Stigma in response to mental disorders: a comparison of Australia and Japan

BACKGROUND: There are few national or cross-cultural studies of the stigma associated with mental disorders. Australia and Japan have different systems of psychiatric health care, and distinct differences in cultural values, but enjoy similar standards of living. This study seeks to compare the nature and extent of stigma among the public in the two countries. METHODS: A household survey of the public was conducted in each country using similar methodologies. The Australian study comprised a national survey of 3998 adults aged over 18 years. The Japanese survey involved 2000 adults aged 20 to 69 from 25 regional sites distributed across the country. Interviewees reported their personal attitudes (personal stigma, social distance) and perceptions of the attitudes of others (perceived stigma, perceived discrimination) in the community with respect to four case vignettes. These vignettes described a person with: depression; depression with suicidal ideation; early schizophrenia; and chronic schizophrenia. RESULTS: Personal stigma and social distance were typically greater among the Japanese than the Australian public whereas the reverse was true with respect to the perception of the attitudes and discriminatory behaviour of others. In both countries, personal stigma was significantly greater than perceived stigma. The public in both countries showed evidence of greater social distance, greater personal stigma and greater perceived stigma for schizophrenia (particularly in its chronic form) than for depression. There was little evidence of a difference in stigma for depression with and without suicide for either country. However, social distance was greater for chronic compared to early schizophrenia for the Australian public. CONCLUSION: Stigmatising attitudes were common in both countries, but negative attitudes were greater among the Japanese than the Australian public. The results suggest that there is a need to implement national public awareness interventions tailored to the needs of each country. The current results provide a baseline for future tracking of national stigma levels in each country

Public beliefs about causes and risk factors for mental disorders: a comparison of Japan and Australia

BACKGROUND: Surveys of the public in a range of Western countries have shown a predominant belief in social stressors as causes of mental disorders. However, there has been little direct cross-cultural comparison. Here we report a comparison of public beliefs about the causes of mental disorders in Japan and Australia. METHODS: Surveys of the public were carried out in each country using as similar a methodology as feasible. In both countries, household interviews were carried out concerning beliefs about causes and risk factors in relation to one of four case vignettes, describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. In Japan, the survey involved 2000 adults aged between 20 and 69 from 25 regional sites spread across the country. In Australia, the survey involved a national sample of 3998 adults aged 18 years or over. RESULTS: In both countries, both social and personal vulnerability causes were commonly endorsed across all vignettes. The major differences in causal beliefs were that Australians were more likely to believe in infection, allergy and genetics, while Japanese were more likely to endorse "nervous person" and "weakness of character". For risk factors, Australians tended to believe that women, the young and the poor were more at risk of depression, but these were not seen as higher risk groups by Japanese. CONCLUSION: In both Japan and Australia, the public has a predominant belief in social causes and risk factors, with personal vulnerability factors also seen as important. However, there are also some major differences between the countries. The belief in weakness of character as a cause, which was stronger in Japan, is of particular concern because it may reduce the likelihood of seeking professional help and support from others

Nagasaki Schizophrenia Study: Relationship Between Ultralong-term Outcome (after 28 years) and Duration of Untreated Psychosis

Objective: Numerous studies have shown a relationship between the duration of untreated psychosis (DUP) in schizophrenia and short-termoutcome. However, few studies have investigated the relationships between DUP and the medium-term and long-term outcomes. Furthermore,we are unaware of any reports regarding the relationship between DUP and the ultralong-term outcome. This study aimed to investigate therelationship between DUP and ultralong-term outcome at 28 years in patients with schizophrenia.Method: Patients with schizophrenia completed an interview survey 28 years after their initial psychiatric examination during the period 1979-1980. It was possible to conduct the survey using suitable assessment scales in 31 patients in whom DUP was confirmed. These patients weredivided into a short DUP group and a long DUP group on the basis of the median DUP, and the outcomes of these two groups were compared.Results: Longer DUP correlated significantly with poorer symptomatic outcome; degree of social adjustment; and, global functioning. Multiplelinear regression analysis found no changes in these results even after controlling for various factors, including gender, age at onset, mode ofonset, diagnostic subtype, and premorbid adjustment.Conclusion: DUP adversely affected ultralong-term outcome of schizophrenia after 28 years. This finding supports the need to establish asystem to enable early detection and appropriate intervention for patients with schizophrenia to reduce the risk of a deleterious outcome aftermore than 25 years

Epidemiological survey of first-episode psychosis in Nagasaki, Japan: Is the incidence rate of schizophrenia changing?

The Determinants of Outcome of Severe Mental Disorders (DOSMeD) study, a global epidemiological study led by the World Health Organization, reported the annual incidence rate of schizophrenia from 1979 to 1980. In 2011, approximately 30 years later, we conducted a large-scale epidemiological study to investigate the incidence rate of first-episode schizophrenia in Nagasaki using the same method as the DOSMeD study. A telephone survey was conducted by researchers daily at 52 psychiatric hospitals, clinics, and institutes in Nagasaki. When a subject was confirmed, the researcher visited the medical facility in person to evaluate the patient’s symptoms. Of 441,706 people in Nagasaki City, 131 people were surveyed in the way, resulting in the diagnosis of psychosis in 25 patients, 20 of whom were determined to have schizophrenia. These data were used to calculate the incidence rates of psychosis (1.00 per 10,000 population; 95% confidence interval [CI], 0.54-1.46) and schizophrenia (0.80 per 10,000 population; 95% CI, 0.38-1.21). The 95% CI for the incidence rate of psychosis did not include the incidence rate for psychosis (broad definition) reported in the DOSMeD study (2.02). However, the 95% CI for the incidence rate of schizophrenia did include the incidence rate for schizophrenia (restrictive definition) reported in the DOSMeD study (1.01). Although the incidence rate of psychosis appeared to be decreasing, no significant change was found in the incidence rate of schizophrenia, comparing the present findings with those of the survey conducted 30 years ago. The incidence rate of schizophrenia is said to vary with changes in gender differences, racial differences, urbanization, and immigration; we therefore considered this possibility. In the future, it is necessary to carry out longer-term surveys covering multiple cities using the same methods

Heart Disease, Other Circulatory Diseases, and Onset of Major Depression among Community Residents in Japan: Results of the World Mental Health Survey Japan 2002-2004

We examined whether selected circulatory diseases (heart disease, stroke, diabetes and hypertension) were associated with an increased risk of major depression in the Japanese community population. Face-to-face household surveys were carried out in 7 areas, and a total of 2,436 persons participated (overall response rate: 58.4%) from 2002 to 2004. The WHO Composite International Diagnostic Interview 3.0 was used to diagnose major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and additional interviews assessed the presence of circulatory diseases. Using data from a random subsample of the respondents (n=832), we conducted Cox proportional hazards models to calculate hazard ratios for the onset of major depression with comorbid circulatory diseases as a time-dependent covariate. Heart attack was significantly associated with the onset of major depression (hazard ratio [HR], 7.51 [95%Confidential Interval (CI), 1.36-41.45]) after adjusting for sex, birth cohort, smoking, alcohol intake, and education. Heart disease (HR, 2.12 [95% CI, 0.79-5.70]), diabetes (HR, 2.36 [95% CI, 0.42-13.34]) and hypertension (HR, 0.97 [95% CI, 0.37, 2.50]) were not significantly associated. There were no subjects who developed major depression after stroke. These results suggest that heart attack, and maybe also heart disease and diabetes, affect the onset of major depression.</p

Relationship between motor coordination, cognitive abilities, and academic achievement in Japanese children with neurodevelopmental disorders

Background/Objective: Motor coordination impairment is common in children with neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (AD/HD). The purpose of this study was to investigate the relationship between motor coordination, cognitive ability, and academic achievement in Japanese children with neurodevelopmental disorders. Methods: Thirty-four school-age (6?12 years old) children with neurodevelopmental disorders and 34 age-matched typically developing (TD) children were recruited in this study. Correlations between the scores of the Movement Assessment Battery for Children-2 (M-ABC2) and the Kaufman Assessment Battery for Children ? Second Edition (K-ABCII) that assesses cognitive abilities, and academic achievement were analyzed. Results: The children with neurodevelopmental disorders obtained a lower total score and all component scores on M-ABC2 compared to the TD children. In children with neurodevelopmental disorders, M-ABC2 Manual Dexterity score was significantly correlated with K-ABCII Simultaneous Processing (r =.345, p =.046), Knowledge (r =.422, p =.013), Reading (r =.342, p =.048), Writing (r =.414, p =.017), and Arithmetic (r =.443, p =.009) scores. In addition, M-ABC2 Balance score was significantly correlated with K-ABCII Learning (r =.341, p =.048), Writing (r =.493, p =.004), and Arithmetic (r =.386, p =.024) scores. Conclusion: These findings stress that it is essential to accurately identify motor coordination impairments and the interventions that would consider motor coordination problems related to cognitive abilities and academic achievement in Japanese children with neurodevelopmental disorders

The relationship between physical signs of aging and social functioning in persons with Down syndrome in Japan

Background: In Japan, there have been no substantial studies of social function and physical aging in adults with Down syndrome. The aim of the present study was to examine social functions (movement, conversation, and daily living skills) and physical signs of aging in adults with Down syndrome in Japan, and to analyze the relationship between changes in social function and age.Methods: A cross-sectional survey of persons with Down syndrome who were 15 years of age or older (15-65 years old) was conducted. The survey was conducted in patients associations, institutes, group homes, and workplaces from July to December 2009. Primary caregivers, such as family members and institute staff, were asked to complete a questionnaire on the subjects’ living situation, movement ability, conversational skills, daily living skills, and 10 characteristics of physical aging at the time of the survey.Results: The total number of subjects was 315. Subjects’ movement ability, conversational ability, and daily living skills declined as a function of age. Canities (40.6%) were the most prevalent physical sign of aging, followed by missing teeth, hump back, and skin wrinkling. Further, physical aging was related to a decline in social functions (p < 0.001).Conclusion: The present study showed that adults with Down syndrome exhibit signs of physical aging earlier than do the general population, and that physical aging is associated with social functioning. Thus, the appearance of physical aging might indicate a decline in social functioning

Mental health conditions in Korean atomic bomb survivors: a survey in Seoul

More than 60 years have elapsed since the atomic bombings to Hiroshima and Nagasaki, and since all of the atomic bomb survivors have become old, the importance of caring their mental health has become increasing in Japan. Although approximately 70% of overseas atomic bomb are living in Korea, there have been quite few studies on their mental health. The objectives of the present study were to elucidate whether the mental health conditions of atomic bomb survivor in Korea are similar to those in Japan. The subjects were 181 Korean atomic bomb survivors living in Korea (cases) and 209 outpatients of a hospital in Seoul who were not exposed to atomic bombs (controls). Interviewers administered them at the hospital a questionnaire with Impact of Event Scale-Revised, General Health Questionnaire 12 (GHQ-12), Korean version of short form Geriatric Depression Scale and the K scale of the Minnesota Multiphasic Personality Inventory. Excluding subjects with incomplete responses we analyzed 162 cases and 189 controls. The proportion of subjects with high score of GHQ-12 ( 4) was significantly higher in cases (78/162 or 48.1%) than in controls (42/189 or 22.2%) (p < 0.0001, Fisher\u27s exact test). The present results, though preliminary, indicate that atomic bomb survivors in Korea have also mental health problems similar to those observed in Japanese atomic bomb survivors, indicating the necessity of a larger study

The mental health status of children who have been evacuated or migrated from rural areas in Fukushima prefecture after the Fukushima daiichi nuclear power station accident: results from the Fukushima health management survey

Introduction: We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children's experience of the nuclear disaster. Methods: We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS);FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the "Strengths and Difficulties Questionnaire (SDQ)" scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster - "nuclear disaster (+)" and "nuclear disaster (-)" - were also compared. Results: Our effective response was 93 (59.6%);the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between "elementary school" and "junior high school" or "nuclear disaster" (+) and (-). There was no significant difference between these items. Conclusions: We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster