Sandra Dietrich

Public beliefs about and attitudes towards people with mental illness: a review of population studies

Objective:  To provide a review of population‐based attitude research in psychiatry during the past 15 years.

Courtesy stigma--a focus group study of relatives of schizophrenia patients.

Abstract.Background:Stigmatization of people with mental illness has been investigated in numerous studies. Little research, however, has been done to explore how relatives of people with schizophrenia perceive and experience stigmatization and how they can fight such stigmatization.Method:Aiming to explore stigma from the perspective of relatives of people with schizophrenia, focus group interviews were conducted with 122 members of advocacy groups from different parts of Germany. Focus group sessions were tape- and video-recorded and transcribed. Transcripts were coded using an inductive method, generating categories (domains) from the material.Results:The analysis of focus group data shows that, contrary to previous research findings, discrimination and disadvantages encountered by relatives of schizophrenia patients reach far beyond the spheres of direct social interaction and access to social roles. Our study revealed two additional domains in which relatives encounter stigmatization: structural discrimination and public images of mental illness. Furthermore, psychiatry has been identified as one important source of stigma. Relatives also suggested numerous anti-stigma interventions. These can be grouped into five main categories: communication measures, support for the ill and their relatives, changes in mental health care, education and training, and control and supervision.Discussion:Based on our findings,ways of how relatives of schizophrenia patients and mental health professionals can fight against stigma are discussed.

The Stigma of Mental Illness: Patients’ Anticipations and Experiences

Background: There are studies that either deal with the stigmatization patients anticipate or with patients’ concrete stigmatization experiences. Up until now, however, research is short of studies that investigate both aspects of subjective stigmatization simultaneously. Aims: This study aims at investigating to what extent patients with schizophrenia or depression anticipate and experience stigmatization and how this is influenced by the type of mental disorder and the social environment. Method: A total of 210 patients with schizophrenia or a depressive episode were interviewed, one half living in a city and the other in a small town. Results: Most of the patients expect negative reactions from the environment, particularly as concerns the access to work. Concrete stigmatization experiences were most frequently reported in the domain of interpersonal interaction. Even though schizophrenia patients and patients with depression anticipated stigmatization similarly frequently, the former reported concrete stigmatization experiences more frequently than the latter. Conversely, patients living in a small town anticipated stigmatization more frequently than patients from the city, even though both had actually experienced stigmatization at a similar rate. Conclusion: The results underline the necessity to differentiate between anticipated and experienced stigmatization. This is highly relevant for planning interventions aimed at reducing the stigma of mental disorder.

Public attitudes toward psychiatric treatment

AimIn order to examine whether there is a relationship between the state of mental health care and the acceptance of psychiatry, public attitudes toward psychiatric treatment in three countries where the reform of mental health care has progressed to a different degree will be compared.MethodsPopulation surveys on public beliefs about mental illness and attitudes toward psychiatric treatment were conducted in Bratislava, Slovak Republic, and Novosibirsk, Russia. The data were compared with those from a population survey that had recently been carried out in Germany. In all three surveys, the same sampling procedure and fully structured interview were applied.ResultsAlthough respondents from all three countries were equally inclined to seek help from mental health professionals, those from Bratislava and Novosibirsk tended to recommend more frequently to address other medical or nonmedical professionals or members of the lay support system. In all three countries, psychotherapy was the most favored treatment modality, followed by psychotropic medication. Although natural remedies were more frequently recommended in Bratislava and Novosibirsk, meditation/yoga was more popular among the German public. Across all three countries, the endorsement of a brain disease as cause was associated with a greater willingness to seek help from medical professionals (psychiatrist, GP). Respondents who adopted biological causes tended to recommend psychotropic medication more frequently.ConclusionIn countries with less developed mental health care systems, there appears to be a tendency of the public toward more frequently relying on helping sources outside the mental health sector and on traditional “alternative” treatment methods. However, it is our prognosis that with the progress of reforms observed, differences may further decrease.

THE RELATIONSHIP BETWEEN BIOGENETIC CAUSAL EXPLANATIONS AND SOCIAL DISTANCE TOWARD PEOPLE WITH MENTAL DISORDERS: RESULTS FROM A POPULATION SURVEY IN GERMANY

Aims: Several studies have found an inverse relationship between peoples readiness to endorse biogenetic causal explanations of mental disorder and their desire for social distance from people with mental disorders. The aim of this study is to examine why this may be the case. Method: In the spring of 2001, a population survey was carried out among German citizens aged 18 years and older, living in private households. A total of 5025 interviews were conducted, reflecting a response rate of 65.1%. At the beginning of the personal, fully structured interview, respondents were presented with a vignette containing a diagnostically unlabelled psychiatric case history, either depicting a case of schizophrenia or major depressive disorder. Using five-point Likert scales, causal attributions as well as perceived dangerousness, fear and the desire for social distance were assessed. Results: The more respondents endorse a brain disease as a cause, the more dangerous they believe the person with schizophrenia or major depression to be. Respondents who perceive the individual in the vignette as being dangerous express a higher degree of fear and a greater preference for social distance from these individuals. As compared with brain disease, the relationships between heredity and perceived dangerousness are less pronounced for both disorders. Conclusions: Our analysis showed that endorsing biogenetic explanations decreases the likelihood of social acceptance of people with schizophrenia and major depression. Rejecting behavioural responses in the form of social distance desired from people with schizophrenia and major depression result from cognitive emotional processes in which biogenetic causal attributions are linked to lack of self-control, unpredictability and dangerousness, which, in turn, are associated with fear of these people.

Adverse parenting as a risk factor in the occurrence of anxiety disorders : a study in six European countries.

ObjectiveThe aim of the study was to test the homogeneity of the association between adverse parenting and anxiety disorders within these disorders as well as among six European countries.MethodBased on data from 8,232 respondents (part II sample) originating from the European study of the epidemiology of mental disorders (ESEMeD), we examined the association between three dimensions of parental rearing (care, overprotection, authoritarianism) measured by a short form of the parental bonding instrument (PBI) and anxiety disorders by computing one logistic regression model per disorder.ResultsA similar pattern of recalled parenting behaviour across the four anxiety disorders assessed was found, with care and overprotection having the strongest associations. There were only minor country-specific variations of this pattern.ConclusionOur results suggest an association between adverse parenting and the risk of anxiety disorders in particular as well as psychiatric disorders in general that is rather non-disorder specific.

Quality of life in persons with schizophrenia in out‐patient treatment with first‐ or second‐generation antipsychotics

Objective:  Effects of first in comparison with second‐generation antipsychotics on the subjective quality of life (QoL) of patients with schizophrenia under routine treatment conditions were examined.

[Evaluation of target-group oriented interventions aimed at reducing the stigma surrounding mental illness].

OBJECTIVE To provide a systematic review of target-group oriented interventions aimed at reducing the stigma surrounding mental illness. METHODS An electronic literature search was carried out based on PubMed. In addition, the reference lists of included studies were examined and other sources like the internet were used. RESULTS 51 studies could be identified, over half of them being targeted at school students. There was a large variation in the format of the various interventions. One half of interventions were based exclusively on education, the other half on a combination of education with contact with someone with a mental disorder. The vast majority of studies reported positive intervention effects. However, in several studies the effect did not persist over a time period of a few months. It appears easier to improve knowledge or to change misconceptions of mental disorders than to reduce the tendency to distance oneself from people with mental illness. When directly comparing the effect of interventions based exclusively on education with those combining education with facilitating contact with people with mental disorders, the latter proved more effective. CONCLUSION A remarkable number of targeted interventions aimed at reducing the stigma attached to mental illness have been carried out. However, due to methodological limitations no definite assessment of the effect of these interventions is possible at the present time. There is a pressing need for research that adheres more closely to the methodological standards of evaluation research.Dem Problem der Stigmatisierung psychisch Kranker wurde in den letzten Jahren vermehrt Aufmerksamkeit geschenkt. Die Tatsache, dass psychisch Kranke auch heutzutage vielfältigen Diskriminierungen ausgesetzt sind, rückte im− mer stärker in das Bewusstsein der Öffentlichkeit und der Fachwelt [1,2]. In Reaktion darauf wur− den weltweit zahlreiche Programme initiiert, die das Ziel verfolgen, das Stigma, das psychischen Krankheiten anhaftet, zu reduzieren. Am bekann− testen ist das Programm der WPA 1Open the doors“, an dem zurzeit 20 Länder, darunter auch Österreich, Deutschland und die Schweiz, betei− ligt sind (WPA Homepage 1Open the Doors“). In− zwischen wurde eine Vielzahl von ganz unter− schiedlichen Antistigma−Interventionen durch− geführt. Prinzipiell kann man zwischen Interven− tionen, die sich an die breite Öffentlichkeit rich− ten (z. B. [3]), und solchen, die sich an bestimmte Zielgruppen (z. B. Schüler) wenden, unterschei− den. Um letztere geht es in der vorliegenden Arbeit. Wir wollen uns mit der Frage beschäfti− gen, inwieweit mittels zielgruppenorientierter Antistigma−Interventionen eine Reduzierung der Stigmatisierung und Diskriminierung psychisch kranker Menschen erreicht werden kann. Methode !

Empirical evidence for an invariant three-factor structure of the Parental Bonding Instrument in six European countries

The objective of the present study was to test the Parental Bonding Instruments (PBI) three-factor structure (care, overprotection, and authoritarianism) found by [Cox, B.J., Enns, M.W., Clara, I.P. 2000, The Parental Bonding Instrument: confirmatory evidence for a three-factor model in a psychiatric clinical sample and in the National Comorbidity Survey, Social Psychiatry and Psychiatric Epidemiology 35 (2000) 353-357.] on an eight-item short form of the scale. A total of 8813 respondents from the six European countries participating in the ESEMeD project (Belgium, France, Germany, Italy, The Netherlands, and Spain) completed either the PBI-paternal or the PBI-maternal scale. Maximum likelihood confirmatory factor analysis was used to compare the original factor model of Cox et al. with a three-factor solution that emerged from an exploration of the structure with principal component factor analysis. When gender and age subgroups, as well as different countries, were taken into account, the accuracy of the model was confirmed. The fit indices for the new model indicated a generally better model fit than the ones for the model originally developed by Cox et al. Further efforts should be directed to the modeling of the dimension authoritarianism. The results provide the opportunity to estimate the influence of the extracted factors on mental disorders in different countries. The application of the short form of the PBI seems suitable primarily for large epidemiological studies.

Analysis of child—dog play behavior in child psychiatry

Abstract Children have a natural affinity for animals and most often communicate with them nonverbally; nonverbal communication is authentic and difficult to influence deliberately. This study examines whether characteristic interaction patterns exist during pet-facilitated therapy with dogs, and whether these can be used for diagnosing psychiatric disorders in children and adolescents. Forty children and adolescents with anorexia, bulimia, anxiety disorder or autism (classified according to the International Classification of Diseases – ICD 10) were monitored while in the same room as a therapy dog; their behavior during a 25-minute encounter was video-recorded and analyzed. The patients demonstrated significant diagnosis-specific behavioral differences; the greatest differences were found when the autistic patients were compared with the anxiety and eating disorder patients. The autistic childrens behavior was characterized by many brief interaction phases, whereas anxiety disorder patients interacted less often, with longer lasting episodes. While autistic children showed greater fear of the dog, anxiety disorder patients were more afraid of inter-human contact. A discriminant analysis assigned 77.5% of the patients to the correct diagnostic group. Child–dog interaction analysis can provide a valuable contribution to the psycho-diagnosis of children and adolescents.