International Journal of Social Psychiatry

Stigma toward mentally ill individuals acts as a barrier to accessing care and receiving treatment.

To review current evidence pertaining to stigma toward mental illness in the Middle East in order to inform effective and sustainable interventions in this region.

We conducted a systematic literature search using the PubMed database and evaluated all identified studies according to specific inclusion criteria.

Stigma toward individuals with mental illness does exist in the Middle East. Stigmatizing attitudes are particularly high toward culturally proscribed mental illnesses like alcohol abuse and lower for other disorders such as depression and psychosis.

We propose the following initiatives to reduce stigma toward mental illness in the Middle East: (a) educate families to enable them to support their affected relatives, (b) increase cooperation between psychiatrists and faith healers and (c) educate young people in schools to increase their awareness and understanding of mental illnesses and to combat negative stereotypes.

Paramedics dominate primary health care in Malawi where native healers also play a major role in the provision of health care and psychiatric nurses are the backbone of district mental health services.

The aim is to improve understanding of prior care-seeking and treatment of new patients seen at mental health services in a developing country like Malawi.

For one calendar month, 128 newly referred patients to the mental health services in the three psychiatric units in Malawi were interviewed using an encounter form.

Most of the patients went through a first carer before attending a psychiatric unit with only 11.7% going straight to a psychiatric unit. All patients who went straight to a psychiatric unit involved the private/Christian Health Association of Malawi (CHAM) unit in the northern region of Malawi. About 22.7% of the patients had a native healer as a first carer. Only 23% of all patients seen went through a second carer, with none going through a third carer. Over 8% of those who had a paramedic as their first carer had a native healer as their second carer. Duration of stay at different carers varied a lot with about half (48.2%) of all patients who saw a native healer as the first carer spending more than 2 weeks before referral while about 67.0% of those who saw convectional health workers spent 3 days or less before referral.

The pathway to care for patients with psychological problems in Malawi is not very much different to pathways to care in other developing countries whereby native healers and paramedics play a significant role. With the high proportion of patients being seen by native healers and the fact that most patients stay longer at native healers before referral, there is need for official collaboration and training of native healers on mental health.

Unaccompanied refugee adolescents are a small but clinically significant group. This group is vulnerable with physical and psychiatric needs which are often not met. There are several barriers to providing care for this group, originating with the refugees but also due to service provision.

The aim of this research is to appreciate the views and perceptions that unaccompanied minors hold about mental health and services.

Fifteen unaccompanied adolescents engaged with mental health services were interviewed, and thematic analysis was employed to explore relevant issues.

Their views reflected a range of opinions on mental health and the treatments they received, but many held negative attitudes toward mental health and had a lack of trust in services. This could be explained by their descriptions of their experiences within their home country of psychiatric care, their experiences of being a refugee/asylum-seeker or cultural differences.

We argue it is important to engage this group in the development of policy and practice in child mental health, and in developing services.

The shortage of specialized human resources in mental health in Bangladesh requires active recruitment of psychiatric residents. In addition, the involvement of positively inclined health personnel, for example, medical doctors, emerges as an immediate priority.

To explore stigma among medical students toward persons with mental disorders (PMDs) and their attitudes toward psychiatry.

A cross-sectional study was conducted at Faridpur Medical College in Bangladesh before (First year) and following psychiatric rotation (Fifth year). Students (N = 200) filled anonymous questionnaires measuring stigma toward PMDs and attitudes to psychiatry.

Upper medical school year (p = .028), older age (p = .005), mother’s lower academic level (p = .043), upper and lower socioeconomic level affiliation (p = .008) and self-consultation for mental or neurological complaints (p = .032) were associated with increased stigma toward PMDs. More favorable attitudes toward psychiatry were found in upper medical school year (p = .073) and were significantly associated with female gender (p = .018) and middle socioeconomic level affiliation (p = .013).

The relative improvement in attitudes toward psychiatry in the upper medical school year is overshadowed by the increased stigma toward PMDs. Specific anti-stigma program in the curriculum and strategies to improve the attitudes are required.

In routine clinical practice, the subcategories of various somatoform disorders are rarely used by the primary care physicians and there is lack of data to suggest any difference in the clinical manifestations of these subcategories.

To compare the symptom profile, anxiety, depression, alexithymia, somato-sensory amplification and hypochondriasis of patients with persistent somatoform pain disorder with other subtypes of somatoform disorder.

A total of 119 patients diagnosed with somatoform disorders according to the International Classification of Diseases–10th Revision (ICD-10) were evaluated for prevalence of somatic symptoms, anxiety, depression, alexithymia, hypochondriacal worry and somato-sensory amplification.

No significant differences were found in the prevalence of various somatic complaints between those with persistent somatoform pain disorder group and those diagnosed with other somatoform disorders. Co-morbid anxiety and depression were seen in two-thirds of the patients, but again there was no difference in the prevalence of the same between the two groups. Similarly, no significant differences were found on alexithymia, hypochondriasis and somato-sensory amplification scales between the persistent somatoform pain disorder group and the group with other somatoform disorders.

There are no significant differences between the various subcategories of somatoform disorders with regard to the prevalence of somatic symptoms, anxiety or depression and psychological correlates of alexithymia, hypochondriasis and somato-sensory amplification.

Taking care of patients with schizophrenia is a major source of burden to the family. Research on burden experienced by family members of patients living in rural communities is sparse.

Data were obtained from a community intervention program for psychoses in a rural community of south India, where persons with severe mental disorders were identified, treated and followed up. As part of the program, caregivers of 245 schizophrenia patients were interviewed using the Burden Assessment Schedule. Psychopathology (Positive and Negative Syndrome Scale; PANSS), treatment status and disability (Indian Disability Evaluation and Assessment Scale; IDEAS) experienced by the patients were also assessed. Univariate and multivariate analyses were used to study the influence of different factors on the caregiver burden.

Level of burden had a significant direct correlation with disability (Pearson’s r = .35; p < .01) and severity of psychopathology (r = .21; p < .01). Duration of treatment had an inverse correlation with burden (Pearson’s r = −.16; p < .01). Multivariate analysis revealed that total IDEAS score (Beta = .28; t = 4.37; p ≤ .01), duration of treatment (Beta = −.17; t = −2.58; p = .01), age of the family caregiver (Beta = .15; t = 2.4; p = .02) and gender of the patient (Beta = −.13; t = −2.1; p = .04) were significant predictors of burden. The model including total IDEAS score explained 14% of variance (adjusted R² = .139; p < .01).

Burden experienced by family caregivers of schizophrenia patients depends on the level of disability experienced by the patient, age of the family caregivers and gender of the patient. Interventions to reduce disability of the patients may reduce the caregiver burden.

To examine the effects of a recovery-oriented care training program for mental healthcare professionals on mental health consumer outcomes.

The Mental Health Recovery Measure (MHRM) and the Recovery-Promoting Relationship Scale (RPRS) were administered to a sample of 142 consumers with severe mental illness. A repeated measurement design with six measurement occasions was used.

Separate analyses were performed for the MHRM and RPRS subscales. Data were analyzed by means of the software package AMOS for structural equation modeling. First, the means of the five scales were computed at each measurement occasion. Next, two series of regression analyses were conducted: the first series aimed to ascertain whether gender and age have a significant effect on the MHRM and RPRS scores, and the second series aimed to detect a systematic trend in the average scale response of the MHRM and RPRS.

Scores showed a significant change over time for the subscale ‘Learning & new potentials’ of the MHRM. Significant effects were also found for gender, with men scoring higher than women on the subscales ‘Self-empowerment’ and ‘Learning & new potentials’. Age had no effect on the MHRM and RPRS. The scores on the RPRS showed no significant change over time.

One year after completion of the recovery-oriented training program for professionals, positive results were found for two subscales of the MHRM, that is, ‘Self- empowerment’ and ‘Learning & new potentials’.

Different types of accumulated stress have been found to have negative consequences for immigrants’ capacity to adapt to the new environment. It remains unclear which factors have the greatest influence.

The study investigated whether immigrants’ experience of great difficulty in adapting to a new country could best be explained by (1) country of origin, (2) exposure to accumulated stressors before arrival or (3) after arrival in the new country and/or (4) reserved attitude toward integrating into the new society.

The 119 first-generation immigrants from Somalia, Vietnam and China, living in Malmö, Sweden, were interviewed in a standardized manner.

Experiencing great difficulty in adapting to Sweden was independent of length of residence, but significantly related to all four influences, studied one at a time. Country of origin was also related to stressors and attitude. When the effects of the other influences were mutually controlled for, only exposure to accumulated stressors in Sweden (and especially experiencing discrimination/xenophobia/racism) accounted for great adaptation difficulty. Stressors in Sweden had a greater effect if the immigrant had been exposed to stressors earlier.

Immigrants’ long-term experiences of great difficulty in adapting to a new country were explained primarily by exposure to accumulated stressors while moving to and living in the new country, rather than by their backgrounds or attitudes toward integrating. This suggests promoting strategies to avoid discrimination and other stressors in the host country.

This study attempted to examine psychological morbidity among co-residents of older people living in Vellore, Tamil Nadu, India.

This cross-sectional study evaluated psychological morbidity among co-residents using the Self-Reporting Questionnaire and psychiatric morbidity among older people using the 10/66 Dementia Research Group’s population-based studies protocol. Socio-demographic data were also collected. Logistic regression was used for multivariate analysis.

Of 807 residents evaluated, 73 (9.0%) had significant psychological morbidity. Such morbidity was associated with being older, female, poorer, illiterate, currently employed and being a spouse of the older person. A diagnosis of depression, neuropsychiatric symptoms and greater disability in older people were also associated with psychological morbidity among co-residents.

Co-residents living with older people have significant psychological morbidity, which needs to be recognised and treated.

The effects of mental illness stigma on adolescents receiving psychiatric treatment may largely be determined by their coping strategies. Yet, little is known about adolescents’ use of stigma-coping strategies, or how helpful these are for addressing stigma-related stress.

This study explores how adolescents discharged from psychiatric hospitalization anticipate coping with a hypothetical social stigma event related to hospitalization. We examine how well anticipated coping strategies predict adolescents’ self-stigma ratings following 6 months. To evaluate the direction of causality, the reverse order of effects, the influence of self-stigma on coping strategies, is also assessed.

A voluntary sample of 80 adolescents participated in two face-to-face interviews that assessed coping and self-stigma. Anticipated (baseline) and actual (follow-up) coping strategies were measured with a modified Response to Stress Questionnaire (primary and secondary control engagement coping, disengagement) and two stigma-specific strategies developed for this study (disconfirming stereotypes and aggression/confrontation). Relationships between anticipated coping strategies and self-stigma were assessed with ordinary least squares (OLS) regression; multivariate general linear modeling (GLM) and structural equation modeling (SEM) explored the reverse associations.

Youth reporting higher self-stigma ratings at follow-up anticipated using more disengagement and effort to disconfirm stereotypes and less secondary control engagement coping at baseline. Anticipated use of secondary control engagement coping was uniquely significant in predicting participants’ self-stigma when controlling for baseline self-stigma. At the same time, higher baseline self-stigma ratings predicted less adaptive coping (disengagement and effort to disconfirm stereotypes) at follow-up.

The results point to the particular importance of secondary control engagement coping for helping to mitigate the impact of peer prejudice or discrimination on self-stigma among youth receiving psychiatric services. At the same time, higher initial levels of self-stigma likely drive less adaptive coping with peer stigma. These bidirectional influences point to a vicious cycle between internalizing negative stereotypes and coping in ways that perpetuate negative outcomes.

The perception of old age differs in different societies and cultures: in the Western societies, the loss of youth, multiple losses of functions and independence resulting in inability produce a social stigma. Dementia is common among the elderly, regardless of their ethnic background. In countries dominated by Western philosophical thought, the cognitive domain has been privileged over other mental domains. Knowledge of cultural factors is essential to an understanding of aging and dementia; studies are currently dominated by biomedical models that consider dementing disorders solely as a pathological entity caused by neuronal and neurotrasmitters loss, and focus on the individual without regard to sociocultural context.

The purpose of this study is to explore how the phenomenon of dementia is perceived in ethnically diverse groups and cultures.

Medline and Google Scholar searches were conducted for relevant articles, chapters and books published before 2014. Search terms used included anthropology, culture, ethnic elderly and dementia. Publications found through this indexed search were reviewed for further relevant references.

The experience of dementia is not universal, but is profoundly shaped by culture in which the demented person lives. Sociocultural conceptualization of the symptoms of dementing diseases remains obscure in many countries.

Sociocultural conceptualization of Alzheimer’s disease and other dementias is of growing interest in shaping the interpretation of the symptoms of dementing diseases. To explore the intersection of culture with the expression of dementia may optimize the management of these complex and chronic conditions.