Attitudes towards Alcohol Dependence and Affected Individuals: Persistence of Negative Stereotypes and Illness Beliefs between 1990 and 2011

Background: Alcohol dependence is among the most severely stigmatized mental disorders. We examine whether negative stereotypes and illness beliefs related to alcohol dependence have changed between 1990 and 2011. Methods: We used data from two population surveys with identical methodology that were conducted among German citizens aged ≥18 years, living in the ‘old' German states. They were conducted in 1990 and 2011, respectively. In random subsamples (1990: n = 1,022, and 2011: n = 1,167), identical questions elicited agreement with statements regarding alcohol dependence, particularly with regard to the illness definition of alcohol dependence and blame. Results: Overall, agreement with negative stereotypes did not change in the course of 2 decades. About 55% of the respondents agreed that alcohol dependence is an illness like any other, >40% stated that it was a weakness of character and 30% endorsed that those affected are themselves to blame for their problems. Conclusions: It is apparent that promoting an illness concept of alcohol dependence has not been an easy solution to the problem of stigma. We discuss how the normative functions of alcohol dependence stigma might have prevented a reduction of negative stereotypes

Public Continuum Beliefs for Different Levels of Depression Severity

Introduction: The notion that depression is a disorder that moves along a continuum is well-established. Similarly, the belief in the continuity of mental illness is considered an important element in the stigma process. Against this background, it is the aim of this study to examine whether public continuum beliefs vary with the severity of depressive symptoms. Methods: Analyses were based on computer-assisted telephone interviews (CATIs) conducted in winter 2019/2020 in Germany (N = 1,009, response rate 46.8%). Using three vignettes representing mild, moderate, and severe depressive symptoms, beliefs regarding the continuity of symptoms, specifically a fundamental difference, were assessed with seven items. Sociodemographic characteristics and own experiences with depression (affliction and contact) were introduced as covariates. Results: Significant differences between the three groups of severity were found for the majority of the items measuring continuum beliefs or perceived fundamental difference. However, only few items showed a linear trend indicating a parallel between symptom severity and beliefs. Multivariate regression models showed that a moderate degree of depression was positively associated with stronger continuum beliefs but also with greater perceived difference compared to the mild degree, while no significant associations emerged for the severe vignette. Limitations: Although a comparison of our sample with official statistics supports the external validity, we cannot rule out a selection bias. It is arguable in how far short case vignettes convey a holistic picture of a person affected by depressive symptoms. Conclusion: Our results do not indicate a parallel between symptom severity and public continuum beliefs

Individuals with currently untreated mental illness: causal beliefs and readiness to seek help

Aims. Many people with mental illness do not seek professional help. Beliefs about the causes of their current health problem seem relevant for initiating treatment. Our aim was to find out to what extent the perceived causes of current untreated mental health problems determine whether a person considers herself/himself as having a mental illness, perceives need for professional help and plans to seek help in the near future. Methods. In a cross-sectional study, we examined 207 untreated persons with a depressive syndrome, all fulfilling criteria for a current mental illness as confirmed with a structured diagnostic interview (Mini International Neuropsychiatric Interview). The sample was recruited in the community using adverts, flyers and social media. We elicited causal explanations for the present problem, depression literacy, self-identification as having a mental illness, perceived need for professional help, help-seeking intentions, severity of depressive symptoms (Patient Health Questionnaire – Depression), and whether respondents had previously sought mental healthcare. Results. Most participants fulfilled diagnostic criteria for a mood disorder (n = 181, 87.4%) and/or neurotic, stress-related and somatoform disorders (n = 120, 58.0%) according to the ICD-10. N = 94 (45.4%) participants had never received mental health treatment previously. Exploratory factor analysis of a list of 25 different causal explanations resulted in five factors: biomedical causes, person-related causes, childhood trauma, current stress and unhealthy behaviour. Attributing the present problem to biomedical causes, person-related causes, childhood trauma and stress were all associated with stronger self-identification as having a mental illness. In persons who had never received mental health treatment previously, attribution to biomedical causes was related to greater perceived need and stronger help-seeking intentions. In those with treatment experience, lower attribution to person-related causes and stress were related to greater perceived need for professional help. Conclusions. While several causal explanations are associated with self-identification as having a mental illness, only biomedical attributions seem to be related to increase perceived need and help-seeking intentions, especially in individuals with no treatment experiences. Longitudinal studies investigating causal beliefs and help-seeking are needed to find out how causal attributions guide help-seeking behaviour. From this study it seems possible that portraying professional mental health treatment as not being restricted to biomedical problems would contribute to closing the treatment gap for mental disorders

The downside of tobacco control? Smoking and self-stigma: a systematic review

Objective Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves. Methods We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigan's progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles. Results Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smoking-related stigma. Conclusion While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted

Public Continuum Beliefs for Different Levels of Depression Severity

Introduction: The notion that depression is a disorder that moves along a continuum is well-established. Similarly, the belief in the continuity of mental illness is considered an important element in the stigma process. Against this background, it is the aim of this study to examine whether public continuum beliefs vary with the severity of depressive symptoms.Methods: Analyses were based on computer-assisted telephone interviews (CATIs) conducted in winter 2019/2020 in Germany (N = 1,009, response rate 46.8%). Using three vignettes representing mild, moderate, and severe depressive symptoms, beliefs regarding the continuity of symptoms, specifically a fundamental difference, were assessed with seven items. Sociodemographic characteristics and own experiences with depression (affliction and contact) were introduced as covariates.Results: Significant differences between the three groups of severity were found for the majority of the items measuring continuum beliefs or perceived fundamental difference. However, only few items showed a linear trend indicating a parallel between symptom severity and beliefs. Multivariate regression models showed that a moderate degree of depression was positively associated with stronger continuum beliefs but also with greater perceived difference compared to the mild degree, while no significant associations emerged for the severe vignette.Limitations: Although a comparison of our sample with official statistics supports the external validity, we cannot rule out a selection bias. It is arguable in how far short case vignettes convey a holistic picture of a person affected by depressive symptoms.Conclusion: Our results do not indicate a parallel between symptom severity and public continuum beliefs

Psychometric Evaluation of the German Version of the Social Functioning in Dementia Scale

BACKGROUND: Dementia is one of the most common and most severe disorder in old age. In addition to cognitive decline and functional impairment, changes in social functioning occur in the course of dementia. Currently, there is no valid instrument in German language to assess social functioning in individuals with dementia. OBJECTIVE: We aim to adapt and psychometrically evaluate a German version of the Social Functioning in Dementia Scale (SF-DEM). METHODS: First, a multi-step and team-based translation process based on the TRAPD model was performed. Second, we interviewed dyads of individuals with mild dementia and caregivers to test the internal consistency, test-retest reliability, interrater reliability, construct validity, and acceptance of the German version of the SF-DEM. RESULTS: The internal consistency of the patient-rated (α= 0.72) and the caregiver-rated (α= 0.76) SF-DEM is at an acceptable level. The interrater reliability was excellent for both versions (patients: ICC = 0.98, CI [0.95-0.99]; caregiver: ICC = 0.95, CI [0.89-0.98]) and the test-retest reliability was moderate (patients: ICC = 0.57, CI [0.26-0.77]; caregiver: ICC = 0.58, CI [0.27-0.78]). Caregiver-rated SF-DEM correlated strong with LSNS-6 (rs = 0.60, p < 0.01), QoL-AD (marriage: rs = 0.61, p < 0.01; friends: rs = 0.51, p = 0.01). In addition, the SF-DEM was accepted by the participants. CONCLUSION: The German SF-DEM is a valid, reliable, and acceptable instrument to assess social functioning in individuals with dementia. Further research should address the psychometric properties in individuals with more severe dementia

Public Attitudes towards Prevention of Obesity

OBJECTIVE: To investigate obesity prevention support in the German general public and to assess determinants of general prevention support as well as support of specific prevention measures. METHODS: This study was a cross-sectional analysis of a telephone based representative German study (3,003 subjects (52.8% women, mean age 51.9, s.d.  = 18.0, range 18-97 years). Likert scale-based questions on general prevention support and support of specific measures were used. Furthermore willingness to take part in preventive programs and willingness to pay were assessed. Stigmatizing attitudes were assessed with the Fat Phobia Scale (FPS). Causation of obesity was differentiated in three dimensions (internal, e.g. lack of exercise; external, e.g. social surroundings; and genetic factors). RESULTS: Obesity prevention was perceived as possible (98.2%), however, almost exclusively lifestyle changes were named. Participants with higher stigmatizing attitudes were less likely to believe obesity prevention is possible. The majority of participants would take part in preventive programs (59.6%) and pay at least partially themselves (86.9%). Factor analysis revealed three dimensions of preventive measures: promoting healthy eating, restrictive and financial, governmental prevention efforts. In regard to these, promoting healthy eating was the most supported measure. Higher age, female gender and external causation were associated with higher support for all three dimensions of preventive measures. Only for governmental regulation, higher age was associated with lower support. CONCLUSION: Obesity prevention support in Germany is high. Structural prevention efforts are supported by the majority of the general public in Germany. The vast majority proclaims willingness to pay themselves for programs of weight gain prevention. This could be an indication of higher perceived self-responsibility in the German system but also for risen "fear of fat" in the population due to media coverage. For Germany, the government and communities ought to be encouraged by these results to start the implementation of structural obesity prevention

Validity and psychometric properties of the self-identification as having a mental illness scale (SELF-I) among currently untreated persons with mental health problems

Conceptualizing own symptoms as potential signs of a mental illness is an important, yet underresearched step towards appropriate help. Few validated measures address recognition and identification of own mental illness. Aim of this study is to investigate performance and correlates of the ‘Self-Identification as Having a Mental Illness’ scale (SELF-I) in a group of 229 currently untreated individuals with mental health problems, predominantly depression. Measures included: self-identification with having a mental illness (SELF-I), depressive and somatic symptom severity (PHQ-9 and PHQ-15), illness perceptions (B-IPQ-R-C), and sociodemographic variables. Principal-component analysis revealed in a unidimensional factor structure. The SELFI showed good reliability in terms of internal consistency (Cronbach’s alpha, 0.85-0.87) and retest reliability over three months (Intraclass correlation coefficient, 0.74). Associations with depressive symptoms, previous treatment experiences and self-labelling demonstrated construct and criterion validity. Low associations with somatic symptoms and with illness-perceptions as measured by the B-IPQ-R-C indicated discriminant validity. We did not observe any floor or ceiling effects. The SELF-I scale is a brief, unidimensional and reliable measure of selfidentification as having a mental illness that offers useful research perspectives

The effects of causal and self-efficacy beliefs on help-seeking for people with depressive complaints: a quasi-experimental online study

BackgroundOnly approximately a third of people with depressive symptoms seek professional health care. Furthermore, people labelled as mentally ill may experience stigmatisation, which can impede help-seeking behaviour.AimTo examine the effects of three vignette-based interventions endorsing biopsychosocial causal beliefs and strengthening self-efficacy on help-seeking intention and behaviour, as well as the predictive values of these variables and previous treatment experience.MethodA quasi-experimental online study utilising a fractioned factorial design was carried out. People were screened for depressive symptoms and their current treatment status. After baseline assessment, they were randomly allocated into one of 24 groups receiving a combination of interventional messages. Actual help-seeking behaviour was measured at follow-ups 3 and 6 months after baseline.ResultsAltogether, N = 1,368 participants were included in the final analyses and N = 983 provided data on their help-seeking behaviour within 3 to 6 months after the baseline assessment. The intention to seek help from a general practitioner or a mental health professional was significantly influenced by the interventions. However, help-seeking behaviour was not influenced by the interventions. On a conceptual level, biopsychosocial causal beliefs (β = 0.09–0.23) and self-efficacy to seek help (β = 0.16–0.25) predicted help-seeking intention. There was a negative interaction effect of both self-efficacy beliefs on intention and behaviour, which changed depending on depression severity. In all models, the intention was the main predictor of actual behaviour. Treatment experience predicted both help-seeking intention and behaviour.ConclusionBiopsychosocial causal beliefs and self-efficacy have a direct effect on help-seeking intention. Interventions should include information on how to actually seek help as a means to strengthen self-efficacy beliefs and simulate previous treatment experience. Further research is needed to investigate the respective interaction effects on intention and behaviour.Clinical Trial Registrationhttps://drks.de/search/de/trial/DRKS00023557, German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021

Psychometric validation of the self-identification of having a mental illness (SELF-I) scale and the relationship with stigma and help-seeking among young people

Purpose Self-identification of having a mental illness has been shown to be an important factor underpinning help-seeking behaviour and may mediate the relationship between personal stigma and mental health service use. This study validates a new scale for the self-identification of having a mental illness among a non-clinical, community cohort of young people in the UK. Methods Following consultation with a group of young person experts with experience of mental health problems, we evaluated the psychometric properties of the self-identification of mental illness scale (SELF-I) among 423 young people aged 13–24 years who are part of an ongoing prospective community cohort. We performed test retest reliability among a subset of 53 participants. Psychometric validation for the scale used measures of Cronbach’s alpha and Pearson’s correlation coefficient. Item performance was assessed along and in relation with each covariate. Results The SELF-I demonstrated robust psychometric properties including high test–retest reliability (0.95) and good internal consistency (0.87 as determined by the Cronbach’s alpha). The inter-total correlations for each item, which ranged from 0.62 to 0.74, supported keeping all items in the scale. Reporting greater psychiatric symptomatology via the SDQ (β: 0.82 95% confidence interval 0.40, 1.23), psychotic-like experiences (β: 0.37 95% confidence interval 0.14, 0.59), and use of mental health services (β: 0.92 95% confidence interval 0.71, 1.13) were associated with a greater self-perception as having a mental illness (p < 0.05), providing evidence of convergent validity. As expected, we found that less intended stigmatising behaviour was associated with greater self-perceptions of having a mental illness (B: 0.18, 95% CI 0.07, 0.28). Conclusions The SELF-I scale provides a method to gather insight into how young people, who may not identify as service users, perceive their own mental state and potential risk for developing a mental illness. This can be important for understanding perceived need for help and likelihood of using services among those with mental health problems