The self-stigma of patients with epilepsy in Japan: A qualitative approach.

The mental health of patients with epilepsy represents a substantial public health concern in Japan. For instance, the Japanese term for epilepsy, "tenkan", has the negative meaning of "mad" and "a violent temperament that is apt to be infatuated". Although epilepsy is now understood as a disease caused by abnormal neuronal activity in the brain, discrimination and stigma against people with epilepsy remain deeply rooted in Japanese culture. Understandably, this stigma can have a serious impact on the psychology and behavior of individuals with epilepsy. To our knowledge, no studies have clarified the formation process or examined the treatment of self-stigma in patients with epilepsy in Japan. Characterizing coping strategies and examining methods for reducing self-stigma will increase our understanding of the experiences of patients and facilitate effective psychiatric rehabilitation. Accordingly, the purpose of our study was to investigate the quality and degree of cognition regarding self-stigma and to examine coping strategies in patients with epilepsy living in the community. The participants were psychiatric outpatients aged 20-65 years who had been diagnosed with epilepsy and visited our psychiatric outpatient clinic between October 1 and December 31, 2016. We conducted semi-structured interviews with 20 patients who consented to participate. For data analysis, we used the content analysis method proposed. Our study revealed details of self-stigma in patients with epilepsy. Patients and their families are often aware of the presence of this self-stigma, and many do not know how to address it. In this study, we qualitatively examined self-stigma in patients with epilepsy on the basis of patient narratives. Per our findings, we would like to examine intervention methods for reducing self-stigma in patients with epilepsy.

Cognitive behavioural therapy for Japanese children and adolescents with anxiety disorders: a pilot study.

BACKGROUND: Thirty-three Japanese children and adolescents diagnosed with an anxiety disorder participated in individual or group Cognitive Behaviour Therapy (CBT) that was modelled after evidence-based intervention programs developed in Western countries. METHOD: The treatment consisted of: (a) building rapport and education; (b) identifying emotions and recognizing cognitive self-talk; (c) challenging anxious self-talk; (d) developing an anxiety hierarchy and in vivo exposures; and (e) planning for future challenges. RESULTS: Three months following treatment, 20 of the 33 children and adolescents (60.91%) no longer met criteria for their principal anxiety disorders and 16 (48.48%) were free from all anxiety disorders. Self-reported anxiety, depression, and cognitive errors also decreased significantly from pre- to post-treatment and these gains were maintained at 3-month follow-up. For the most part, similar outcomes were found in both the group and individual formats of CBT. CONCLUSIONS: This study provides preliminary support for the transportability of CBT in both an individual and group format to Japan.

Development and validation of the Epilepsy Self-Stigma Scale.

OBJECTIVE: Self-stigma is the internalization of negative public attitudes and is often experienced by patients with epilepsy (PWE). Greater self-stigma is associated with lower self-esteem and hinders therapeutic behavior. The study aims were to develop the Epilepsy Self-Stigma Scale (ESSS) to assess self-stigma in PWE and to examine the scale's reliability and validity. METHODS: We created a test scale based on items from an existing stigma scale and the results of a previous qualitative analysis we conducted. We recruited 200 outpatients from departments specializing in epilepsy (psychiatry, neurology, and pediatric neurology) at four facilities in Tokyo and Saitama prefecture, Japan, between September and December 2020. Participants also completed the Rosenberg Self-Esteem Scale (RSES) and Beck Depression Inventory (BDI-II). RESULTS: Questionnaires were returned from 102 participants (response rate: 51%). After excluding two participants with incomplete questionnaires, data for 100 participants were analyzed (53 women, 47 men; mean age [standard deviation]: 39.86 [17.45] years). Exploratory factor analysis extracted eight items loading on three factors: internalization of stigma, societal incomprehension, and confidentiality. Cronbach's α for all items and each factor demonstrated acceptable internal consistency (α = 0.76-0.87). Test-retest reliability was confirmed using data from 21 participants who completed the scale twice (r = 0.72 to 0.90). ESSS total scores and subscale scores correlated with RSES and BDI-II scores (r = -0.30 to 0.55). The ESSS demonstrated substantial constructive validity. However, total scores did not significantly correlate with objective physician assessment of self-stigma. SIGNIFICANCE: The results showed that the eight-item ESSS has high reliability and validity. This scale could facilitate the examination of factors associated with self-stigma in PWE, which could inform the development of effective interventions for reducing stigma.

An investigation of anxiety about radiotherapy deploying the Radiotherapy Categorical Anxiety Scale.

BACKGROUND: Radiotherapy is one of the major methods for treating cancer, but many patients undergoing radiotherapy have deep concerns about receiving radiation treatment. This problem is not generally appreciated and has not been adequately studied. METHODS: The objective of this investigation was to empirically investigate the anxieties that cancer patients feel towards radiotherapy by using questionnaires to classify and quantitatively measure their concerns. A preliminary interview to develop a questionnaire was carried out with 48 patients receiving radiotherapy to discover their anxieties about on-going treatments. Subsequently, a main study was performed using a questionnaire with 185 patients to classify their types of anxiety and to ascertain the reliability and validity of the responses. Confirmatory factor analysis was then carried out with a 17-item Radiotherapy Categorical Anxiety Scale. RESULTS: Three anxiety factors were abstracted by factor analysis: (1) adverse effects of radiotherapy, (2) environment of radiotherapy, and (3) treatment effects of radiotherapy. Reliability, content validity, and concurrent validity were obtained. The adequacy of the three-factor model of anxiety concerning radiotherapy was confirmed. CONCLUSION: A 17-item Radiotherapy Categorical Anxiety Scale was formulated to quantitatively measure the specific types of anxiety among cancer patients receiving radiotherapy.

Developing the universal unified prevention program for diverse disorders for school-aged children.

BACKGROUND: Psychological problems during childhood and adolescence are highly prevalent, frequently comorbid, and incur severe social burden. A school-based universal prevention approach is one avenue to address these issues. OBJECTIVE: The first aim of this study was the development of a novel, transdiagnostic cognitive-behavioral universal prevention program: The Universal Unified Prevention Program for Diverse Disorders (Up2-D2). The second aim of this study was to examine the acceptability and fidelity of the Up2-D2. METHODS: Classroom teachers who attended a 1-day workshop implemented the Up2-D2 independently as a part of their regular curricula. To assess the acceptability of the Up2-D2, 213 children (111 boys and 102 girls) aged 9-12 years completed questionnaires about their enjoyment, comprehension, attainment, applicability, and self-efficacy after completing Lessons 1-12. For fidelity, research assistants independently evaluated audio files that were randomly selected and assigned (27.3%). RESULTS: Our preliminary evaluation revealed the program was highly enjoyable, clear, and applicable for students. In addition, self-efficacy demonstrated a trend of gradually increasing over the 12 sessions. The total fidelity observed in the two schools was sufficient (76.2%), given the length of the teacher training. CONCLUSIONS: The results of this study supported the theory that the Up2-D2 could be feasible in real-world school settings when classroom teachers implement the program. We discussed current research and practical issues of using universal prevention to address mental health problems in school, based on implementation science for user-centered design.

Evaluation of a one-question interview for depression in a radiation oncology department in Japan.

This study aims to clarify the validity of the brief screening measure of depression in Japan. It was the single-item interview "Are you depressed?" that provided a reliable and remarkable accurate screen in North America. The study was conducted on 282 participants receiving radiotherapy for cancer. The criterion diagnosis were given by the Structured Clinical Interview for DSM-(SCID). On the basis of the receiver operating characteristic (ROC) analyses, we compared the results obtained using single-item interview with major and minor depressive disorders defined by DSM-TR and calculated the sensitivity, specificity and likelihood ratio (LR). The result of the present study indicated a sensitivity of 42% (95% CI 22-61%) and a specificity of 86% (95% CI 82-91%), and LR of 3.1. In conclusion, single-item interview "Are you depressed?" did not have sufficient sensitivity.

Self-stigma in depressive patients: Association of cognitive schemata, depression, and self-esteem.

Many empirical studies have indicated that various psychosocial and psychiatric variables are correlated with levels of self-stigma. Treatment methods for reducing self-stigma have been investigated in recent years, especially those examining the relationship between negative cognitive schemata and self-stigma. This study examined the relationship of self-stigma with cognitive schemata, depression, and self-esteem in depressive patients. Furthermore, structural equation modeling (SEM) was conducted to evaluate three hypothetical models. Study participants were 110 patients with depression (54 men, 56 women; mean age=45.65years, SD=12.68; 83 diagnosed with mood disorders; 22 with neurotic, stress-related, or somatoform disorders; and 5 with other disorders) attending a psychiatric service. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Center for Epidemiologic Studies Depression Scale, and Rosenberg's Self Esteem Scale. The analysis indicated a better fit of the model that assumed self-stigma as mediator, suggesting that cognitive schemata influence self-stigma, while self-stigma affects depression and self-esteem. The tested models using SEM indicated that (1) self-stigma has the potential to mediate the relationship between cognitive schemata and depression, and (2) depression and self-stigma have a similar influence on self-esteem. Although low self-esteem is considered one of the symptoms of depression, when we aim to recover self-esteem, we do not only observe improvement in depressive symptoms; thus, approaches that focus on the reduction of self-stigma are probably valid.

Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients.

OBJECTIVE: There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. METHODS: We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age=38.57 years, SD=8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale. RESULTS: Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. CONCLUSIONS: Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.

Estimation of anxiety and depression in patients with early stage breast cancer before and after radiation therapy.

BACKGROUND: Most previous studies about anxiety and depression in patients undergoing radiotherapy have only measured the quantity of general depression and anxiety and have not studied specific periods of involvement. The aim of this study was to assess anxiety and depression among early breast cancer patients, and the anxiety experienced immediately before and after radiotherapy. METHODS: Women who started radiotherapy for stage I or II breast cancer (n = 172) were asked to answer two questionnaires: the Hospital Anxiety and Depression Scale (HADS) and Radiotherapy Categorical Anxiety Scale immediately before and after radiation therapy. RESULTS: The results showed that the mean scores of anxiety and depression (HADS and Radiotherapy Categorical Anxiety Scale) decreased after radiotherapy. The mean score of depression (HAD-D) in the group receiving conventional radiotherapy was higher than in those receiving hypofractionated radiotherapy before and after radiotherapy. The mean scores of anxiety and depression (HADS) in the endocrine therapy group were lower than in the group without endocrine therapy before treatment. However, the scores after treatment of both groups were not significant. CONCLUSION: Some intervention may be needed to decrease the temporary anxiety and depression raised during radiotherapy for early stage breast cancer patients. This is especially so for patients who do not receive concurrent endocrine therapy and choose the conventional radiotherapy course.

Deliberate self-harm and childhood hyperactivity in junior high school students.

The present study aimed to explore the status of deliberate self-harm (DSH) among junior high-school students, and investigate the relationship between DSH and substance use and childhood hyperactivity. Subjects were 239 boys (mean age = 14.16 years, SD = 0.67) and 238 girls (14.22, 0.68) from a junior high-school in Kanagawa, Japan. A self-reporting questionnaire consisting of original questions on self-cutting, self-hitting, and tobacco and alcohol use was employed with the Wender Utah Rating Scale (WURS) for assessing childhood hyperactivity. Overall, 8.00% and 27.70% of males and 9.30% and 12.20% of females reported self-cutting and self-hitting, respectively. Regarding substance use, 33.10% and 74.10% of males and 14.30% and 63.40% of females reported tobacco and alcohol use, respectively. Comparisons of WURS scores between those with and without experience of problematic behaviors revealed that with all problematic behaviors in both genders, scores of those with experience were significantly higher than those without (P < 0.01 except for self-cutting in females, P < 0.05). The present study indicated that DSH is an important problem, even among children as young as junior high-school age. An association between DSH and childhood hyperactivity was also suggested.