14 research outputs found
The Role of Insight in Moderating the Association Between Depressive Symptoms in People With Schizophrenia and Stigma Among Their Nearest Relatives: A Pilot Study
Background: There is evidence of a positive association between insight and depression among patients with schizophrenia. Self-stigma was shown to play a mediating role in this association. We attempted to broaden this concept by investigating insight as a potential moderator of the association between depressive symptoms amongst people with schizophrenia and stigmatizing views towards people with mental disorders in their close social environment. Method: In the initial sample of 120 pairs, data were gathered from 96 patients with a diagnosis of âparanoid schizophreniaâ and 96 of their nearest relatives (80 response rate). In this cross-sectional study data were collected by clinical interview using the following questionnaires: âThe Scale to Assess Unawareness of Mental Disorder,â âCalgary Depression Scale for Schizophrenia,â and âBrief Psychiatric Rating Scale.â The stigmatizing views of patientsâ nearest relatives towards people with mental disorders were assessed with the âMental Health in Public Conscienceâ scale. Results: Among patients with schizophrenia depressive symptom severity was positively associated with the intensity of nearest relativesâ stigmatizing beliefs (âNonbiological vision of mental illness,â Ï = 0.24; P < .001). The association was moderated by the level of patientsâ awareness of presence of mental disorder while controlling for age, sex, duration of illness and psychopathological symptoms. Conclusions: The results support the hypothesis that the positive association between patientsâ depression and their nearest relativesâ stigmatizing views is moderated by patientsâ insight. Directions for further research and practical implications are discussed
Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic
Rationale: Mental health-related stigma and discrimination not only affect persons living with schizophrenia but also their whole families. Stigma and discrimination reduction is key to respond to the unmet needs of persons with mental illness. The local context is of particular importance in this endeavor, as stigma and its manifestations depend on the specific conditions of the target population and across cultures and settings. Evidence on effective approaches to reduce stigma is sparse and lacking from Central and Eastern Europe, including from the Czech Republic. Objective: Our aim was to inform an anti-stigma campaign undertaken in the framework of the national mental health reform in the Czech Republic. Methods: We conducted a qualitative study based on semi-structured in-depth interviews with relatives of patients diagnosed with schizophrenia in the Czech Republic. Initial respondents were identified through local mental health services and usersâ organizations with a consecutive chain-referral sampling. Transcribed narratives were thematically analyzed within a pre-developed four-level thematic framework to comprehensively identify experiences of stigma and discrimination in all areas of the respondentsâ lives. Results: Stigma experiences of 25 diverse family members of persons living with schizophrenia spanned four levels of respondentsâ lives (macro-, meso-, micro-, and intro-level). The overarching issues were: (1) general lack of understanding and misconceptions about mental illness; (2) structural discrimination and paucity of governmental and public support system; (3) burden of âpervasive and unlimitedâ care and inability of independent living. Conclusions: We identified several features of mental health related stigma and the ensuing discrimination in Czech Republic experienced by persons with severe mental illness and their relatives. We developed a set of recommendations for policy-makers aimed at reducing ignorance and prejudice amongst the public and professionals, improving health and social servicesâincluding employment, housing and community integrationâand the provision of family support
Early career training in Addiction Medicine : A qualitative study with health professions trainees following a specialized training program in a Canadian setting
Background: There has been a notable deficiency in the implementation of addiction science in
clinical practice and many healthcare providers feel unprepared to treat patients with substance
use disorders (SUD) following training. However, the perceptions of addiction medicine training
by learners in health professions have not been fully investigated. This qualitative study explored
perceptions of prior training in SUD care among early-career trainees enrolled in Addiction
Medicine fellowships and electives in Vancouver, Canada.
Methods: From April 2015 â August 2018, we interviewed 45 early-career physicians, social
workers, nurses, and 17 medical students participating in training in addiction medicine. We coded
transcripts inductively using qualitative data analysis software (NVivo 11.4.3).
Results: Findings revealed six key themes related to early-career training in addiction medicine:
(1) Insufficient time spent on addiction education, (2) A need for more structured addictions
training, (3) Insufficient hands-on clinical training and skill development, (4) Lack of patientcenteredness
and empathy in the training environment, (5) Insufficient implementation of
evidence-based medicine, and (6) Prevailing stigmas towards addiction medicine.
Conclusion: Early clinical training in addiction medicine appears insufficient and largely focused
on symptoms, rather than etiology or evidence. Early career learners in health professions
perceived benefit to expanding access to quality education and reported positive learning outcomes
after completing structured training programs.Medicine, Faculty ofNon UBCFamily Practice, Department ofReviewedFacultyResearche
Experience of stigma in the public life of relatives of people diagnosed with schizophrenia in the Republic of Belarus
Substance use disorders among forcibly displaced people:a narrative review
Purpose of review Forced displacement, from wars, terrorism, internal disputes and environmental disasters, has been witnessed throughout human history. Forcibly displaced people face unimaginable difficulties and atrocities in their attempts to survive. Provision of support often focuses on basic needs, such as food, shelter and essential health demands. We present here a narrative review informed by syndemic theory to understand the existing literature on the associations between substance use disorders and experiences of forced displacement.Recent findings The risk factors associated with SUDs are similar to or overlap with those experienced by forcibly displaced people, yet there is substantial heterogeneity in patterns and prevalence of substance use across the different forcibly displaced people. Despite recognition that SUDs among forcibly displaced people are concerning, there are large gaps in knowledge. These include questions around whether forced displacement is directly and consistently linked with SUDs prevalence, what the patterns of risk and resilience look like across different cultures experiencing different causes of displacement over varying durations, and what constitutes effective interventions for these groups. These gaps are at least partly due to research having been disproportionately conducted in developed countries rather than in low- and middle-income countries.Summary Specifically, we categorise syndemic risks of both forced displacement and substance use disorders into four areas: trauma and violence, loss and instability, transit and resettlement and acculturation. We use causal loop diagramming to illustrate important synergistic interactions. We propose a research and intervention policy agenda informed by a broad and varied stakeholder base, accounting for generational and life-course effects and context specific cultural, structural and economic priorities and values
Attitudes towards People with Mental Illness and Low Interest in Psychiatry among Medical Students in Central and Eastern Europe
Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness - study protocol for an international multisite non-randomised controlled study
Background Stigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve studentsâ ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding. Methods/design READ training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess studentsâ knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention. Discussion This is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patientsâ experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed