The Maristán stigma scale: a standardized international measure of the stigma of schizophrenia and other psychoses

Background: People with schizophrenia face prejudice and discrimination from a number of sources including professionals and families. The degree of stigma perceived and experienced varies across cultures and communities. We aimed to develop a cross-cultural measure of the stigma perceived by people with schizophrenia.Method: Items for the scale were developed from qualitative group interviews with people with schizophrenia in six countries. The scale was then applied in face-to-face interviews with 164 participants, 103 of which were repeated after 30 days. Principal Axis Factoring and Promax rotation evaluated the structure of the scale; Horn’s parallel combined with bootstrapping determined the number of factors; and intra-class correlation assessed test-retest reliability.Results: The final scale has 31 items and four factors: informal social networks, socio-institutional, health professionals and self-stigma. Cronbach’s alpha was 0.84 for the Factor 1; 0.81 for Factor 2; 0.74 for Factor 3, and 0.75 for Factor 4. Correlation matrix among factors revealed that most were in the moderate range [0.31-0.49], with the strongest occurring between perception of stigma in the informal network and self-stigma and there was also a weaker correlation between stigma from health professionals and self-stigma. Test-retest reliability was highest for informal networks [ICC 0.76 [0.67 -0.83]] and self-stigma [ICC 0.74 [0.64-0.81]]. There were no significant differences in the scoring due to sex or age. Service users in Argentina had the highest scores in almost all dimensions.Conclusions: The MARISTAN stigma scale is a reliable measure of the stigma of schizophrenia and related psychoses across several cultures. A confirmatory factor analysis is needed to assess the stability of its factor structure.We are also grateful for support from the Pan-American Health Office (PAHO), Camden and Islington NHS Foundation Trust and University College London (UCL)

Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study

Objectives: the aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. the training intervention was a multifaceted program over 96 h focused on development of a shared care model.Method: A quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes.Results: Six to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes.Conclusions: Training professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary. (C) 2013 Elsevier Inc. All rights reserved.Universidade Federal de São Paulo, BR-04021070 São Paulo, BrazilUniv Estado Rio de Janeiro, Rio de Janeiro, BrazilFundacao Oswaldo Cruz, Escola Nacl Saude Publ, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilUniv Manchester, NIHR Sch Primary Care Res, Manchester Acad Hlth Sci Ctr, Manchester M13 9PL, Lancs, EnglandUniversidade Federal de São Paulo, Dept Psychiat, BR-04021070 São Paulo, BrazilKings Coll London, Ctr Publ Mental Hlth, Hlth Serv & Populat Res Dept, Inst Psychiat, London WC2R 2LS, EnglandUniv Manchester, Hlth Serv Res, NIHR Sch Primary Care Res, Manchester Acad Hlth Sci Ctr, Manchester M13 9PL, Lancs, EnglandUniversidade Federal de São Paulo, BR-04021070 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-04021070 São Paulo, BrazilWeb of Scienc