Change in attitudes after a suicide prevention media campaign in the Mid-Norway region.

BACKGROUND: Suicide prevention media campaigns are one way of reaching people at increased suicide risk who would otherwise not seek help. This is the first study of a Norwegian campaign directed both at individuals at risk for suicide and at their social network. METHODS: We evaluated a media campaign consisting of outdoor posters, feature articles, film clips, and online banners in print, digital, and social media spread across the Mid-Norway region in late autumn 2022. This campaign material consisted of information about how to seek help for suicide thoughts and mental health problems and how to help a friend in similar situations. Before and after this campaign, 1149 adult individuals living in Mid-Norway participated in a survey on attitudes to suicide, mental ill health, and help-seeking. RESULTS: There were only marginal changes in attitudes and help-seeking literacy after the campaign. This result was sustained when controlling for age, sex, and campaign visibility. For males, there were a few changes in the negative direction, i.e. lack of willingness to seek help from family and friends, after the campaign. CONCLUSION: We conclude that the campaign did not seem to have the desired effect and suggest ways of improving future regional Norwegian media campaigns.

Dyadic effects of stigma on quality of life in people with schizophrenia and their family caregivers: Mediating role of patients' perception of caregivers' expressed emotion.

Schizophrenia, as a stressful diagnosis, profoundly impacts the whole family, especially people with schizophrenia and their caregivers. This study tested the potential mediating role of expressed emotion in the association between mental health stigma and quality of life in caregiver-patient dyads. Using a 2-wave longitudinal design with a 6-month interval between assessments, 161 dyads of patients with schizophrenia and their family caregivers (one patient and one caregiver) completed measures of mental health stigma, expressed emotion, and quality of life. The results showed that patients' self-stigma had no significant actor or partner effect on expressed emotion or quality of life. In contrast, caregivers' stigmatizing attitudes toward patients had a significant partner effect on patients' perception of caregivers' expressed emotion and quality of life. The mediating effect of patients' perception of caregivers' expressed emotion in the association between caregivers' stigmatizing ideas toward patients and patients' quality of life was significant. By focusing on the interdependence of patients and their caregivers, this study highlights the role of caregivers' stigmatizing attitudes toward patients and patients' perception of caregivers' expressed emotion on patients' quality of life. Psychoeducation and interventions should not only aim to reduce the self-stigma of people with schizophrenia but also their caregivers' stigmatizing ideas toward patients. Family interventions targeted at reducing the EE level of caregivers and patients' perception of caregivers' EE would also benefit the adaptation and quality of life of people with schizophrenia and their caregivers.

Mental health stigma and internship nursing students' attitudes toward seeking professional psychological help: a cross-sectional study.

BACKGROUND: Self-stigma and negative attitudes toward mental illness have been identified as significant barriers that hinder individuals from seeking psychological assistance, leading to adverse consequences in their lives. AIM: This study aimed to assess mental health stigma and internship nursing students' attitudes toward seeking professional help. METHODS: A cross-sectional design was conducted in the current study including a purposive sample of 228 participants of internship nursing students using a Socio-demographic data sheet, Self-Stigma of Seeking Help scale (SSOSH), and Attitude toward seeking professional psychological help scale (ATSPPH). The data acquisition period spanned from August to November 2022. RESULTS: This study revealed significant insights into the attitudes of internship nursing students toward seeking professional psychological help. Gender emerged as a notable factor, with males exhibiting higher levels of self-stigma compared to females (mean = 2.872). Attitudes towards seeking professional help varied significantly based on age, gender, residence, and marital status. Specifically, participants aged 23 years, females, rural residents, and married individuals demonstrated the highest Mean scores reflecting attitudes that lean more positively towards seeking help. Furthermore, a significant negative correlation (r = -0.372, p < 0.01) was observed between self-stigma and attitudes toward seeking professional help. CONCLUSION: This study concluded that more than three-fifths of internship nursing students hadn't stigma towards seeking professional psychological help while the vast majority had a positive attitude towards seeking professional psychological help. However, the majority of students reported that financial barriers, specifically the high cost of therapy, prevent them from seeking psychological help. This highlights the need for more affordable mental health services for this population.

Assessing the dimensionality and construct validity of the military stigma scale across current service members.

US service members are at elevated risk for distress and suicidal behavior, compared to the general US population. However, despite the availability of evidence-based treatments, only 40% of Service members in need of mental health care seek help. One potential reason for the lower use of services is that service members experience stigma or concerns that the act of seeking mental health care from a mental health provider carries a mark of disgrace. The Military Stigma Scale (MSS) was designed to assess two theoretical dimensions of help-seeking stigma (public and self), specifically among service members. The goal of the current study was to further examine the validity of the MSS among 347 active duty service members. Examination of unidimensional, two-factor, and bifactor models revealed that a bifactor model, with a general (overall stigma), two specific factors (public and self-stigma), and one method factor (accounting for negatively worded items) provided the best fit to the data. Ancillary reliability analyses also supported the MSS measuring a broad stigma factor associated with seeking mental health care in the military. Subsequent model analyses showed that the MSS was associated with other stigma-related constructs. Overall, findings suggest that the MSS is a reliable and validated scale that can be used to assess military help-seeking stigma and to evaluate results of programs designed to reduce stigma.

Suicidal Ideation Among Kenyan Youth: A Qualitative Analysis of Online Life Stories.

This study examines the experiences of suicidal ideation among Kenyan youth through a qualitative analysis of online narratives, a sample that comprised 15 young individuals aged 17-26 who shared their stories on online platforms. Employing Interpretative Phenomenological Analysis (IPA), the study highlights complex interactions of societal pressures, mental health challenges, and identity struggles that contribute to suicidal ideation. Key themes identified include the impact of cultural expectations, mental health stigma, isolation, and identity crises. By prioritizing the personal voices of the youth, the study sheds light on the deeply contextual nature of suicidal ideation and offers insights into the meanings individuals ascribe to their experiences. The findings advocate for culturally sensitive interventions and underscore the need to address mental health stigma, aiming to foster a supportive societal environment for Kenyan youth grappling with these issues.

Global inequalities in mental health problems: understanding the predictors of lifetime prevalence, treatment utilisation and perceived helpfulness across 111 countries.

Socio-economic inequalities in mental health problems are found in measures covering prevalence, treatment utilisation, and treatment helpfulness. However, whether these inequalities exist globally and what factors explain between-country variation is unclear. We use a nationally representative individual-level survey dataset (Wellcome Global Monitor, 2020) in 111 countries (N = 117,088) to test if socio-economic factors (household income, education), psycho-social factors (stigma perception, trust in health professionals) and country-level factors (GDP, Gini, health expenditure) predict (1) self-reported lifetime prevalence of anxiety and depression symptomology, (2) treatment utilisation and (3) perceived treatment helpfulness talking to a mental health professional and taking prescribed medication. Multi-level logistic regression models were used. Across both HICs and LMICs, being in the richest income quintile within each country is associated with a lower probability of experiencing symptoms of anxiety and depression compared to the poorest quintile (OR = 0.67 CI[0.64-0.70]), as well as a higher probability of talking to a mental health professional (OR = 1.25[1.14-1.36]), and of perceiving this treatment as very helpful (OR = 1.23[1.07-1.40]). However, being among the richest income quintile is not associated with taking prescribed medication (OR = 0.97[0.89-1.06]) and its perceived helpfulness (OR = 1.06[0.94-1.21]) across all countries. Trust in health practitioners is associated with higher mental health professional utilisation (OR = 1.10[1.06-1.14]) and helpfulness (OR = 1.32[1.25-1.40]). This analysis reveals a global 'triple inequality in mental health', whereby disadvantages of lower SES individuals persist in three outcomes (lifetime prevalence, treatment utilisation and helpfulness). Treatment utilisation and helpfulness also vary by trust in healthcare professionals and treatment type. Policymakers must address all three inequalities and their fundamental causes.

Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms.

BACKGROUND: Major depressive disorder (MDD) is the most prevalent affective disorder and the leading cause of illness and disability among young people worldwide. Besides being more susceptible to the onset of depression, young people have a higher risk of loneliness, and their personal and social development is impacted by social relationships during this time. It is thought that mental health stigma can undermine both help-seeking and longer-term outcomes for disorders like depression in young people. However, how stigma (i.e., related to depression) might affect young people's feelings of loneliness, social isolation, and relationships is unclear. Using qualitative research methods, this study aimed to explore the subjective experiences of public and internalized stigma and its effects on loneliness, social isolation, and relationship quality in young people with depression symptoms. METHODS: We carried out in-depth, semi-structured interviews with N = 22 young people aged 17-25 (Mage = 22 years) who reported high symptoms of depression (Mood and Feelings Questionnaire (MFQ) score > 27) (i.e., community sample, N = 9) or had been previously diagnosed with depression by a medical professional (i.e., clinical sample, N = 13). Data were analysed using thematic analysis. We explored the subjective effects of depression stigma on loneliness, social isolation, and relationships. RESULTS: Participants described both public stigma (i.e., initiated by others) and internalized stigma (i.e., self-imposed) as disrupting social relationships and eliciting loneliness, isolation, and depressive symptomology. Four main themes about young people's subjective experiences of stigma were identified: 1) Others' Misunderstanding of Mental Health Disorders and the Impact Misunderstanding has on Relationships; 2) Effects of Stigma on the Self and Wellbeing; 3) Stigma Fosters Secrecy Versus Disclosure; and 4) Stigma Increases Loneliness Driven by Avoidance of Social Contexts. CONCLUSIONS: Young people's accounts revealed a wide range of consequences beyond their depression diagnosis. Participants often felt discriminated against, misunderstood, and judged by others as a result of public stigma; they discussed internalizing these attitudes. They suggested that a lack of understanding from others, for example from their partners, family, and peers, and unreliable and/or absent support systems resulted in increased feelings of loneliness and social isolation and reduced the quality and quantity of relationship formation, social bonds, and interactions. Stigma also reduced their self-esteem and confidence, which in turn fostered secrecy and a reluctance to disclose their depression. Despite depression's stigma, most participants reported having long-term goals and aspirations to reconnect with others. These goals stood in contrast to feeling hopeless and unmotivated during periods of depression. Overall, we reveal how stigma can impact feelings of loneliness, social isolation, and relationships among young people with depression, which could lead to targeted interventions to lessen the impact of stigma in this population.

A randomised controlled trial evaluating the Guide Cymru mental health literacy intervention programme in year 9 (age 13-14) school pupils in Wales.

BACKGROUND: Adolescent mental health has become a public health concern as 10-20% of adolescents have experiences with mental health problems. Improving mental health education is critical to reducing stigma and improving access to appropriate care when needed. Here we examine the impact of a mental health literacy programme (Guide Cymru) in young adolescents in the UK. A randomised controlled trial assessed the effectiveness of the Guide Cymru intervention. METHOD: A total of 1,926 pupils (860 males and 1066 females) aged 13-14 (year 9) took part in the study. The secondary schools were randomised into the active and control arms of the study. Teachers in the active arm of the study were trained on the Guide Cymru and then delivered the intervention to their pupils. Pupils in the active groups received six modules of mental health literacy (the Guide Cymru), and control schools received teaching as usual. Mental health literacy across several domains (e.g., knowledge, stigma, help-seeking intentions) were assessed both before and after the intervention. Data collection for the randomised controlled trial ran from September 2019 to March 2020. Multi-level modelling analysis was conducted to account for the clustered nature of the design. RESULTS: All aspects of mental health literacy, including mental health knowledge (g = 0.32), good mental health behaviours (g = 0.22), mental health stigmas (g = 0.16), intentions to seek help (g = 0.15), and avoidant coping (g = 0.14) improved after completing the Guide Cymru programme (ps < .001). DISCUSSION: The current study presents evidence for the Guide Cymru's effectiveness in improving secondary school pupils' mental health literacy. We demonstrate that providing teachers with appropriate resources and training to deliver the Guide Cymru programme within their classrooms can improve the mental health literacy of pupils. These findings have important implications for the beneficial impacts the secondary school system can have on reducing the burden of mental health problems at a critical point in a young person's life. TRIAL REGISTRATION: ISRCTN15462041. Registered 03/10/2019.

Psychometric validation of the Reported and Intended Behaviour Scale (RIBS) in Hungary with a particular focus on 'Don't know' responses and further scoring recommendations.

AIMS: Reported and Intended Behaviour Scale (RIBS) was designed to measure mental health stigma-related behaviors in the general public. We aimed to examine its psychometric properties and validate the scale in a Hungarian non-clinical community sample. The secondary aim of this study was to assess the appropriateness of the current scoring recommendations of 'Don't know' responses being coded as neutral, which had never been investigated before. In addition, we provide an overview of the results of already existing studies on the scale. METHODS: Hungarian participants completed the RIBS within this cross-sectional online survey study and were considered non-clinical individuals based on a cut-off point of the Global Severity Index T score of 63 on the Symptom Checklist-90-Revised. Confirmatory factor analysis, reliability measures, and comparative analyses were performed. RESULTS: Of the n = 5,701, n = 5,141 participants were included in the analysis. The mean age was 27.8 ± 11.1 years, and 89.2% (n = 4,587) of the sample were female. The unidimensional structure was supported by good model fit indices (RMSEA = 0.031, CFI = 0.999, TLI = 0.996, and WRMR = 0.006). Internal consistency of the RIBS and its test-retest reliability with a 5-month follow-up period were found to be good (Cronbach's alpha = 0.88 and ICC = 0.838). We found statistically significant differences between the total scores when the 'Don't know' responders were excluded from the sample or when they were coded as neutral as recommended by the scale authors (16 (IQR:13-18) vs. 15 (IQR:13-18) p < 0.0001). There were also statistically significant differences between 'Neither agree nor disagree' and 'Don't know' participants in several aspects of lived experiences of mental health problems. CONCLUSIONS: The RIBS demonstrated good psychometric properties and can be transferred to the Hungarian context. It will be a valuable tool in assessing stigmatizing behavior and testing the efficacy of antistigma programs. Our results suggest that 'Neither agree nor disagree' and 'Don't know' responses bear different meanings, and coding should account for this.

Mental health stigma experiences among caregivers and service users in South Africa: a qualitative investigation.

The study aimed to understand the nature and context of mental health stigma among people living with a mental health condition and the subsequent effect on their caregivers. Semi-structured qualitative face to face interviews were conducted by trained mental healthcare professionals with mental health service users (n = 26) and caregivers (n = 24) in private rooms at a tertiary health facility, where service users were admitted. Following transcription and translation, data was analysed using framework analysis. There was limited knowledge about their mental health diagnosis by service users and generally low mental health literacy among service users and caregivers. Mental health service users reported experiences of stigma from their own families and communities. Caregivers reported withholding the patient's diagnosis from the community for fear of being stigmatised, and this fear of stigma carries the risk of negatively affecting care treatment-seeking. Limited mental health knowledge, coupled with a high prevalence of perceived family and community stigma among caregivers and service users, impedes the capacity of caregivers to effectively cope in supporting their family members living with mental illness. There is a need for interventions to provide psychoeducation, reduce community stigma, and support coping strategies for caregivers and people with mental health conditions.

"Thandi should feel embarrassed": describing the validity and reliability of a tool to measure depression-related stigma among patients with depressive symptoms in Malawi.

PURPOSE: There are no validated tools in Malawi to measure mental health stigma. Accordingly, this study evaluates the validity and reliability of a short quantitative instrument to measure depression-related stigma in patients exhibiting depressive symptoms in Malawi. METHODS: The SHARP study began depression screening in 10 NCD clinics across Malawi in April 2019; recruitment is ongoing. Eligible participants were 18-65 years, had a patient health questionnaire (PHQ-9) score ≥ 5, and were new or current diabetes or hypertension patients. Participants completed a baseline questionnaire that measured depression-related stigma, depressive symptoms, and sociodemographic information. The stigma instrument included a vignette of a depressed woman named Thandi, and participants rated their level of agreement with statements about Thandi's situation in nine prompts on a 5-point Likert scale. Inter-item reliability was assessed with Cronbach's alpha. Exploratory factor analysis (EFA) was used to assess structural validity, and OLS regression models were used to assess convergent and divergent validity between measured levels of depression-related stigma and covariates. RESULTS: The analysis of patient responses (n = 688) to the stigma tool demonstrated acceptable inter-item reliability across all scales and subsequent subscales of the instrument, with alpha values ranging from 0.70 to 0.87. The EFA demonstrated clustering around three domains: negative affect, treatment carryover, and disclosure carryover. Regression models demonstrated convergence with several covariates and demonstrated divergence as expected. CONCLUSION: This study supports the reliability and validity of a short stigma questionnaire in this population. Future studies should continue to assess the validity of this stigma instrument in this population.

Mental Health Stigma Reduction in the Midwestern United States: Evidence from a Digital Campaign Using a Collective Impact Model.

Addressing mental stigma is a key component of improving mental health outcomes. A digital media campaign was implemented to reduce mental health stigma in the Omaha Metropolitan area. The campaign used evidence-based approaches within a collective impact framework. Two surveys were conducted at baseline and at 10-month follow-up to evaluate the campaign within the Omaha and Council Bluffs intervention region, and a control region in Iowa. Analysis revealed significant improvements in desires for social distance and perceptions toward treatment efficacy within the intervention group. Improvements were seen across measures of personal and community attitudes towards mental health conditions, confidence in supporting others, and likelihood of disclosing a mental health condition. The trends were generally not replicated within the control group. Respondents who were aware of the campaign showed fewer stigmatizing views, including lower desires for social distance, improved attitudes toward treatment, and significant improvements in providing support and caring for their own mental health. The results suggest that the implemented evidenced-based approach could potentially create positive shifts in stigma reduction. This evaluation further supports the potential for scaling and adapting digital media campaigns for stigma reduction in different geographic locations.

Should I write about mental health on my med school app? Examining medical school admissions committee members' biases regarding mental health conditions.

Mental health conditions can impact college students' academic achievements and experiences. As such, students may choose to disclose mental illnesses on medical school applications. Yet, no recent studies have investigated to what extent disclosure of a mental health condition may impact whether an applicant is accepted to medical school. We conducted an audit study to address this gap and surveyed 99 potential medical school admissions committee members from over 40 M.D.-granting schools in the United States. Participants rated a fictitious portion of a single medical school application on acceptability, competence, and likeability. They were randomly assigned to a condition: an application that explained a low semester grade-point average due to 1) a mental health condition, 2) a physical health condition, or 3) offered no explanation. After rating their respective application, all committee members were asked about when revealing a mental health condition would be beneficial and when it would be detrimental. Using ANOVAs, multinomial regression, and open coding, we found that medical school admissions committee members do not rate applications lower when a mental health condition is revealed. Committee members highlighted that revealing a mental health condition to demonstrate resiliency could be beneficial, but if the reference is vague or the condition is not being managed, it could be detrimental to a student's application. This work indicates that medical school admissions committee members do not exhibit a bias against mental health conditions and provides recommendations on how to discuss mental illness on medical school applications.

Impact of Opera on Mental Health Stigma: Pilot of Provider/Community Workshop.

BACKGROUND: Arts can influence mental health stigma, but little is known about impact of operas. We examined effects of a two-opera workshop on complicated grief and schizophrenia. METHODS: Pre-post audience surveys with post-workshop discussion. The primary outcome was a 4-item measure of willingness to engage with persons with grief or schizophrenia. Secondary outcomes were perceptions of art affecting stigma and stigma mediators. Of 47 participants, 33 had pre-post surveys for both operas. RESULTS: There was a significant pre-post opera increase in audience willingness to engage with persons with grief or schizophrenia (p < .001). Perceptions of impact on mediators such as empathy, were significantly greater for the opera on schizophrenia relative to grief (p < .001).. CONCLUSION: The pre- to post increase in audience willingness to engage with affected persons (primary) with greater impact on secondary mediators for the schizophrenia opera and post-discussion suggest that operas may be a forum for addressing mental health stigma and promoting empathy.

Feasibility and acceptability of a mental health stigma intervention for low-income South African caregivers: A qualitative investigation.

Background: Common mental health illnesses such as depression and anxiety disorders are increasing globally. There remain significant gaps in health services provision and support for mental illness linked to stigma in developing countries. Aim: Our study aimed to assess the feasibility and acceptability of a mental health intervention for caregivers of mental health service users. Setting: Low-income South African communities. Method: Our study qualitatively assessed the feasibility of an anti-stigma mental health intervention for family caregivers in low-income settings. The intervention was structured into five sessions delivered over three days. Caregivers attended all the sessions at a centralised community venue. Semi-structured qualitative interviews were held separately with caregivers (n = 10) and their service users (n = 9) eight weeks post-intervention. Interviews were translated verbatim from local languages to English prior to framework analysis. Results: Post-intervention, service users reported improved family relations and understanding of mental illness among family members. The intervention was reported as acceptable and helpful by caregivers as it increased knowledge, fostering better relationships with service users. Group discussions were noted as a critical driver of intervention success. Widespread mental health stigma within communities remained a key concern for caregivers and service users. Conclusion: With the government's drive for deinstitutionalisation, the need to integrate anti-stigma interventions within community mental health services is vital, as is the need for population-wide anti-stigma interventions to support the integration of mental health service users within communities.

Evaluation of mental health first aid training for family members of military veterans with a mental health condition.

BACKGROUND: A concerning proportion of former Australian Defence Force (ADF) members meet criteria for a mental health condition. Mental health difficulties not only affect the individual veteran. They have been found to negatively impact the mental health of family, with an increased likelihood for family members of veterans developing a mental health condition. The aim of this study was to evaluate whether participating in a Mental Health First Aid (MHFA) program improved family members of veterans mental health knowledge, reduced personal and perceived mental health stigma, reduced social distancing attitudes and increased confidence and willingness to engage in MHFA helping behaviours. Additionally, the study measured participant's general mental health and levels of burnout. METHOD: The study utilised an uncontrolled design with assessment at three time points (baseline, post-program and three-month follow-up). Participants (N = 57) were immediate and extended family members of former ADF members with a mental health condition, who took part in a two-day standard adult MHFA program. At each time point, participants completed self-report measures assessing mental health knowledge, personal and perceived mental health stigma, social distancing attitudes, confidence and willingness to engage in MHFA helping behaviours, general mental health and burnout. Cochranes Q and repeated measures ANOVA was computed to measure the impact of time on the outcome variables. RESULTS: Results indicated significant improvements in MHFA knowledge and confidence in providing MHFA assistance. Significant reductions in personal mental health stigma (i.e. an individual's attitude towards mental health) for schizophrenia were observed and maintained at follow up. High levels of perceived mental health stigma (i.e. the belief an individual holds about others attitudes towards mental health) were reported with no significant changes observed following the MHFA program. Results did not indicate any significant benefit in improving general psychological distress or burnout at follow up. The participant sample had high levels of mental health difficulties with over half reporting a lifetime mental health diagnosis. CONCLUSION: The study is an important contribution to the international literature on MHFA. The provision of a MHFA program to family members of military veterans has not previously been evaluated. Implications of the findings are discussed with regards to future directions of MHFA research and implementing MHFA programs in this population.

Operational challenges in the implementation of an anti-stigma campaign in rural Andhra Pradesh, India.

BACKGROUND: Despite of literature available on mental health-related stigma interventions, little is reported about the operational challenges faced during the planning, implementation and evaluation phases. METHODS: The Systematic Medical Appraisal, Referral and Treatment Mental Health Project was implemented in 42 villages of the West Godavari district in India. Andersen's Behavioural Model for Health Services Use was adopted to understand the factors influencing anti-stigma campaign delivery and the strategies identified to overcome these challenges. RESULTS: The challenges faced during the planning and implementation phase included distance and time taken for travel by the field staff, inadequate mental health services and infrastructure within communities, engagement of community with the field staff and community's poor mental health literacy and knowledge. Strategies used to overcome these challenges were regular engagement with community stakeholders, understanding mental health literacy levels and seeking inputs from the community regarding campaign design, organizing live drama shows at community's preferred time and place and screening of recorded drama video clips where lives shows were difficult. The evaluation phase posed challenges such as non-availability of key stakeholders and inadequate time and funding to evaluate the entire study population. CONCLUSION: The reported findings can help in planning and scaling up of the anti-stigma campaign in large trials in similar settings.

Physicians' attitudes to disability pension - impact of diagnosis: an experimental study.

BACKGROUND: The purpose of this study is to increase understanding of physicians' attitudes towards disability pension applicants, and the impact of diagnosis. We hypothesize that physicians are more likely to think that patients with physical illnesses should get a disability pension than those with mental illness or alcohol dependence. Disability pension is an important source of income for those unable to work because of a disability and type of diagnosis should not impact accessing these benefits. METHODS: We conducted an experiment with a 2 by 3 factorial structure in Sweden. Each physician was randomly assigned one of six patient vignettes, with the same background description but with a different diagnosis. Each vignette had a diagnosis of either depression, alcohol dependence or low back pain, and was about a man or a woman. Logistic regression was used to examine the odds of a physician reporting that a patient should get a disability pension. Effects are reported in terms of odds ratios (ORs). RESULTS: 1414 Swedish registered physicians in psychiatry or general practice (24% response rate) completed the survey. Physicians assigned the alcohol dependent vignette had OR 0.45 (95% CI: 0.34 to 0.60) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette. Physicians assigned the depression vignette had OR 1.89 (95% CI: 1.42 to 2.50) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette. CONCLUSION: The patient diagnosis was associated with the physicians' response regarding if the patient should get a disability pension. A physician's perception is likely to impact a patient's access to disability pension.

The Effects of Immersive Virtual Reality in Reducing Public Stigma of Mental Illness in the University Population of Hong Kong: Randomized Controlled Trial.

BACKGROUND: Public stigma in mental health often brings various adverse effects on people with mental illness. Researchers have been developing different interventions in combating public stigma. OBJECTIVE: This study investigates the effects of immersive virtual reality (IVR) in reducing the public stigma of mental illness using a single-blinded randomized control trial. METHODS: A pre-post experimental design with a 1-week follow-up was conducted. Participants (N=206) were recruited through the mass mail system of The Chinese University of Hong Kong and randomized into 3 conditions: immersive animation, text, and control. In the immersive animation condition (n=72), participants experienced the simulation of daily life and the stigma experienced as an animated story protagonist with mixed anxiety and depressive disorder with IVR. In the text condition (n=65), participants experienced an identical story to the immersive animation condition with first-person audio narration using the same virtual reality headset. In the control condition (n=69), participants watched a video about planets with IVR. All participants received interventions with a researcher-assisted Oculus Go virtual reality headset. Participants' public stigma was measured through self-administered online questionnaires and compared across conditions and at different time points using repeated measures analysis of variance. Simple and sequential mediation analyses on the relationship of condition (immersive animation vs text) and follow-up public stigma with possible mediators, including sense of embodiment and story transportation, were conducted using PROCESS. RESULTS: Public stigma did not differ significantly across conditions at pre-experiment (P>.99). In the immersive animation and text conditions, public stigma was significantly reduced at postexperiment and at the 1-week follow-up compared to pre-experiment (all with P<.001). Public stigma in the control condition at postexperiment and follow-up remained unchanged compared with pre-experiment (P=.69). Immersive animation had significantly lower public stigma than the control at postexperiment (P=.003) and follow-up (P=.02). Text also had lower public stigma than the control at postexperiment (P=.007) and follow-up (P=.03). However, immersive animation did not significantly differ from text in public stigma at postexperiment and follow-up (both P>.99). In simple mediation models, both sense of embodiment (95% CI -0.22 to 0.46) and story transportation (95% CI -0.18 to 0.00) were not significant mediators. In the sequential mediation model, both sense of embodiment and story transportation were significant sequential mediators. Sense of embodiment was positively associated with story transportation (P<.001), while story transportation was negatively associated with public stigma (P<.001). The indirect effect of the sequential mediation model was significant (95% CI -0.38 to -0.11). CONCLUSIONS: This study provides novel findings and a rigorous comparison in understanding the effects of IVR on public stigma. The findings showed that IVR and text with audio narration performed similarly and significantly in stigma reduction. Sense of embodiment and story transportation were found to be sequentially associated with public stigma reduction. TRIAL REGISTRATION: Centre for Clinical Research and Biostatistics Clinical Trial Registry CUHK_Ccrb00638; https://www2.ccrb.cuhk.edu.hk/registry/public/632.

Medical Education and the Stigmatization of Mental Illness in the Philippines.

A mixed-methods study assessed mental illness stigma within the Philippine medical community. A 43-item survey was completed by three groups: (1) medical students with no prior mental health training (N = 76, 31%), (2) medical students with psychiatric classroom and/or clerkship experience (N = 43, 18%), and (3) graduate physicians (N = 125, 51%). Exploratory factor analysis identified three de-stigmatized factors for comparisons between the three Filipino groups and with medical students from 5 other countries. Surveys were followed by in-depth qualitative interviews (N = 15). The three de-stigmatized factors were as follows: (1) acceptance of social integration of mental health patients, (2) positive personal interactions with people experiencing mental illness, and (3) rejection of supernatural explanations for mental illness. While overall scores among the sample showed highly de-stigmatized attitudes, graduate physicians reported more stigmatized scores than students on social integration and personal socialization (F = 3.45, p = 0.033, F = 4.11, p = 0.018, respectively). Filipino medical students also had less stigmatizing mental health attitudes compared to students from the USA, Brazil, Ghana, Nigeria, and China. Qualitative interviews confirmed low levels of mental health stigma among the Philippine medical community, while acknowledging the persistence of stigma in the general Philippine populace.