Association of parasuicidal behaviour to early maladaptive schemas and schema modes in patients with BPD: The Oulu BPD study.

The present study aimed to examine which early maladaptive schemas (EMSs) and schema modes emerged in parasuicidal and non-parasuicidal patients with BPD participating in the Oulu BPD study. The patients' EMSs were assessed using the Young Schema Questionnaire, and schema modes using the Young Atkinson Mode Inventory. Sixty patients with BPD responded to both the schema and schema mode questionnaires; of these, 46 (76.7%) fulfilled the criteria for parasuicidality. In BPD patients with parasuicidality, the EMSs of emotional deprivation, abandonment/instability, mistrust/abuse and social isolation were the most prevalent, and the schema modes of vulnerable child, angry child, detached protector and compliant surrender were prominent. In patients without parasuicidality, the schema modes of healthy adult and happy child were the most prevalent. Significant correlations were observed between the schema modes of detached protector, vulnerable child, punitive parent and angry child and almost every EMS in BPD patients with parasuicidality. Our preliminary findings suggest that associations between certain EMSs and schema modes to parasuicidality in BPD patients may provide valuable information when planning and implementing their treatment.

Personal stigma and use of mental health services among people with depression in a general population in Finland.

BACKGROUND: A minority of people suffering from depression seek professional help for themselves. Stigmatizing attitudes are assumed to be one of the major barriers to help seeking but there is only limited evidence of this in large general population data sets. The aim of this study was to analyze the associations between mental health attitude statements and depression and their links to actual use of mental health services among those with depression. METHODS: We used a large cross-sectional data set from a Finnish population survey (N = 5160). Attitudes were measured by scales which measured the belief that people with depression are responsible for their illness and their recovery and attitudes towards antidepressants. Desire for social distance was measured by a scale and depression with the Composite International Diagnostic Interview Short Form (CIDI-SF) instrument. Use of mental health services was measured by self-report. RESULTS: On the social discrimination scale, people with depression showed more social tolerance towards people with mental problems. They also carried more positive views about antidepressants. Among those with depression, users of mental health services, as compared to non-users, carried less desire for social distance to people with mental health problems and more positive views about the effects of antidepressants. More severe depression predicted more active use of services. CONCLUSIONS: Although stronger discriminative intentions can reduce the use of mental health services, this does not necessarily prevent professional service use if depression is serious and views about antidepressant medication are realistic.

Predictors of stigmatizing attitudes towards people with mental disorders in a general population in Finland.

BACKGROUND: For planning effective and well-targeted initiatives to reduce stigma, we need to identify which factors are associated with stigmatizing of people with mental disorders. AIMS: This study examined how well a combination of variables predicts stigmatizing attitudes and discrimination in a general population. METHODS: A survey questionnaire was sent to 10,000 persons aged 15-80 years residing in western Finland. Attitudes were measured using a scale consisting of negative stereotypes about people with depression and stereotypical beliefs connected with mental problems, while discrimination was measured by a social distance scale. Predictors included demographic variables, mental health resources, personal experience of depression or psychological distress, knowing someone who suffers from mental health problems, and negative stereotypical beliefs. RESULTS: Although 86% of the population thought that depression is a real medical condition, the majority of respondents believed that people with depression are responsible for their illness. Social discrimination was significantly associated with respondents' age, gender, native language, sense of mastery, depression, stereotypical beliefs and familiarity with mental problems. CONCLUSIONS: The results suggest that the need to address stigma is higher among men, older people and those without familiarity with mental problems. When planning interventions to shape stereotypes, the need for change is highest among those with a low sense of life control and poor social networks. Direct interactions with persons who have mental problems may change the stereotypical beliefs and discriminative behaviour of those who do not have familiarity with mental problems.

Attitudes towards people with mental disorders: the psychometric characteristics of a Finnish questionnaire.

BACKGROUND: The prevalence of mental disorders, especially depression, increasingly creates concern for our mental, social and economic well-being. The public has insufficient knowledge about mental disorders and their treatment. A stigma is attached to mental disorders, which has a multifaceted impact on the lives of patients and their families. A Finnish general population survey studied knowledge of and attitudes towards mental health problems. This study examines the background dimensions of the attitude items used in the survey. METHODS: An eight-page health survey questionnaire with 16 items on attitudes to mental health and depression was sent to a randomly selected sample of 10,000 persons aged 15-80 years. The overall response rate was 55.2%. The data were submitted to a principal component analysis (PCA). Two components were extracted by means of this analysis and submitted to further reliability analyses as well as to a preliminary validity analysis. RESULTS: The PCA identified four components: (1) depression is a matter of will, (2) mental problems have negative consequences, (3) one should be careful with antidepressants and (4) you never recover from mental problems. CONCLUSION: The internal consistencies of the first two components were sufficient to build dimension scales for future analyses. The extracted components fit consistently with the leading stigma theories and earlier studies measuring public attitudes.

The 'European Alliance Against Depression (EAAD)': a multifaceted, community-based action programme against depression and suicidality.

Action programmes fostering partnerships and bringing together regional and national authorities to promote the care of depressed patients are urgently needed. In 2001 the 'Nuremberg Alliance Against Depression' was initiated as a community-based model project within the large-scale 'German Research Network on Depression and Suicidality' (Kompetenznetz 'Depression, Suizidalität'). The 'Nuremberg Alliance Against Depression' was an action programme, conducted in the city of Nuremberg (500,000 inhabitants) in 2001/2002, addressing four intervention levels (Hegerl et al. Psychol Med 2006;36:1225). Based on the positive results of the Nuremberg project (a significant reduction of suicidal behaviour by more than 20%) 18 international partners representing 16 different European countries established the 'European Alliance Against Depression' (EAAD) in 2004. Based on the four-level approach of the Nuremberg project, all regional partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international levels. This paper gives a brief overview of the background for and experiences with the EAAD. It describes the components of the programme, provides the rationale for the intervention and outlines the current status of the project. The aim of the paper is to disseminate information about the programme's potential to reduce suicidal behaviour and to provide examples of how European community-based 'best practice' models for improving the care of depressed patients and suicidal persons can be implemented using a bottom-up approach. EAAD is mentioned by the European commission as a best practice example within the Green Paper 'Improving the mental health of the population: Towards a strategy on mental health for the European Union' (European Commission 2005).