Luis Falcato

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.

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.

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.

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.

Determinants of attitude to volunteering in psychiatry: Results of a public opinion survey in Switzerland

Background: The United Nations proclaimed 2001 the “international Year of Volunteers”. Little is known about factors influencing the attitude to volunteering in psychiatry. However, knowledge about these factors is important as target groups to be addressed by an awareness and promotion campaign could be identified. Aims: To determine the influence of demographic, psychological and sociological factors on the attitude to volunteering in psychiatry. Methods: Multiple logistic regression analysis of the results of opinion survey conducted on a representative population sample in Switzerland (n = 1737). Results: Public attitude is mostly positive. It depends, however, on the form of volunteering. Two explanatory models for volunteering in psychiatry were found: first, the “antipathetic person” having social distance to and negative stereotypes towards the mentally ill. Second, the “people with social responsibility and commitment” who have former experience in volunteering, a positive attitude to community psychiatry, interest in mass media, a social profession and perceive discrimination of mentally ill persons. Age and gender are significant predictors. Conclusions: An awareness and promotion campaign to use the vast potential of people willing to volunteer in psychiatry can be primarily focused on those with a basic interest in social issues. Volunteering must be limited in time and responsibility. Contacting people with a positive attitude by mass media is a promising way.

Community psychiatry : Results of a public opinion survey

Background: Mental health authorities must know the publics attitude to community psychiatry when planning community mental health services. However, previous studies have only investigated the impact of demographic variables on the attitude to community psychiatry. Aim: To assess the influence of psychological and sociological parameters on the public opinion of community psychiatry in Switzerland. Method: Linear regression analyses of the results of a public opinion survey on a representative population sample in Switzerland (n 1/4 1737). Results: Most respondents have positive attitudes to community psychiatry. In the regression analysis (R2 adjusted 1/4 21.2%), negative emotions towards mentally ill people as depicted in the vignette, great social distance, a positive attitude to restrictions, negative stereotypes, high rigidity and no participation in community activities significantly influenced negative attitudes to community psychiatry. Additionally, other parameters, e.g. contact with mentally ill people and the nationality of the interviewee, have a significant influence. Conclusions: In planning psychiatric community services, general individual traits and emotive issues should be considered because they influence the response towards community psychiatry facilities in the host community.

Wie effektiv sind Methadonbehandlungen in Privatpraxen

SummaryObjectives:Involvement of private practitioners in methadone maintenance treatment (MMT) enhances its availability. However, effectiveness of such treatments is still debated.Methods:A retrospective case register analysis comparing the retention of private practices with that of specialised institutions. All methadone maintenance treatment starting between January 1, 1997 and December 31, 1999. Kaplan-Meier survival estimates to test for different retention times; Cox-regression procedure to control for baseline differences between the two populations.Results:Even after controlling for distinct patient characteristics, MMT by private practitioners resulted in a longer retention time.Conclusions:Our findings favour the involvement of private practitioners. Providing better professional and financial support may enhance their participation.

QTc prolongation in methadone maintenance - the role of HCV infection

OBJECTIVES Several studies have reported prolonged QTc intervals in patients under methadone maintenance treatment, including development of torsade-de-pointes arrhythmia and death. It is still not clear why some patients develop critical QTc extensions while others do not. METHODS ECG findings in a convenience sample of 210 methadone-maintained heroin-dependent patients, taking HCV-infection status and methadone dosage into account simultaneously by means of a multiple linear regression model with QTc-interval as the dependent variable. RESULTS Prolonged QTc-time is associated with hepatitis C infections (p = 0.005) and higher doses of racemic methadone (p = 0.012). CONCLUSION Infection with hepatitis C increases the likelihood of critical QTc prolongation in patients in methadone maintenance treatment.