Israel Journal of Psychiatry and Related Sciences最新文献

Background: While Asian groups have immigrated worldwide, suicide risk models have neglected to integrate cultural components. This study incorporates how stigma associated with failure to uphold clan/kinship roles can increase suicide risk in highly-marginalized Lao-Americans.

Methods: One focus group with five Lao participants and 21 individual semi-structured interviews with community family members were conducted. Transcripts were coded via directed content analysis using the "What Matters Most" and Cultural Theory of Suicide frameworks.

Results: Violating role-expectations associated with youth, adults and older adults appears to be associated with risk for suicide. This suggests that the failure of adults to fulfill their roles might potentially threaten loss of "full personhood" and trigger stigma, thus potentially evoking greater suicide risk.

Conclusion: Interventions would benefit from cultural considerations of fulfilling role-expectations and "personhood" to combat suicide and stigma within cultural communities.

Background: A four stage regressive model that links public stigma to self-stigma is applied to mental illness and substance use disorder. We assess this four stage model in those with co-occurring disorders versus those who have mental illness or substance use disorder alone.

Method: 366 people who self-identified as having either a mental illness or co-occurring mental illness with substance use disorder were recruited from MTurk and completed measures on identity and self-stigma.

Results: Higher group identity predicted lower selfstigma in those with mental illness while this effect was not present for participants with co-occurring disorders. Limitations include that this study only looked at mental illness identity for those with both mental illness and substance use disorder; sample limitations are also discussed.

Conclusions: Those with co-occurring disorders may identify more with certain groups over others.

Background: Stigma and discrimination are major difficulties for people with psychosis. However, despite the dominance of biomedical ideology in public education and de-stigmatization efforts, there is substantial evidence that campaigns based on the "medical model" (such as the "mental illness is an illness like any other" approach) are not only ineffective, but can actually compound the problem. This paper considers the alternative role of psychosocial explanatory frameworks in promoting more tolerant and enlightened approaches to, and attitudes about, psychosis.

Data: A summary of theoretical and empirical research on the effectiveness of mental health anti-stigma campaigns is presented.

Conclusions: There is a reasonably substantial evidencebase supporting the hypothesis that anti-stigma campaigns which frame psychosis as a meaningful response to adversity are effective. They are a more promising approach to "humanizing" people with complex mental health problems than strategies based on models of disease and disability.

Background: While explicit negative stereotypes of mental illness are well established as barriers to recovery, implicit attitudes also may negatively impact outcomes. The current study is unique in its focus on both explicit and implicit stigma as predictors of recovery attitudes of mental health practitioners.

Method: Assertive Community Treatment practitioners (n = 154) from 55 teams completed online measures of stigma, recovery attitudes, and an Implicit Association Test (IAT).

Results: Three of four explicit stigma variables (perceptions of blameworthiness, helplessness, and dangerousness) and all three implicit stigma variables were associated with lower recovery attitudes. In a multivariate, hierarchical model, however, implicit stigma did not explain additional variance in recovery attitudes. In the overall model, perceptions of dangerousness and implicitly associating mental illness with "bad" were significant individual predictors of lower recovery attitudes.

Conclusions: The current study demonstrates a need for interventions to lower explicit stigma, particularly perceptions of dangerousness, to increase mental health providers' expectations for recovery. The extent to which implicit and explicit stigma differentially predict outcomes, including recovery attitudes, needs further research.

Background: Stigma resistance, one's ability to block the internalization of stigma, appears to be a key domain of recovery. However, the conditions in which one is most likely to resist stigma have not been identified, and models of stigma resistance have yet to incorporate one's ability to consider the mind of others. The present study investigated the impact of the interaction between metacognition, or one's ability to form an integrated representation of oneself, others, and the world, and fear of negative evaluation on one's ability to resist stigma.

Methods: Narratives of encounters with stigma shared by 41 persons with schizophrenia or schizoaffective disorders were first coded for spontaneous expressions of fear of negative evaluation from others. Two-step cluster analyses were then conducted in order to test the hypothesis that metacognition and fearing negative evaluation from others are important, interacting pathways which contribute to resisting stigma.

Results: Those with high (n = 11; 26.8%), intermediate (n = 9; 22.0%), and low metacognition (n = 21; 51.2%) significantly differed on stigma resistance (F = 9.49, p<0.001) and the high metacognition group was most likely to resist stigma. Those with high and low metacognition did not express fear of negative evaluation, while those with intermediate metacognition did express fear of negative evaluation.

Background: The uneven progression of mental health funding in the United States, and the way that the funding climate seems to be influenced by local and regional differences, raises the issue of what factors, including stigma, may impact mental health funding decisions. Criticisms that mental health stigma research is too individually-focused have led researchers to consider how broader, macro-level forms of stigma - such as structural stigma - intersect with micro-level forms of individual stigma. While some studies suggest that macro and micro stigma levels are distinct processes, other studies suggest a more synergistic relationship between structural and individual stigma.

Method: Participants in the current study (N = 951; national, convenience sample of the U.S.) completed a hypothetical mental health resource allocation task (a measure of structural discrimination). We then compared participants' allocation of resources to mental health to participants' endorsement of negative stereotypes, beliefs about recovery and treatment, negative attributions, intended social distancing, microaggressions, and help-seeking (measures of individual stigma).

Results: Negative stereotyping, help-seeking self-stigma, and intended social distancing behaviors were weakly but significantly negatively correlated with allocating funds to mental health programs. More specifically, attributions of blame and anger were positively correlated to funding for vocational rehabilitation; attributions of dangerousness and fear were negatively correlated to funding for supported housing and court supervision and outpatient commitment; and attributions of anger were negatively correlated to funding for inpatient commitment and hospitalization.

Conclusions: Individual stigma and sociodemographic factors appear to only partially explain structural stigma decisions. Future research should assess broader social and contextual factors, in addition to other beliefs and worldviews (e.g., allocation preference questionnaire, economic beliefs).

Background: Narrative enhancement and cognitive therapy (NECT) is aimed at decreasing self-stigma and promoting recovery. The current study used a mixed-methods approach to explore the process and mechanisms by which NECT affects self-stigma and recovery.

Method: Sixty-two participants with serious mental illness (SMI) and enrolled in NECT completed questionnaires assessing self-clarity, recovery, self-stigma, and hope before and after the intervention, and the two latter questionnaires also after completing two defined parts of the intervention. In addition, one group's transcriptions were qualitatively analyzed and compared with changes in quantitative measures.

Results: Quantitative analysis revealed a significant increase in self-clarity and a decrease in self-stigma, which occurred early in the intervention. Qualitative analysis identified factors contributing to such changes. Limitations include lack of a comparison group, bias selection in the qualitative analysis and case record diagnoses.

Conclusions: NECT was found to be effective in reducing self-stigma and improving self clarity and the mechanisms and process were identified.