Scott B. Morris

Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies

OBJECTIVE Public stigma and discrimination have pernicious effects on the lives of people with serious mental illnesses. Given a plethora of research on changing the stigma of mental illness, this article reports on a meta-analysis that examined the effects of antistigma approaches that included protest or social activism, education of the public, and contact with persons with mental illness. METHODS The investigators heeded published guidelines for systematic literature reviews in health care. This comprehensive and systematic review included articles in languages other than English, dissertations, and population studies. The search included all articles from the inception of the databases until October 2010. Search terms fell into three categories: stigma, mental illness (such as schizophrenia and depression), and change program (including contact and education). The search yielded 72 articles and reports meeting the inclusion criteria of relevance to changing public stigma and sufficient data and statistics to complete analyses. Studies represented 38,364 research participants from 14 countries. Effect sizes were computed for all studies and for each treatment condition within studies. Comparisons between effect sizes were conducted with a weighted one-way analysis of variance. RESULTS Overall, both education and contact had positive effects on reducing stigma for adults and adolescents with a mental illness. However, contact was better than education at reducing stigma for adults. For adolescents, the opposite pattern was found: education was more effective. Overall, face-to-face contact was more effective than contact by video. CONCLUSIONS Future research is needed to identify moderators of the effects of both education and contact.

Estimating Effect Sizes From Pretest-Posttest-Control Group Designs:

Previous research has recommended several measures of effect size for studies with repeated measurements in both treatment and control groups. Three alternate effect size estimates were compared in terms of bias, precision, and robustness to heterogeneity of variance. The results favored an effect size based on the mean pre-post change in the treatment group minus the mean pre-post change in the control group, divided by the pooled pretest standard deviation.

Staff burnout and patient satisfaction: Evidence of relationships at the care unit level.

Research on burnout has thus far focused primarily on the individual; however, in work environments in which teamwork is emphasized, it seems plausible that a meaningful group-level burnout construct could emerge. This theory was tested by examining burnout in psychosocial rehabilitation teams and its effects on patient satisfaction. Three hundred thirty-three staff from 31 behavioral health teams completed the Maslach Burnout Inventory; 405 of the clients they served completed the Consumer Satisfaction Scale. Multilevel analyses (hierarchical linear modeling) confirmed the existence of a meaningful team-level burnout construct. Team-level analyses revealed significant relationships between team burnout and patient satisfaction.

Emotion Recognition in Schizophrenia : Further Investigation of Generalized Versus Specific Deficit Models

In this study, the authors examined the nature of emotion perception in schizophrenia. Two samples of people with schizophrenia, one receiving acute care for a recent exacerbation of symptoms and the other receiving extended care, were compared with a nonclinical control group on emotion perception and general perception measures. The nonclinical control group obtained the highest scores on all of the study measures, and the acutely ill group obtained the lowest scores. Furthermore, the acutely ill sample had a specific deficit in emotion perception that remained present after controlling for performance on the general perception tasks. Conversely, the deficits in emotion discrimination in the extended-care sample reflected generalized poor performance. Differences in performance on the emotion identification task between the 2 clinical groups were reduced when controlling for active symptoms.

Distribution of the standardized mean change effect size for meta-analysis on repeated measures

When conducting a meta-analysis on studies with repeated measures, a useful measure of effect size is Beckers (1988) standardized mean change. This paper examines the distributional properties of the standardized mean change, and discusses potential problems with the variance formulae given in Becker (1988). First, an error in the exact variance formula can lead to severe underestimation of the actual sampling variance. Second, Becker (1988) recommended the use of an approximation which is shown to underestimate the sampling variance when sample size is small. Using the approximation can decrease the accuracy of meta-analysis results; however, the degree of error is generally small.

Mental health stigma and primary health care decisions

People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.

Accents in the workplace: Their effects during a job interview

As the workplace becomes increasingly global, organizations are more likely to employ persons from other countries whose accents clearly identify them as different from the local workforce. Understanding the impact of accents in the workplace is important because accents can be salient in the same way as ethnicity, age, gender, and skin color and may be a source of employment discrimination. The present study looked at the influence of accents on the evaluation of job applicants during an interview for a human resource manager position. Participants from the US were asked to evaluate an applicant with one of three accents (Midwestern US, French, Colombian) by listening to an audiofile. The results showed that the applicant with the Midwestern US accent was evaluated more positively than the applicant with the French accent; however, the applicant with the Colombian accent did not receive an evaluation that differed significantly from those given to the applicants with either the French or the Midwestern US accent. Analyses of process variables indicated that the bias against the French-accented applicant was mediated by perceived lower similarity. These results are consistent with the similarity-attraction hypothesis, which states that demographic variables will impact judgments to the extent to which they make the decision-maker view the applicant as similar or dissimilar. The ability of accent to trigger bias highlights the importance of considering the full array of characteristics that can lead to discrimination in employment settings. Research on employment discrimination has traditionally focused on visual cues such as gender and ethnicity, but in an interview situation, the way the applicant speaks is also important.

Patient satisfaction with nursing care: a multilevel analysis.

Although prior research has suggested that satisfaction with nursing care is affected by multilevel factors (e.g., patient characteristics, episode-of-care, the institution providing care), these studies typically focused only on a single level of analysis. The present study examines three levels of influence simultaneously to assess the relative effect each has on satisfaction. Results suggest that satisfaction is determined primarily by the patient and the episode of care; organization-level factors explained almost no additional variance.

Predicting the Occurrence, Conviction, Distress, and Disruption of Different Delusional Experiences in the Daily Life of People with Schizophrenia

Recent research has shown that negative emotional states of increased anxiety and sadness prospectively predict the occurrence of persecutory ideation, but it is not known whether these findings extend to other subtypes of delusions. The current study explored whether these negative emotional states, as well as hallucinations, biased reasoning style (ie, jumping to conclusions), and negative self-esteem prospectively predict the occurrence and various dimensions of delusions of control, reference, and grandiosity in real time, as they occur in daily life. One hundred and thirty community-dwelling participants with schizophrenia or schizoaffective disorder completed laboratory measures and momentary self-reports generated by a personal digital assistant multiple times per day, over 7 consecutive days. Analyses were time lagged allowing simultaneous examination of person-level and within-person time-varying relationships among the variables. Approximately, half of the participants reported having at least one delusional experience during the week, and approximately, a quarter of those individuals reported experiencing all 3 delusion subtypes. Hallucinations were a significant predictor of the occurrence of delusions of control and reference over the subsequent hours of the same day, but negative emotional states of anxiety and sadness were not. Negative self-esteem predicted the frequency of all 3 delusion subtypes during the week, and a reasoning style characterized by reduced information gathering was a significant predictor of the frequency of delusions of control. Delusional dimensions of conviction, distress, and disruption had different associations with the variables tested for each delusion subtype.

Testing for Adverse Impact When Sample Size Is Small

Adverse impact evaluations often call for evidence that the disparity between groups in selection rates is statistically significant, and practitioners must choose which test statistic to apply in this situation. To identify the most effective testing procedure, the authors compared several alternate test statistics in terms of Type I error rates and power, focusing on situations with small samples. Significance testing was found to be of limited value because of low power for all tests. Among the alternate test statistics, the widely-used Z-test on the difference between two proportions performed reasonably well, except when sample size was extremely small. A test suggested by G. J. G. Upton (1982) provided slightly better control of Type I error under some conditions but generally produced results similar to the Z-test. Use of the Fisher Exact Test and Yatess continuity-corrected chi-square test are not recommended because of overly conservative Type I error rates and substantially lower power than the Z-test.