Shuntaro Ando

Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey

BACKGROUND Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. METHODS In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. FINDINGS 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coefficient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in finding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. INTERPRETATION Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving effective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the effects of stigma when it is already established. FUNDING European Commission, Directorate General for Health and Consumers, Public Health Executive Agency.

Review of mental-health-related stigma in Japan.

The aim of this study is to understand the nature and characteristics of mental‐health‐related stigma among Japanese people. We searched relevant studies in English or Japanese published since 2001 using MEDLINE and PsycINFO, and found 19 studies that examined mental‐health‐related stigma in Japan. Regarding knowledge about mental illness, reviewed studies showed that in the Japanese general population, few people think that people can recover from mental disorders. Psychosocial factors, including weakness of personality, are often considered the cause of mental illness, rather than biological factors. In addition, the majority of the general public in Japan keep a greater social distance from individuals with mental illness, especially in close personal relationships. Schizophrenia is more stigmatized than depression, and its severity increases the stigmatizing attitude toward mental illness. The literature also showed an association between more direct social contact between health professionals and individuals with mental illness and less stigmatization by these professionals. Less stigmatization by mental health professionals may be associated with accumulation of clinical experience and daily contact with people who have mental illness. Stigmatizing attitudes in Japan are stronger than in Taiwan or Australia, possibly due to institutionalism, lack of national campaigns to tackle stigma, and/or societys valuing of conformity in Japan. Although educational programs appear to be effective in reducing mental‐health‐related stigma, future programs in Japan need to address problems regarding institutionalism and offer direct social contact with people with mental illness.

A greater number of somatic pain sites is associated with poor mental health in adolescents: a cross-sectional study

BackgroundIdentifying indicators of poor mental health during adolescence is a significant public health issue. Previous studies which suggested an association between the number of somatic pains and depression have mainly focused on adults or have employed samples with a narrow age range. To date, results from previous studies have been inconsistent regarding the association between somatic pain and academic impairment. Therefore, the main aims of the present study were to 1) investigate the association between the number of somatic pain sites and poor mental health using a community sample of adolescents aged 12 to 18 years and employing a simple method of assessment, and 2) examine the association between the number of somatic pain sites and perceived academic impairment.MethodsData analysis was conducted using a large cross-sectional survey of adolescents in grades 7 to 12. The one-month prevalence rates for three sites of somatic pain including head, neck and shoulders, and abdomen were examined. Poor mental health was evaluated using the General Health Questionnaire, and perceived academic impairment was measured using a self-report questionnaire.ResultsA total of 18,104 adolescents participated in the survey. A greater number of pain sites was associated with poor mental health, and this association was consistent across age and gender. There was no difference in effect on mental health between any of the pain sites. Although there was an association between the number of somatic pain sites and perceived academic impairment, the results suggested that the association was mediated by poor mental health.ConclusionsSimple reporting methods for assessing the number of pain sites may be a feasible indicator of poor mental health in adolescents. Professionals working with adolescents should consider the possibility of poor mental health, especially when students report multiple somatic pains.

Effect of Name Change of Schizophrenia on Mass Media Between 1985 and 2013 in Japan: A Text Data Mining Analysis

BACKGROUND Mass media such as newspapers and TV news affect mental health-related stigma. In Japan, the name of schizophrenia was changed in 2002 for the purposes of stigma reduction; however, little has been known about the effect of name change of schizophrenia on mass media. METHOD Articles including old and new names of schizophrenia, depressive disorder, and diabetes mellitus (DM) in headlines and/or text were extracted from 23169092 articles in 4 major Japanese newspapers and 1 TV news program (1985-2013). The trajectory of the number of articles including each term was determined across years. Then, all text in news headlines was segmented as per part-of-speech level using text data mining. Segmented words were classified into 6 categories and in each category of extracted words by target term and period were also tested. RESULTS Total 51789 and 1106 articles including target terms in newspaper articles and TV news segments were obtained, respectively. The number of articles including the target terms increased across years. Relative increase was observed in the articles published on schizophrenia since 2003 compared with those on DM and between 2000 and 2005 compared with those on depressive disorder. Word tendency used in headlines was equivalent before and after 2002 for the articles including each target term. Articles for schizophrenia contained more negative words than depressive disorder and DM (31.5%, 16.0%, and 8.2%, respectively). CONCLUSIONS Name change of schizophrenia had a limited effect on the articles published and little effect on its contents.

Auditory verbal hallucinations increase the risk for suicide attempts in adolescents with suicidal ideation

OBJECTIVE It is important to prevent patients with suicidal ideation from actually attempting suicide. A school based cohort study suggested that auditory verbal hallucinations (AVHs) might play an important role in driving young people with mental health problems to attempt suicide. However, no clinical study to date has specifically investigated the association between AVHs and suicide attempts among young patients with suicidal ideation. METHOD We conducted a cross-sectional study of first-visit psychiatric referrals aged 10-15years at two general child and adolescent mental health hospitals in Japan. We administered self-reported questionnaires to measure suicidal ideation and suicide attempts, AVHs, and depression in the two weeks prior to the date of first-visit. RESULTS Among 188 patients with suicidal ideation, the presence of AVHs was associated with increased odds of suicide attempts (OR 3.4, 95% CI 1.7-6.9; p<0.05); however, depression was not associated with a significant change of odds (OR 0.7, 95% CI 0.4-1.3; p=0.29). CONCLUSIONS AVHs may increase the risk of suicide attempts made by adolescents with suicidal ideation. Clinicians should consider AVHs when adolescent patients present with suicidal ideation.

Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: findings from a cross-sectional survey of 16,131 adolescents

BACKGROUND Recent evidence suggests that psychotic-like experiences (PLEs) in the general population are important markers of risk of suicidal problems. However, there have been no epidemiological studies investigating help-seeking status in individuals with PLEs and elevated risk of suicide. METHODS Information on PLEs, self-awareness of mental distress (SAMD), help-seeking behaviours (HSBs), and suicidal problems was collected from 16,131 Japanese adolescents. Participants were divided into two groups, those with and without PLEs, and then both groups were further divided into three subgroups: a group without SAMD, who had no HSB by definition; a group with both SAMD and HSB; and a group with SAMD but without HSB (poor-help-seeking group), yielding a total of six groups. RESULTS Adolescents with PLEs (14.3%) had significantly higher risk of suicidal problems than those without PLEs. Among the individuals with both PLEs and SAMD, 38.1% did not seek any help (poor-help-seeking status). Among the six groups, odds of suicidal ideation was the highest among poor-help-seeking adolescents with PLEs, with a 20-fold increase compared to those without PLEs, SAMD and HSB (adjusted for age and sex), while the odds was increased 10-fold in those with PLEs, SAMD and HSB. After adjusting for anxiety/depression level, the odds ratios remained significant in both poor-help-seeking adolescents with PLEs (OR=3.8 [3.0-4.9 (95% CI)]) and those with PLEs, SAMD and HSB (OR=2.5 [2.0-3.1]). CONCLUSIONS Adolescents with PLEs and self-awareness of mental distress are at high risk for suicidal problems, particularly those without help seeking.

Development of a Japanese version of the reported and intended behaviour scale: reliability and validity.

The Reported and Intended Behaviour Scale (RIBS) was developed in the UK to measure mental health‐related behavior. The current study aimed to evaluate the applicability, and reliability of a Japanese version of the RIBS (RIBS‐J) in a Japanese context, and further examine the construct validity of the RIBS‐J.

Mental health‐related stigma among Japanese children and their parents and impact of renaming of schizophrenia

Mental‐health‐related stigma affects help‐seeking behavior and service utilization among young people. Whether mental‐health‐related stigma is different or correlated between parents and their children is unknown. It is also unknown whether the name change of schizophrenia in 2002 has had long‐term effects on reducing stigma for adults in the general population.

Associations between renaming schizophrenia and stigma‐related outcomes: A systematic review

Renaming schizophrenia is a potential strategy to reduce the stigma attached to people with schizophrenia. However, the overall associations between renaming schizophrenia and stigma‐related outcomes have not been fully elucidated. We conducted a systematic review of studies that empirically examined the outcomes between new or alternative terms and old or existing terms for schizophrenia. We searched for relevant articles in eight bibliographic databases, conducted a Google search, examined reference lists, and contacted relevant experts. We found a total of 2601 reference records, and 23 articles were included in this review. Overall, in countries where schizophrenia has been renamed, the name changes may be associated with improvements in adults’ attitudes toward people with schizophrenia, and with increased diagnosis announcement. However, studies conducted in countries where schizophrenia has not been renamed report inconsistent findings. In addition, renaming may not influence portrayals of schizophrenia in the media. Most studies included in our review had a risk of bias in their methodology, and we employed a vote‐counting method to synthesize study results; therefore, the impacts of renaming are still inconclusive. Future studies are needed to address the following issues: use of univariate descriptive statistics, adjustment for confounding variables, use of reliable measures, and employing a question that addresses the image of split or multiple personalities. Evidence is limited regarding the associations between renaming and stigma experienced by both people with schizophrenia and their families (e.g., perceived stigma, self‐stigma, discrimination experience, and burden). Further research in these populations is needed to confirm the effects of renaming schizophrenia.

Length of mechanical restraint following haloperidol injections versus oral atypical antipsychotics for the initial treatment of acute schizophrenia: a propensity-matched analysis from the Japanese diagnosis procedure combination database.

Differences in effectiveness between haloperidol injection and oral atypical antipsychotics in the acute-phase treatment of schizophrenia are not well examined. We retrospectively investigated whether these treatment options affected the length of mechanical restraint. We used the Japanese Diagnosis Procedure Combination Database to identify schizophrenia patients who were involuntarily hospitalized and receiving mechanical restraint between July and December, 2006-2009. Data included patient demographics, use of antipsychotics, and number of days on which patients underwent mechanical restraint. Propensity score matching was performed to compare the number of days of mechanical restraint between the haloperidol injection group and the oral atypical antipsychotics group. We used survival analysis to examine whether the initial difference in treatment affected the number of days of mechanical restraint. Cox regression was performed to compare the concurrent effects of various factors. Among 1731 eligible patients, 574 were treated with haloperidol injections and 420 with atypical antipsychotics. Matching produced 274 patients in each group. Cox regression analysis showed that the initial therapeutic agents did not significantly affect the number of days of mechanical restraint. The results indicate that atypical antipsychotics were as effective as haloperidol injections in the acute-phase treatment of schizophrenia.