Investigating Religious Orientation and the Attribution Model of Mental Illness Stigma

Indiana University-Purdue University Indianapolis (IUPUI)Objectives: The Attribution Model of mental illness stigma posits that attributions about the causes and controllability of mental illness contribute to prejudicial emotional reactions, which in turn may lead to discriminatory behaviors towards people with mental illnesses. Given that people make different assumptions about different mental illnesses, if this model is correct, it suggests that specific diagnoses would elicit different types of stigma. Another important, but unexamined, predictor is extrinsic religious orientation, which correlates positively with other types of prejudice and may predict higher levels of mental illness stigma. The purpose of this study was to test the Attribution Model of stigma and examine the relationships between diagnosis, religious orientation, and stigma. Methods: Participants (n = 334) were recruited via Amazon Mechanical Turk, randomized to read one of three vignettes about a person with a mental illness (i.e., schizophrenia, anorexia nervosa, depression), and completed measures of mental illness stigma, religious orientation and affiliation, familiarity with mental illness, and authoritarianism. Using latent variable path analysis, analysis of covariance, and multiple regression analyses, relationships in the Attribution Model of mental illness stigma were assessed, as well as the impact of diagnosis and extrinsic religiosity on specific aspects of stigma as measured by the Attribution Questionnare-27 subscales (i.e., blame, anger, pity, danger/fear, avoidance, segregation, and coercion). Results: Assessment of the Attribution Model indicated moderate overall model fit after respecification. Path coefficients indicated strong relationships between variables that were generally consistent with paths predicted by the model. One notable exception was that feelings of pity were not associated with greater helping behaviors. Analysis of covariance suggested that diagnosis was a key predictor of stigma, and that schizophrenia was the most stigmatized. Multiple regression analyses revealed that extrinsic religiosity was also an important predictor of stigma; extrinsic religiosity appeared to increase certain types of stigma, and moderate the relationship between diagnosis and stigma overall. Discussion: Although the respecified Attribution Model fit the data fairly well, the findings suggest that either the scale or the model would benefit from further refinement. Results support prior evidence that severe mental illnesses like schizophrenia are more stigmatized than other diagnoses. Extrinsic religiosity was also predictive of increased stigma, both directly and indirectly. As a moderator, extrinsic religiosity may decrease the impact of diagnosis on stigma, raising stigma for diagnoses perceived as more “controllable” (i.e., anorexia nervosa, depression) such that levels were similar to schizophrenia. Limitations and suggestions for future research are discussed

Metacognition moderates the relationship between self-reported and clinician-rated motivation in schizophrenia

Introduction Prior work has found varied relationships between self-reported and clinician-rated motivation measures in schizophrenia, suggesting that moderators might impact the strength of this relationship. This current study sought to identify whether metacognition – the ability to form complex representations about oneself, others, and the world – moderates the relationship between self-reported and clinician-rated motivation measures. We also explored whether clinical insight and neurocognition moderated this relationship. Methods Fifty-six participants with a schizophrenia-spectrum disorder completed the Motivation and Pleasure Self-Report Scale and the clinician-rated motivation index from the Heinrichs-Carpenter Quality of Life Scale. Results Metacognition significantly moderated the relationship; self-reported and clinician-rated motivation were positively and significantly correlated only when metacognition was relatively high. Neither clinical insight nor neurocognition moderated the relationship. Discussion Metacognition appears to be a key variable impacting the strength of the relationship between self-reported and clinician-rated motivation measures and may help to partly explain the varied relationships observed in prior work. Using a metacognitive framework to guide assessment interviews and targeting metacognition in psychosocial treatments may help to improve the synchrony between self-perceptions and clinician ratings of motivation

Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth

Background Substance use is prevalent among justice-involved youth and given the risk of recidivism and other poor outcomes associated with substance use, justice systems have implemented efforts to improve substance use screening and connection to treatment. Although many justice systems use drug screening to monitor substance use, research on patterns of substance use based on drug screen records is lacking. The current study examined court records of drug screens among youth to explore patterns of substance use as well as rates of court-ordered referral to substance use treatment and treatment completion. We also examined differences in these patterns of use and treatment referral and completion by race, ethnicity, and gender. Method We examined court records for N = 3440 youth with records of positive oral drug screen (ODS) between 2011 and 2016 to assess patterns of ODS results (e.g., number and of positive screens), court-ordered referrals to substance use treatment, and rates of treatment completion. Results Of 3440 youth with a positive ODS, 96% tested positive for cannabis and 9.8% for opioids at least once; 48.5% were court-ordered to substance use treatment. Of those referred, 67% had history of completing at least one treatment episode; black youth ( OR = 0.54, p < .01) were less likely to have history of completing substance use treatment. Conclusion Our results underscore the need to utilize objective measures as well as validated self-reports of substance use history in both research and justice system decision-making to aid in identifying youth in need of services. Additional research should identify barriers to substance use treatment completion among this population

Mobile Enhancement of Motivation in Schizophrenia: A Pilot Randomized Controlled Trial of a Personalized Text Message Intervention for Motivation Deficits

Objective: Motivation deficits remain an unmet treatment need in schizophrenia. Recent research has identified mechanisms underlying motivation deficits (i.e., impaired effort-cost computations, reduced future reward-value representation maintenance) that may be effective treatment targets to improve motivation. This study tested the feasibility and preliminary effectiveness of Mobile Enhancement of Motivation in Schizophrenia (MEMS), an intervention that leverages mobile technology to target these mechanisms with text messages. Method: Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over 8 weeks. Participants in the MEMS group additionally received personalized, interactive text messages on their personal cellphones each weekday. Results: Retention and engagement in MEMS were high: 92.6% completed 8 weeks of MEMS, with an 86.1% text message response rate, and 100% reported being satisfied with the text messages. Compared to participants in the control condition, the participants in the MEMS condition had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and attained significantly more recovery-oriented goals at 8 weeks. There were no significant group differences in purported mechanisms (performance-based effort-cost computations and future reward-value representations) or in self-reported motivation, quality of life, or functioning. Conclusion: Results demonstrate that MEMS is feasible as a brief, low-intensity mobile intervention that could effectively improve some aspects of motivation (i.e., initiation and maintenance of goal-directed behaviors) and recovery goal attainment for those with schizophrenia-spectrum disorders. More work is needed with larger samples and to understand the mechanisms of change in MEMS

A Mixed-Methods Investigation of the Implications of Substance Use Disorder Stigma for Justice-Involved Youth

Objectives: Compared to youth without justice-involvement, justice-involved youth are more likely to experience substance use disorders. Yet, few justice-involved youth receive appropriate, evidence-based treatment for substance use disorders. Although there are numerous barriers to the accessibility of appropriate treatment, research also suggests that it is difficult to engage justice-involved youth in treatment even when it is available and accessible. It is possible that substance use disorder stigma, or negative attitudes towards youth with substance use disorders, may contribute to low treatment accessibility, and make it more difficult for justice-involved youth to engage with available treatment. Few researchers have examined substance use disorder stigma among this population. The purpose of this study was to 1) explore the nature of substance use disorder stigma among justice-involved youth, at multiple ecological levels and 2) examine the role of substance use disorder stigma in limiting the accessibility of and engagement in treatment and justice-involved youth’s engagement in treatment.Methods: Participants (n = 44 youth-guardian dyads) were referred to the study by juvenile probation departments in two Indiana counties. In addition, 66 system personnel participants who work with justice-involved youth with substance use disorders were recruited from community mental health centers and juvenile probation departments in rural and suburban Indiana counties. All participants completed survey measures of substance use disorder stigma and familiarity with substance use; youth-guardian dyads also provided information about the youth’s substance use history and treatment utilization. A subset of participants (n = 9 youth, 11 guardians, 12 system personnel) completed qualitative interviews, providing perspectives on substance use disorder stigma and the role of stigma in discouraging treatment. Using analysis of covariance, multiple regression analyses, and qualitative grounded theory analysis, I explored the nature of stigma toward justice-involved youth with substance use disorders and examined the impact of stigma on treatment accessibility and engagement.Results: For aim 1, as hypothesized, public stigma (assessed by survey data) varied significantly according to participant role and specific substance, with guardians endorsing greater stigma than system personnel. All participants expressed greater negative emotions towards youth with opioid use disorder compared to marijuana use disorder. Interview data revealed particularly nuanced attitudes about marijuana use. Contrary to expectations, youth reported little self-stigma. Both youth and guardians described limited knowledge of problematic substance use. For aim 2, interview data suggests that youth and guardians may identify more stigma associated with seeking treatment for problematic substance use than with using substances. All participants reported that perceived stigma has improved in recent years, and that youth feel more comfortable discussing their substance use. However, guardians identified family attitudes about behavioral health treatment as negatively impacting engagement among youth. In addition, system personnel reported that stigma continues to limit the accessibility of youth SUD treatment.Discussion: Youth endorsed lower than expected levels of self-stigma with no difference by primary substance type; this may have been affected by youth’s limited understanding of problematic substance use and lower than expected heterogeneity in substance use type among participants. Consistent with prior research, self-stigma was directly related to the severity of mental health symptoms. The high prevalence of public stigma among guardians of JIY with SUDs suggests that parents and guardians would benefit from interventions to better support their caregiving experiences