, chronic pulmonary disease among the married and psychiatric illness appear to be associated with suicide among the elderly.

Considerations on the Stigma of Mental Illness

Stigma, prejudice, and discrimination are closely related and tightly interwoven social constructs. These constructs affect many, based on age, religion, ethnic origin, or socioeconomic status. However, a person can potentially move out of these groups, if not physically—as in age or ethnic background—then by moving up the social ladder, which makes the affected person less of a target. Conversely, stigma, prejudice, and discrimination against those with mental illness cut across all classes and social groups, and, to the extent that many mental conditions are chronic and incapacitating, those affected can hardly migrate out of the grip of negative social attitudes. The result is social annihilation that constricts the lives of those with mental illness, preventing them from fully reengaging in their communities and participating in the social activities of their groups of reference. The general public most frequently makes contact with mental illness through the media or the movies. Unfortunately, the media often depict patients as unpredictable, violent, and dangerous (1), and movies usually follow the popular “psychokiller” plot (2) long exploited by the cinematographic industry. Associating mental illness with violence helps to perpetuate stigmatizing and discriminatory practices against mentally ill persons; it is only one of many negative stereotypes and common prejudicial attitudes about them. This editorial has 2 purposes. It first reviews theoretical elements fundamental to stigma as a social construct, together with stigma’s negative consequences for persons with mental illness and their families (3). Second, based on the review, it comments on this issue’s papers on stigmatization and discrimination.

Understanding causal paths between mental illness and violence

Abstract The stigma associated with mental illness is a major concern for patients, families, and providers of health services. One reason for the stigmatization of the mentally ill is the public perception that they are violent and dangerous. Although, traditionally, mental health advocates have argued against this public belief, a recent body of research evidence suggests that patients who suffer from serious mental conditions are more prone to violent behaviour than persons who are not mentally ill. It is a point of contention, however, whether the relationship between mental illness and violence is only one of association, or one of causality; that mental illness causes violence. A proven causal association between mental illness and violence will have major consequences for the mentally ill and major implications for caregivers, communities, and legislators. This paper outlines the key methodological barriers precluding casual inferences at this time. The authors suggest that a casual inference about mental illness and violence may yet be hasty. Because a premature statement advocating a causal relationship between mental illness and violence could increase stigma and have devastating effects on the mentally ill the authors urge researchers to consider the damage that may be produced as a result of poorly substantiated causal inferences.

From Sin to Science: Fighting the Stigmatization of Mental Illnesses:

Our paper provides an overview of current stigma discourse, the origins and nature of the stigma associated with mental illnesses, stigmatization by health providers, and approaches to stigma reduction. This is a narrative review focusing on seminal works from the social and psychological literature, with selected qualitative and quantitative studies and international policy documents to highlight key points. Stigma discourse has increasingly moved toward a human rights model that views stigma as a form of social oppression resulting from a complex sociopolitical process that exploits and entrenches the power imbalance between people who stigmatize and those who are stigmatized. People who have a mental illness have identified mental health and health providers as key contributors to the stigmatization process and worthy targets of antistigma interventions. Six approaches to stigma reduction are described: education, protest, contact-based education, legislative reform, advocacy, and stigma self-management. Stigma denigrates the value of people who have a mental illness and the social and professional support systems designed to support them. It creates inequities in funding and service delivery that undermine recovery and full social participation. Mental health professionals have often been identified as part of the problem, but they can redress this situation by becoming important partners in antistigma work.

Epidemiology of major depression in a predominantly rural health region.

Abstract.Background: Several large-scale cross-sectional studies have evaluated the prevalence of major depression in Canadian populations. Few studies have employed prospective methods, which are necessary to evaluate incidence, and few have focused on predominantly rural areas. Methods: Subjects who had participated in a cross-sectional general health survey were invited to participate in a second wave of data collection 6 months later. These subjects were recontacted using a telephone interview. A brief diagnostic instrument for major depression was used in both waves,and a variety of other variables relevant to the epidemiology of major depression were measured. Results: Of 801 subjects initially enrolled, 666 (83.1 %) consented to be recontacted, and 501 (75.2 %) of these were successfully reached. The incidence of major depression was 3.8%. The incidence was higher in women, although this difference did not attain statistical significance. Having a past history of depression and having a high level of perceived stress were predictors of risk. An exploratory comparison with data collected using similar methods in a nearby urban centre determined that the rural prevalence was lower than urban, and that a variety of factors (street drugs, deficits in social support, unemployment, recent life events) may contribute have to this difference. Conclusions: The 6-month cumulative incidence of depressive disorder was much higher than that reported by most previous studies. This may be a result of the diagnostic instrument employed, which captures a broader spectrum of depressive morbidity than the instruments used in most previous studies. Also, as the study did not exclude subjects with previous depressive episodes during their lifetime, the incidence rate reflects risks of major depressive episodes rather than major depressive disorders.

Elderly suicide in Alberta : Difference by gender

Objective: To determine differences by gender among elderly persons who commit suicide on demographic characteristics, place of suicide, suicide method, previous suicide behaviour, and precipitant stressor. Method: This study included completed suicides of individuals aged 55 years and over during 1984–1995 in Alberta (n = 920). Information was abstracted from suicide records of medical examiners. Results: Relative to elderly female suicides, elderly males who commit suicide characteristically use guns to commit suicide (43.8%), are single (12.5%), live in rural areas (46.7%), and have a lower frequency of previous suicide attempts (16.5%). Physical illness and financial difficulty as precipitant stressors of suicide are significantly more frequent among males (40.3% and 8.7% respectively) than females (29.9% and 1.8% respectively). Mental illness as a precipitant stressor is more common among females, 35.8% for women and 15.3% for men. Conclusions: Lethal methods of suicide and physical illness and financial difficulty as precipitant stressors of suicide are more common among elderly males than females who commit suicide.

Epidemic theory and group violence

Abstract.Background:Epidemics can be represented mathematically using a variety of models. One of these, the Kermack-McKendrick model, has been used to support health policy decisions concerning vaccination requirements. An unrelated body of literature suggests that some behaviours, including some types of violence, may spread in ways analogous to the contagious spread of infectious diseases, a process that has been characterized as “behavioural contagion”.Method:Various parameter values reflecting the characteristics of crowds were substituted into the Kermack-McKendrick model. Computer simulations were used to evaluate the impact of these parameter values.Results:The simulations reproduced several features of crowd violence: the tendency for riots to occur in large groups, the importance of rapid removal of violent individuals from crowds, and the roles of alcohol consumption and social identification processes.Conclusions:Epidemic models may be of relevance to the prevention and control of violent behaviour as they can assist with the identification of high-risk situations and prevention strategies. Theoretical constructs related to epidemic theory may have broad applicability for modelling the unstable course of some mental disorders.