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Journal article Full text available online for free

The role of shame in people with a diagnosis of schizophrenia

Authors:
KEEN Nadine, et al
Journal article citation:
British Journal of Clinical Psychology, 56(2), 2017, pp.115-129.
Publisher:
Wiley-Blackwell

Objectives: To examine the role of shame and its relationship to depression in schizophrenia. It was predicted that individuals with a diagnosis of schizophrenia would exhibit higher levels of shame due to the stigma associated with their diagnosis, independently of depression levels, compared with psychiatric and medical control groups. Design: Cross-sectional design with three groups: individuals with a diagnosis of (1) schizophrenia, (2) depression, and (3) rheumatoid arthritis. Methods: Sixty individuals participated in the study (20 per group). Groups were compared on questionnaires assessing external shame, trait shame and guilt, and depression. Results: The pattern of group differences depended on the type of shame measure used. Both the schizophrenia and depression groups exhibited higher levels of external shame, or seeing others as shaming, than the medical group. For individuals with schizophrenia, seeing others as shaming was associated with higher levels of depression, a relationship not found in either control group. They also showed lower levels of trait guilt and shame (at trend level), compared with both control groups. No difference was found between the groups on depression, suggesting that the observed differences were not attributable to differences in levels of depression. Conclusions: The findings highlight the importance of shame in schizophrenia, especially the link between seeing other people as shaming and depression, which was unique to this group. These results suggest that stigma associated with a diagnosis of mental illness, and schizophrenia in particular, has negative emotional consequences that may impede recovery, and should be addressed by psychological and social interventions. (Publisher abstract)

Journal article Full text available online for free

Economic evaluation of the anti-stigma social marketing campaign in England 2009-2011

Authors:
EVANS-LACKO Sara, et al
Journal article citation:
British Journal of Psychiatry, 202(s55), April 2013, pp.s95-s101.
Publisher:
Royal College of Psychiatrists

Evidence on the economic impact of social marketing anti-stigma campaigns in relation to people with mental illness is limited. To describe the economic impact of the Time to Change (TTC) anti-stigma social marketing campaign, data collected for the evaluation of TTC were combined with the social marketing campaign expenditure data to investigate differences in knowledge, attitudes and behaviour in relation to campaign awareness. To evaluate the return on investment, a decision model that estimated the impact on employment for people with depression was applied. Based on average national social marketing campaign costs, the economic benefits outweighed costs even if the campaign resulted in only 1% more people with depression accessing services and gaining employment if they experienced a health improvement. The cost per person with improved intended behaviour was at most £4 if we assume the campaign was responsible for 50% of the change. Costs associated with improved knowledge and attitudes, however, were more variable. The findings suggest that the TTC anti-stigma social marketing campaign is a potentially cost-effective and low-cost intervention for reducing the impact of stigma on people with mental health problems. (Edited publisher abstract)

Journal article

Using participatory video to challenge the stigma of mental illness: a case study

Authors:
BUCHANAN Avril, MURRAY Michael
Journal article citation:
International Journal of Mental Health Promotion, 14(1), 2012, pp.35-43.
Publisher:
Taylor and Francis

Despite advances in the treatment of different forms of mental ill health, it continues to attract substantial stigmatisation, with public attitudes being increasingly negative. While reviews have highlighted the extensive research on the nature of this stigma, there is limited work on the development of strategies to challenge the stigma. The aim of this case study was to examine the potential of researchers and mental health service users (MHSUs) working collaboratively to identify the main problems the service users experience in their everyday lives and to produce a video challenging the negative image of mental ill health. Discussions were held with volunteers involved in a mental health media action group; all volunteers had been or were currently MHSU. These discussions identified a variety of problems including difficulties in everyday social interaction and negative portrayal of mental ill health in the media. A short video was developed with volunteers summarising the issues they had raised: this was subsequently shown to a wider audience. The MHSUs reported considerable personal benefits of participation in the project. The paper discusses these findings and the process of producing the video.

Journal article

Stigmatised attitudes towards the ‘stressed’ or ‘ill’ models of mental illness

Authors:
LUTY Jason, EASOW Joby Maducolil, MENDES Vania
Journal article citation:
Psychiatrist (The), 35(10), October 2011, pp.370-373.
Publisher:
Royal College of Psychiatrists

Tackling discrimination, stigma and inequalities in mental health is a major objective of the UK government. This aim of this research was to determine whether there was any difference in stigmatised attitudes towards a fictitious person with a mental illness who was presented either as having a biological illness or a disorder that arose from psychosocial stress to two randomised representative panels of the general public. The 20-point Attitude to Mental Illness Questionnaire (AMIQ) was used to assess stigmatised attitudes. The two groups were presented with slightly different vignettes describing “Tim” and then asked to complete the questionnaire. Overall, 187 individuals returned their questionnaires (74% response rate). The mean AMIQ stigma score for the ‘ill’ group was 1.4; for the ‘stress’ group was 0.5. The authors conclude that there was no statistical or practical difference in the stigmatised attitudes towards a person with mental illness regardless of whether they were presented as biologically ill or as having an illness that was a response to psychosocial stress. Some limitations of the study are noted: the self-selecting participants, the possibility of social desirability bias and whether the values expressed would be enduring.

Journal article

The public stigma of mental illness and drug addiction: findings from a stratified random sample

Authors:
CORRIGAN Patrick W., KUWABARA Sachiko A., O'SHAUGHNESSY John
Journal article citation:
Journal of Social Work, 9(2), April 2009, pp.139-147.
Publisher:
Sage

Previous research has shown that people labelled with drug addiction are viewed as more blameworthy and dangerous compared to individuals labelled with mental illness who, in turn, are viewed more harshly than those with physical disabilities. Endorsement of such stereotypes often lead to less helping behaviour and more avoidance of people with drug addiction compared to those with mental illness. In this study, attribution and dangerousness models are tested on a stratified random sample of the US population. The sample was recruited from a national online research panel (N = 815). Research participants read a vignette about a person with one of the three health conditions (mental illness, drug addiction, or physically handicapped in a wheelchair) and were asked to complete items representing attribution and dangerousness judgments about the person.  Results found addiction to drugs was seen as more blameworthy and dangerous compared to mental illness.

Journal article

Stigma and coercion in the context of outpatient treatment for people with mental illnesses

Authors:
LINK Bruce, CASTILLE Dorothy M., STUBER Jennifer
Journal article citation:
Social Science and Medicine, 67(3), August 2008, pp.409-419.
Publisher:
Elsevier

The policies and institutional practices developed to care for people with mental illnesses have critical relevance to the production of stigma as they can induce, minimise or even block it. This article addresses two prominent and competing perspectives on the consequences for stigma of using coercion to insure compliance with outpatient mental health services. The Coercion to Beneficial Treatment perspective holds that the judicious use of coercion facilitates treatment engagement, aids in symptom reduction and, in the long run, reduces stigma. The Coercion to Detrimental Stigma perspective claims that coercion increases stigmatisation resulting in low self-esteem, a compromised quality of life and increased symptoms. The authors examine these differing perspectives in a longitudinal study of 184 people with serious mental illness, 76 of whom were court ordered to outpatient treatment and 108 who were not. They were recruited from treatment facilities in the New York boroughs of the Bronx and Queens. They measure coercion in two ways: by assignment to mandated outpatient treatment and with a measure of self-reported coercion. The longitudinal analysis allows stringent tests of predictions derived from each perspective and finds evidence to support certain aspects of each. Consistent with the Coercion to Beneficial Treatment perspective, they found that improvements in symptoms lead to improvements in social functioning. Also consistent with this perspective, assignment to mandated outpatient treatment is associated with better functioning and, at a trend level, to improvements in quality of life. At the same time the Coercion to Detrimental Stigma perspective is supported by findings showing that self-reported coercion increases felt stigma (perceived devaluation–discrimination), erodes quality of life and through stigma leads to lower self-esteem. Future policy needs not only to find ways to insure that people who need treatment receive it, but to achieve such an outcome in a manner that minimises circumstances that induce perceptions of coercion.

Journal article

Rethinking theoretical approaches to stigma: a Framework Integrating Normative Influences on Stigma

Authors:
PESCOSOLIDO Bernice A., at al.
Journal article citation:
Social Science and Medicine, 67(3), August 2008, pp.431-440.
Publisher:
Elsevier

A resurgence of research and policy efforts on stigma both facilitates and forces a reconsideration of the levels and types of factors that shape reactions to persons with conditions that engender prejudice and discrimination. Focusing on the case of mental illness but drawing from theories and studies of stigma across the social sciences, the authors propose a framework that brings together theoretical insights from micro, meso and macro level research: Framework Integrating Normative Influences on Stigma (FINIS) starts with Goffman's notion that understanding stigma requires a language of social relationships, but acknowledges that individuals do not come to social interaction devoid of affect and motivation. Further, all social interactions take place in a context in which organisations, media and larger cultures structure normative expectations which create the possibility of marking “difference”. Labelling theory, social network theory, the limited capacity model of media influence, the social psychology of prejudice and discrimination, and theories of the welfare state all contribute to an understanding of the complex web of expectations shaping stigma. FINIS offers the potential to build a broad-based scientific foundation based on understanding the effects of stigma on the lives of persons with mental illness, the resources devoted to the organisations and families who care for them, and policies and programs designed to combat stigma. The authors end by discussing the clear implications this framework holds for stigma reduction, even in the face of conflicting results.

Journal article

Meta-analysis of stigma and mental health

Authors:
MAK Winnie W. S., et al
Journal article citation:
Social Science and Medicine, 65(2), July 2007, pp.245-261.
Publisher:
Elsevier

Recent research has emphasized the adverse effects of stigma on minority groups’ mental health. Governments and service agencies have put much effort into combating stigma against a variety of conditions. Nevertheless, previous empirical research on the stigma–mental health relationship has yielded inconclusive findings, varying from strong negative to zero correlations. Thus, whether stigma is related significantly to mental health is yet to be confirmed. Using meta-analysis, the associations between stigma and mental health from 49 empirical studies were examined across various stigmatized conditions and mental health indices. Possible moderators were also explored. The mean correlation between stigma and average mental health scores corrected for sampling error, unreliability, and other artifacts was −.28 (N=10,567, k=52). No strong moderators were found, yet meaningful patterns were observed. Implications of the results are discussed.

Journal article

When Channel One met Year 10: using the arts to combat stigma

Authors:
BREWER Paul, MOORE Kylie, REID Marlene
Journal article citation:
A Life in the Day, 8(4), November 2004, pp.4-8.
Publisher:
Emerald

Surveys of mental health services users consistently report stigma as a major barrier to recovery. Those from black or other minority ethnic groups suffer double discrimination. Describes a pilot project in which users and staff from 2 voluntary sector organisations organised an awareness-raising event for pupils in an inner city school to challenge and inform them about mental illness.

Journal article

The role of biological and genetic causal beliefs in the stigmatisation of 'mental patients'

Authors:
READ John, HARRE Niki
Journal article citation:
Journal of Mental Health, 10(2), April 2001, pp.223-235.
Publisher:
Informa Healthcare
Place of publication:
London

Research indicates that the 'mental illness is an illness like any other' approach to destigmatisation has failed to improve attitudes. This study replicated, with 469 New Zealanders, previous findings that the public tends to reject biological and genetic explanations of mental health problems in favour of psychosocial explanations focused on negative life events. It also confirmed previous findings (contrary to the assumption on which most destigmatisation programmes are based) that biological and genetic causal beliefs are related to negative attitudes, including perceptions that 'mental patients' are dangerous, antisocial and unpredictable, and reluctance to become romantically involved with them. The amount of reported personal contact with people who had received psychiatric treatment was correlated with positive attitudes. It is recommended that destigmatisation programmes consider abandoning efforts to promulgate illness-based explanations and focus instead on increasing contact with and exposure to users of mental health services.

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