Determinanten von Stigmatisierung und der Akzeptanz von Zwangsmassnahmen in der Psychiatrie

Abstract

Because they are viewed as violent, unpredictable, and dangerous, psychiatric patients experience a great deal of stigma. People with mental illnesses who are stigmatized may experience undesirable outcomes such social rejection, exclusion, and discrimination. The public's acceptance of coercion in psychiatry and the clinical use of coercion may be affected by this stigmatization, as well as the attitudes of medical professionals. The thesis sought to compare the extent of case-specific public acceptance of coercive measures in psychiatry and the impact of stigmatization (Steiger et al., 2021, study 1), investigate the relationships between the Big Five personality traits, self-esteem, and stigmatization (Steiger et al., 2022, study 2), and to compare the degree of case-specific approval of coercive measures in psychiatry by the public with the degree of general approval of coercive measures in psychiatry by the public. (Steiger et al., 2022, study 3). We conducted a representative survey of the general population (N = 2207) in the canton of Basel-City, Switzerland. Participants were asked to read a vignette depicting either the psychiatric symptoms of a fictitious character or a psychiatric service institution to which the character had been admitted. Regression analyses were employed to examine the associations between approval of coercive measures, desire for social distance, and perceived dangerousness (as indicators for stigmatization) with person - and situation-specific factors that influence stigmatization. The first study showed that the person in the case vignette exhibiting dangerous behavior, showing symptoms of a psychotic disorder, being perceived as dangerous, and treatment being understood as helpful increased approval of coercion in general, while familiarity of the respondents with mental illness decreased approval. The second study found associations between personality traits and stigmatization towards mental illness. Those who scored higher on openness to experience and agreeableness showed a lower desire for social distance and lower perceived dangerousness. Neuroticism was inversely associated with perceived dangerousness. Additionally, high self-esteem was positively associated with social distance and perceived dangerousness. Finally, perceived dangerousness partially mediated the association between desire for social distance and openness to experience as well as agreeableness. Study 3 found that assessment of case vignettes without dangerous behavior was associated with significantly reduced approval of coercion than assessment of a case vignette with dangerousness, while assessment of a psychiatric patient with dangerous behavior in general was connected with a significantly higher approval of coercion than assessment of a case vignette with dangerousness. Concluding, the three presented studies suggest that a considerable part of the approval for coercion is predicted by stigmatization. With the increasing severity of coercive measures, the influence of person- and situation-specific factors and of familiarity with mental illness decreased and generalizing and stigmatizing attitudes became stronger predictors for the approval of more severe measures. Furthermore, the current thesis highlights the role of personality traits and selfesteem in areas of stigma. Finally, case-specific assessment seems to reduce approval for coercion, whereas generalized assessment seems to favor approval of coercive measures