How people react to suicidal ideation: The effect of suicide literacy, suicide stigma, and expressive suppression.

INTRODUCTION: The purpose of this study is to understand the role of suicide literacy and suicide stigma in laypeople's intention to recommend professional help in Korea. Additionally, the study focuses on the role of expressive suppression as a sociocultural factor. METHODS: Participants read vignettes depicting either subclinical distress or suicidal ideation and answered questions measuring suicide literacy, stigma, and expressive suppression. Mediated moderation analyses were used to examine the interactions between these factors. RESULTS: The result found the significant effect of expressive suppression. The mediating effect of suicide stigma on the relationship between suicide literacy and recommendation of professional help was significant for those who do not suppress their emotions. This result indicates that when individuals were not hesitant to express negative emotions, high suicide literacy lowered suicide stigma and led to more willingness to recommend professional help. CONCLUSIONS: The results showed that expressive suppression acts as a barrier deterring Koreans from professional help for their mental health. The findings underscore the importance of sociocultural factors such as expressive suppression in developing suicide prevention strategies.

Stereotype-driven emotional responses and their impact on discriminatory intentions towards suicidal individuals.

BACKGROUND: This research delves into the role of stereotypes and emotional prejudice in behavioral intentions, particularly towards individuals with suicidal tendencies. The study extends the cognitive-affective-behavioral process model, identifying pathways that negative stereotypes use to impact emotional responses and behavioral intentions. METHODS: A cross-sectional online survey was conducted in South Korea, utilizing the largest Korean online panel (1,623,938 users) to recruit 552 eligible participants (49.1% male, 50.9% female) aged 20 and above with online access and no history of suicide attempts. The survey assessed negative stereotypes, prejudices, and behavioral intentions related to suicidal thoughts, employing specific measurements. RESULTS: The findings established the correlation between negative stereotypes and both stigmatized emotional responses and discriminatory intentions. The study uniquely demonstrated that emotional responses act as a bridge between negative stereotypes and behavioral intentions towards suicidal individuals. These findings carry profound implications for health psychology, emphasizing the necessity of modifying attitudes to reduce suicide stigma. It was observed that stereotypical perceptions fuel negative emotions, which in turn provoke various behavioral intentions. CONCLUSIONS: The study enhances our understanding of the influential role emotional reactions can have in shaping attitudes. It points towards the potential that addressing emotions holds in the stigma process, enabling people to shift their attitudes about stigmatized individuals, thus establishing intervention opportunities for stigma reduction in health psychology.

Perceived COVID-19 susceptibility and preventive behaviors: moderating effects of social support in Italy and South Korea.

BACKGROUND: The COVID-19 pandemic hit Italy much harder than South Korea. As a way of explaining the different impact in the two countries, this study examines the moderating role of social support on the relationship between perceived susceptibility and preventive behaviors in the two countries. METHODS: Surveys were conducted in South Korea (n = 1396) and Italy (n = 487) of participants aged 50 to 89 years. RESULTS: South Koreans felt higher levels of perceived social support than their Italian counterparts. As would be expected, greater perceived susceptibility was associated with increased preventive behavior. Furthermore, a significant three-way interaction effect was found for perceived susceptibility, social support, and country. For Italians, a person who feels him/herself highly susceptible will increase preventive behaviors, if there is a lot of social support. On the other hand, for South Koreans, those with a low level of susceptibility perform more preventive measures than people with a high level of susceptibility if there is a lot of social support. CONCLUSIONS: This study provides insights into how cognitive factors, such as susceptibility and severity, as well as social and environmental factors can be taken into account, and the public be told the real risk and given behavioral guidelines when a pandemic is approaching. Given the critical role of social support as a coping mechanism in crisis situations, societies should mull over ways to increase emotional and instrumental support.

Social stigma of suicide in South Korea: A cultural perspective.

This study examined suicide stigma in relation to Korean cultural characteristics, such as Collectivism, Chemyon sensitivity (concern about losing a socially acceptable face), the tendency toward conformity, and the emphasis on the interdependent self. We found that these characteristics were connected to suicide stigma in Korea. Those with high Chemyon sensitivity tended to perceive that suicidal people were incompetent, immoral, selfish, and deviated from society. Conformity tendency was positively associated with five stigma factors: incompetence, glorification, immorality, selfishness, and social exclusion. Those who perceived themselves as interdependent tended to consider suicidal people incompetent, lacking morality, self-centered, and deviant.

Evaluating a shared decision-making intervention regarding dialysis modality: development and validation of self-assessment items for patients with chronic kidney disease.

BACKGROUND: Shared decision-making is a two-way symmetrical communication process in which clinicians and patients work together to achieve the best outcome. This study aimed to develop self-assessment items as a decision aid for choosing a dialysis modality in patients with chronic kidney disease (CKD) and to assess the construct validity of the newly developed items. METHODS: Five focus group interviews were performed to extract specific self-assessment items regarding patient values in choosing a dialysis modality. After survey items were refined, a survey of 330 patients, consisting of 152 hemodialysis (HD) and 178 peritoneal dialysis (PD) patients, was performed to validate the self-assessment items. RESULTS: The self-assessment for the decision aid was refined to 35 items. The structure of the final items appeared to have three dimensions of factors; health, lifestyle, and dialysis environment. The health factor consisted of 12 subscales (α = 0.724), the lifestyle factor contained 11 subscales (α = 0.624), and the dialysis environment factor was represented by 12 subscales (α = 0.694). A structural equation model analysis showed that the relationship between the decision aid factors (health, lifestyle, and dialysis environment), patients' CKD perception, and cognition of shared decision-making differed between HD patients and PD patients. CONCLUSION: We developed and validated self-assessment items as part of a decision aid to help patients with CKD. This attempt may assist CKD patients in making informed and shared decisions closely aligned with their values when considering dialysis modality.

Binge Drinking and Obesity-Related Eating: The Moderating Roles of the Eating Broadcast Viewing Experience among Korean Adults.

Recently, there has been a notable rise in binge drinking and in the popularity of eating broadcasts via TV and online platforms, especially in Korea. This study analyzed the moderating effect of the eating broadcast viewing experience on the relationship between binge drinking and obesity-related eating behaviors. Cross-sectional self-reported online survey data were collected from 1125 Korean adults. Moderation models for restrained, emotional, and external eating behaviors were tested using moderation analyses with Hayes's PROCESS version 3.5 compatible with SPSS. As a result, the eating broadcast viewing experience moderated the relationship between binge drinking frequency and external eating (Fchange = 2.686, p = 0.045). More frequent binge drinking was associated with a higher level of external eating in participants who only watched online eating broadcasts, especially among women. Participants in their twenties showed the same above association; additionally, those who only watched TV eating broadcasts showed an inverse association, indicating that more frequent binge drinking was associated with a lower level of external eating. Consequently, an eating broadcast viewing experience was one of the environmental factors associated with binge drinking that influences obesity-related eating behaviors.

Cultural Differences in Reactions to Suicidal Ideation: A Mixed Methods Comparison of Korea and Australia.

There is evidence for cultural differences in mental health symptoms and help-seeking, but no past research has explored cultural differences in how people react to suicidal ideation communicated by others. Layperson reactions are critical, because the majority of people who experience suicidal ideation disclose to friends or family. Participants were 506 people aged 17-65 recruited from Australia and Korea who completed an experiment in which they responded to a friend who was experiencing either subclinical distress or suicidal ideation. Korean participants did not differentiate between the subclinical and suicidal targets, whereas Australian participants showed more concern for the suicidal target. For both targets, Korean participants were more likely to recommend passive coping strategies ("Time will solve everything" or "Cheer up"), while Australian participants were more likely to recommend active coping strategies ("Let's talk" or "See a doctor"). This study provides the first evidence of cultural differences in the way people typically respond to disclosures of suicidal ideation, and suggests that unhelpful and inappropriate recommendations are commonplace.

Suicide Stigma in Online Social Interactions: Impacts of Social Capital and Suicide Literacy.

This study examined whether and when people are more likely to conform to stigmatizing views on suicide in online social interactions. Two key factors in the study included characteristics of individuals' social capital and suicide literacy. Study 1 analyzed national survey data to explore the relationships, and Study 2 involved a vignette to gauge the extent to which people conform to stigmatizing attitudes toward suicidal people under group pressure. Results showed that those emphasizing social networks demonstrated higher levels of suicide stigma, while those with more interpersonal trust showed lower levels of stigma. However, in relation to interpersonal trust, suicide literacy played a moderating role in that those with lower levels of interpersonal trust showed significantly less conformity when they had high suicide literacy.

Suicide literacy predicts the provision of more appropriate support to people experiencing psychological distress.

Mental health literacy has been hailed as a public health priority to reduce stigma and increase help seeking. We examined the effect of suicide literacy on the type of help provided to those experiencing suicidal ideation. A community sample of 363 Australians were randomly assigned to read one of three messages from a member of their social network (the target). The target reported symptoms consistent with either (1) subclinical distress, (2) clinical depression, or (3) suicidal ideation. Participants were most likely to recommend social support and least likely to recommend professional help. Suicide literacy interacted with the target's presentation, such that participants with higher suicide literacy who considered a suicidal target were less likely to recommend self-help or no action, and more likely to recommend professional help. Suicide literacy was also associated with lower suicide stigma, and unexpectedly, this indirectly predicted more reluctance to recommend professional help. Overall, results indicated that the relationship between mental health literacy, stigma, and provision of help is not straightforward. While suicide literacy was associated with greater sensitivity to a person's risk of suicide, it also predicted fewer recommendations for professional help overall, partly due to the stigma associated with seeking professional help.

Social Stigma Toward Suicide: Effects of Group Categorization and Attributions in Korean Health News.

The purpose of this study is to examine the influence of health news content on the stigma of suicide. In particular, this study tested whether the onset controllability and group categorization had a causal effect on people's stigma toward suicide. The results indicated that stigma scores were lower for those who read an article explaining the causes of suicide as uncontrollable than for those who read an article explaining the causes as controllable. Also, lower stigma scores were observed for those who read an article depicting suicidal people as the in-group compared to those who read an article depicting suicidal people as the out-group. Furthermore, stigma scores were the highest for those exposed to an article with the out-group categorization combined with the controllable causes of suicide.

How direct-to-consumer drug websites convey disease information: analysis of stigma-reducing components.

Given the growing trend of the Internet as a source of health information, this study evaluated whether direct-to-consumer prescription drug websites for stigmatized illnesses contained stigma-reducing components: onset controllability, offset controllability, and recategorization. The authors examined the contents of the first-level homepages and the second-level pages in 88 stand-alone websites for 15 different stigmatized conditions. Overall, about a third of the websites did not provide a direct link to detailed disease information on the homepage. On the homepages, three stigma-reducing components were rarely offered either through textual or visual cues. On the second level, in terms of textual cues, onset controllability and recategorization were the most prevalent, while offset controllability was relatively less frequent. There were no visual cues on the second level. Results point out the limited and insufficient stigma-reducing components of direct-to-consumer prescription drug websites.

Subjective health literacy and older adults' assessment of direct-to-consumer prescription drug ads.

Older adults are increasingly the intended target of direct-to-consumer (DTC) prescription drug ads, but limited evidence exists as to how they assess the educational value of DTC ads and, more importantly, whether their assessment depends on their level of health literacy. In-person interviews of 170 older adults revealed that those with low subjective health literacy evaluated the educational value of DTC ads significantly lower than did those with high subjective health literacy. The results prompt us to pay more scholarly attention to determining how effectively DTC ads convey useful medical information, particularly to those with limited health literacy.

Stigma-reducing components in direct-to-consumer prescription ads: onset controllability, offset controllability, and recategorization.

This study analyzed direct-to-consumer (DTC) print ads for stigmatized illnesses from 1998 to 2008. Attribution theory and recategorization theory were used as theoretical frames to assess whether those DTC ads contained message components to reduce stigma. DTC ads for 10 stigmatized illnesses in National Geographic, Better Homes and Gardens, Ladies' Home Journal, and Time were analyzed for the presence of onset controllability, offset controllability, and recategorization. Results showed that only 3.7% of ads offered the three message components together and, in fact, 21% of the ads did not contain any of the stigma-reducing message elements. Recategorization cue was the most prevalent component, while cues for onset and offset controllability were relatively less frequent, indicating the lack of educational components.

HIV/AIDS stigma and religiosity among African American women.

African American women are disproportionately affected by HIV/AIDS compared with other ethnicities, accounting for two-thirds (67%) of all women diagnosed with HIV. Despite their increased risk of HIV infection, few studies have been conducted to understand culture-specific factors leading to their vulnerability. Given the central role of religious organizations in African American communities, this study explored whether and to what extent religiosity plays a role in stigma toward HIV/AIDS. Results of hierarchical regression showed that after controlling for key factors, religiosity was a significant factor predicting the level of religious stigma. Those with high religiosity displayed significantly higher stigma, associating HIV/AIDS with a curse or punishment from God. Verbatim responses to an open-ended question also revealed seemingly ingrained prejudice against HIV/AIDS from a religious perspective. The findings point to the important role of faith-based organizations (FBOs) in addressing HIV/AIDS issues within African American communities.

Direct-to-consumer prescription drug advertising: history, regulation, and issues.

Direct-to-consumer advertising has changed the way prescription drugs are marketed in the United States. This article traces the history of direct-to-consumer advertising of prescription and over-the-counter medications and describes how drug advertising is regulated and by whom. It also discusses the controversies that surround direct-to-consumer marketing of prescription drugs.

Direct-to-consumer antidepressant ads and young adults' beliefs about depression.

This study examined the extent to which exposure to direct-to-consumer (DTC) antidepressant ads is associated with young adults' understanding of depression as a medical condition. A vignette-based questionnaire was presented to 285 college students. Among those who had not experienced depressive symptoms, high exposure to a DTC antidepressant commercial was significantly associated with recognition of depression cases and listing antidepressants as a treatment option. As their exposure to the DTC ad increased, respondents also demonstrated a more positive evaluation of antidepressant treatment. Such effects were not found, however, for those who had experienced depressive symptoms.

Antidepressant direct-to-consumer advertising and social perception of the prevalence of depression: application of the availability heuristic.

This study examined the effect of antidepressant direct-to-consumer advertising (DTCA) on perceived prevalence of depression. A survey of Midwestern residents showed that those with high recall for antidepressant DTCA tended to estimate the prevalence of depression higher than those with low ad recall. However, with a source-priming cue before their estimation, the significant association was eliminated. Results indicate that people use antidepressant DTCA as a basis for their judgment of the prevalence of depression in normal situations where the veracity of information is not highlighted.

Attitude toward direct-to-consumer advertising and drug inquiry intention: the moderating role of perceived knowledge.

This study examined how consumers' general attitude toward direct-to-consumer advertising (DTCA) influenced their drug inquiry intent, and whether the relationship between attitude toward DTCA and drug inquiry intent was moderated by their perceived knowledge of health and medicine. Results showed that those with favorable views of DTCA were more likely to inquire and request an advertised drug they saw. The effect was greater in magnitude for consumers with high perceived knowledge in health and medicine, however, than for those with low perceived knowledge.