RESUMEN
BACKGROUND: An important issue concerning the worldwide fight against stigma is the evaluation of psychiatrists' beliefs and attitudes toward schizophrenia and mental illness in general. However, there is as yet no consensus on this matter in the literature, and results vary according to the stigma dimension assessed and to the cultural background of the sample. The aim of this investigation was to search for profiles of stigmatizing beliefs related to schizophrenia in a national sample of psychiatrists in Brazil. METHODS: A sample of 1414 psychiatrists were recruited from among those attending the 2009 Brazilian Congress of Psychiatry. A questionnaire was applied in face-to-face interviews. The questionnaire addressed four stigma dimensions, all in reference to individuals with schizophrenia: stereotypes, restrictions, perceived prejudice and social distance. Stigma item scores were included in latent profile analyses; the resulting profiles were entered into multinomial logistic regression models with sociodemographics, in order to identify significant correlates. RESULTS: Three profiles were identified. The "no stigma" subjects (n = 337) characterized individuals with schizophrenia in a positive light, disagreed with restrictions, and displayed a low level of social distance. The "unobtrusive stigma" subjects (n = 471) were significantly younger and displayed the lowest level of social distance, although most of them agreed with involuntary admission and demonstrated a high level of perceived prejudice. The "great stigma" subjects (n = 606) negatively stereotyped individuals with schizophrenia, agreed with restrictions and scored the highest on the perceived prejudice and social distance dimensions. In comparison with the first two profiles, this last profile comprised a significantly larger number of individuals who were in frequent contact with a family member suffering from a psychiatric disorder, as well as comprising more individuals who had no such family member. CONCLUSIONS: Our study not only provides additional data related to an under-researched area but also reveals that psychiatrists are a heterogeneous group regarding stigma toward schizophrenia. The presence of different stigma profiles should be evaluated in further studies; this could enable anti-stigma initiatives to be specifically designed to effectively target the stigmatizing group.
Asunto(s)
Psiquiatría/estadística & datos numéricos , Esquizofrenia , Estereotipo , Adulto , Actitud del Personal de Salud , Brasil/epidemiología , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Prejuicio/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To investigate in a community sample the association of suicide-related cognitions and behaviors ("thoughts of death", "desire for death", "suicidal thoughts", and "suicidal attempts") with the comorbidity of depressive disorders (major depressive episode or dysthymia) and alcohol or substance use disorders. METHOD: The sample was 1464 subjects interviewed in their homes using the Composite International Diagnostic Interview to generate DSM-III-R diagnosis. Descriptive statistics depicted the prevalence of suicide-related cognitions and behaviors by socio-demographic variables and diagnoses considered (major depressive episode, dysthymia, alcohol or substance use disorders). We performed a multivariate logistic regression analysis to estimate the effect of comorbid major depressive episode/dysthymia and alcohol or substance use disorders on each of the suicide-related cognitions and behaviors. RESULTS: The presence of major depressive episode and dysthymia was significantly associated with suicide-related cognitions and behaviors. In the regression models, suicide-related cognitions and behaviors were predicted by major depressive episode (OR=range 2.3-9.2) and dysthymia (OR=range 5.1-32.6), even in the presence of alcohol use disorders (OR=range 2.3-4.0) or alcohol or substance use disorders (OR=range 2.7-2.8). The interaction effect was observed between major depressive episode and alcohol use disorders, as well as between dysthymia and gender. Substance use disorders were excluded from most of the models. CONCLUSION: Presence of major depressive episode and dysthymia influences suicide-related cognitions and behaviors, independently of the presence of alcohol or substance use disorders. However, alcohol use disorders and gender interact with depressive disorders, displaying a differential effect on suicide-related cognitions and behaviors.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Trastorno Depresivo/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/psicología , Trastornos Relacionados con Alcohol/diagnóstico , Trastornos Relacionados con Alcohol/psicología , Brasil/epidemiología , Comorbilidad , Trastorno Depresivo/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Análisis de Regresión , Factores de Riesgo , Factores Socioeconómicos , Intento de Suicidio/psicología , Adulto JovenRESUMEN
Findings on stigmatizing attitudes toward individuals with schizophrenia have been inconsistent in comparisons between mental health professionals and members of the general public. In this regard, it is important to obtain data from understudied sociocultural settings, and to examine how attitudes toward mental illness vary in such settings. Nationwide samples of 1015 general population individuals and 1414 psychiatrists from Brazil were recruited between 2009 and 2010. Respondents from the general population were asked to identify an unlabeled schizophrenia case vignette. Psychiatrists were instructed to consider "someone with stabilized schizophrenia". Stereotypes, perceived prejudice and social distance were assessed. For the general population, stigma determinants replicated findings from the literature. The level of the vignette's identification constituted an important correlate. For psychiatrists, determinants correlated in the opposite direction. When both samples were compared, psychiatrists showed the highest scores in stereotypes and perceived prejudice; for the general population, the better they recognized the vignette, the higher they scored in those dimensions. Psychiatrists reported the lowest social distance scores compared with members of the general population. Knowledge about schizophrenia thus constituted an important determinant of stigma; consequently, factors influencing stigma should be further investigated in the general population and in psychiatrists as well.
Asunto(s)
Psiquiatría/estadística & datos numéricos , Esquizofrenia , Estereotipo , Adulto , Actitud del Personal de Salud , Actitud Frente a la Salud , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prejuicio/psicología , Prejuicio/estadística & datos numéricos , Distancia Psicológica , Encuestas y CuestionariosRESUMEN
CONTEXTO: O estigma que pesa sobre as doenças psiquiátricas é o mais forte impedimento para que o paciente busque tratamento, mais até que a dificuldade de acesso aos serviços de saúde. A esquizofrenia também é a doença mais usada hoje como metáfora na mídia, aparecendo rotineiramente associada a crimes e violência. OBJETIVOS: Avaliação da presença do estigma estrutural na mídia brasileira por meio do levantamento de notícias em imprensa e internet que utilizam o termo "esquizofrenia" e correlatos ("esquizofrênico/a") sob três aspectos: (a) uso médico e científico; (b) atribuição do diagnóstico de esquizofrenia a suspeitos de crimes com pouco ou nenhum rigor médico ou científico; (c) uso metafórico. MÉTODOS: O estudo foi realizado em três etapas: levantamento de notícias, classificação dos itens encontrados e análise do contexto em que foram publicados. O levantamento foi realizado em dois períodos - 2008 e 2011 -, sendo o primeiro restrito ao jornal Folha de S. Paulo e o segundo ampliado para os portais dos principais veículos impressos brasileiros. RESULTADOS: Foram encontrados 229 textos, distribuídos da seguinte forma: 89 (39%) registros em ciência e saúde, com tendência à impessoalidade; 62 (27%) registros em crime e violência, em que o "diagnóstico" de esquizofrenia é feito por leigos e "corroborado" por uma arqueologia da vida do suspeito que arrola toda sorte de comportamentos fora de padrão; 78 (34%) de uso metafórico, sempre de caráter depreciativo. CONCLUSÕES: A maioria dos textos encontrados (a) não dá voz ao portador de esquizofrenia e a seu sofrimento, (b) banaliza a doença psiquiátrica ao empregá-la fora de contexto para caracterizar decisões políticas e econômicas contraditórias ou de caráter duvidoso e (c) reforça o estigma que pesa sobre o portador de esquizofrenia ao personalizá-lo apenas nos raros casos de violência em que se supõe seu diagnóstico.
BACKGROUND: Schizophrenia is the most common illness used today as a metaphor in the media and routinely appears associated with crime and violence with no medical or scientific rigor, reinforcing the stigma against this disorder. OBJECTIVES: Evaluation of the presence of structural stigma in the Brazilian media by means of a survey of printed news and the Internet using the term "schizophrenia" and its correlates under three aspects: (a) medical and scientific uses, (b) assigning a diagnosis of schizophrenia to crime suspects with little or no medical or scientific rigor, and (c) the metaphorical use. METHODS: The study was conducted in three stages: search for publications, classification of items found and analysis of the context in which they were published. The survey was conducted in two periods: 2008 and 2011, the first being restricted to the newspaper Folha de S. Paulo and the second extended to the homepage of the main Brazilian print media. RESULTS: We found 229 texts, distributed as follows: 89 (39%) records as science and health, with a tendency to impersonality; 62 (27%) records as crime and violence, in which the "diagnosis" of schizophrenia is given by lay people and "supported" by an archeology of the life of the suspect which enlists all sorts of non-standard behavior; and 78 (34%) records of metaphorical use, always with a negative meaning. DISCUSSION: Most of the texts found (a) does not give voice to people with schizophrenia and their suffering, (b) trivializes the use of this psychiatric illness out of context to describe contradictory or of dubious character political and economic decisions, and (c) reinforces the stigma that lays over the bearer of schizophrenia individualizing them only in rare violent cases with a supposed diagnosis.
Asunto(s)
Recolección de Datos , Esquizofrenia , Estigma Social , Medios de Comunicación de Masas , Medios de Comunicación de Masas , Medios de Comunicación Sociales , Noticias , PrejuicioRESUMEN
CONTEXTO: A estigmatização é uma questão importante no tratamento e no curso da esquizofrenia. A manutenção de atitudes estigmatizantes pode estar relacionada a fatores socioculturais. OBJETIVOS: Comparar atitudes estigmatizantes de profissionais de saúde mental em países culturalmente diversos: Brasil e Suíça. MÉTODOS: Foram analisados dados de duas grandes pesquisas sobre o estigma na Suíça e no Brasil, focando-se no desejo de distância social em relação a indivíduos com esquizofrenia e atitudes de profissionais de saúde mental em relação à aceitação de efeitos colaterais do tratamento psicofarmacológico. RESULTADOS: Profissionais de saúde mental suíços apresentaram níveis significativamente mais elevados de distância social do que suas contrapartes brasileiras. Houve também um efeito fraco de idade, bem como um efeito da interação entre a origem e a idade. Com relação à aceitação de efeitos colaterais, a influência da origem foi bastante fraca. Com exceção do risco de dependência dos psicotrópicos, a aceitação dos profissionais suíços a efeitos colaterais de longa duração foi significativamente maior do que a de seus colegas no Brasil. CONCLUSÕES: A forte associação entre origem e distância social pode estar relacionada à formação sociocultural dos profissionais de saúde mental; em comparação com a Suíça, o Brasil é muito heterogêneo em termos de estrutura étnica e socioeconômica. A aceitação de efeitos colaterais pode também estar relacionada com os medicamentos mais sofisticados (ou seja, drogas antipsicóticas de nova geração) comumente usados na Suíça.
BACKGROUND: Stigmatization is an important issue in the treatment and course of schizophrenia. The maintenance of stigmatizing attitudes may be related to socio-cultural factors. OBJECTIVES: To compare stigmatizing attitudes of mental health professionals in the culturally diverse countries Brazil and Switzerland. METHODS: We analyzed data of two broad stigmatization surveys from Switzerland and Brazil by focusing on the social distance and attitudes of mental health professionals towards the acceptance of side effects of psychopharmacological treatment. RESULTS: Swiss mental health professionals showed significantly higher levels of social distance than their Brazilian counterparts. There was also a weak effect of age as well as an interaction effect between origin and age. With respect to the acceptance of side effects, the effect of origin was rather weak. With the exception of drug dependence, Swiss professionals' acceptance of long-lasting side effects was significantly higher than for their counterparts in Brazil. DISCUSSION: The strong association between origin and social distance may be related to the socio-cultural background of the mental health professionals. In comparison with Switzerland, Brazil is very heterogeneous in terms of ethnicity and socio-economic structure. The distinct acceptance of side effects may additionally be related to the more sophisticated medicaments (i.e. new generation of antipsychotic drugs) commonly used in Switzerland.
Asunto(s)
Humanos , Masculino , Femenino , Esquizofrenia , Estereotipo , Personal de Salud , Suiza , Brasil , Discriminación SocialRESUMEN
CONTEXTO: A literatura acerca da maneira como a população geral estigmatiza indivíduos com distúrbios mentais aumentou consideravelmente nas últimas décadas. Mas a dúvida sobre se os psiquiatras também estigmatizam seus pacientes ainda permanece. OBJETIVO: O presente estudo visou avaliar as atitudes de psiquiatras brasileiros em relação aos indivíduos com esquizofrenia. MÉTODOS: Dos cerca de 6.000 participantes do Congresso Brasileiro de Psiquiatria em 2009, 1.414 psiquiatras concordaram em participar do estudo. Entrevistas face a face foram realizadas utilizando um questionário que avaliava o estigma em três dimensões: estereótipos, distância social e preconceito, todas relacionadas a alguém com esquizofrenia. Opinião sobre medicações psicotrópicas e tolerância aos efeitos colaterais também foram avaliadas. Dados sociodemográficos e profissionais foram coletados. RESULTADOS: Psiquiatras brasileiros tenderam a estereotipar negativamente pessoas com esquizofrenia. Estereótipos negativos correlacionaram-se com uma melhor opinião sobre medicações psicotrópicas e com maior tolerância a efeitos colaterais. Idade maior correlacionou-se com estereótipos positivos e com menor preconceito. CONCLUSÃO: Os psiquiatras estigmatizam indivíduos com esquizofrenia e possivelmente têm certa dificuldade em admitir esse fato. Campanhas antiestigma para profissionais de saúde mental devem ser promovidas.
BACKGROUND: Literature on how the general population stigmatizes individuals with mental disorders has increased considerably over the last decades. But the question remains if psychiatrists also stigmatize their patients. OBJECTIVE: The present study aimed to assess Brazilian psychiatrists' attitude towards individuals with schizophrenia. METHODS: Out of the approximately 6,000 participants of the 2009 National Psychiatry Congress in Brazil, 1,414 psychiatrists agreed to undergo the survey. Face-to-face interviews were conducted using a questionnaire that assessed stigma in three dimensions: stereotypes, social distance and prejudice towards a person with schizophrenia. Their opinion on psychotropic drugs and tolerance of side-effects were also assessed. Socio-demographic and professional data were collected. RESULTS: Brazilian psychiatrists tend to negatively stereotype individuals with schizophrenia. More negative stereotypes correlated with a positive opinion on psychotropic drugs and with a higher tolerance of side-effects. Higher age was correlated with positive stereotyping and with less prejudice. DISCUSSION: Psychiatrists stigmatize individuals with schizophrenia and possibly find it difficulty admit this fact. Anti-stigma campaigns among mental health professionals should be promoted.
Asunto(s)
Esquizofrenia , Estereotipo , Técnicos Medios en Salud , Prejuicio , PsiquiatríaRESUMEN
OBJECTIVE: To investigate in a community sample the association of suicide-related cognitions and behaviors ("thoughts of death", "desire for death", "suicidal thoughts", and "suicidal attempts") with the comorbidity of depressive disorders (major depressive episode or dysthymia) and alcohol or substance use disorders. METHOD: The sample was 1464 subjects interviewed in their homes using the Composite International Diagnostic Interview to generate DSM-III-R diagnosis. Descriptive statistics depicted the prevalence of suicide-related cognitions and behaviors by socio-demographic variables and diagnoses considered (major depressive episode, dysthymia, alcohol or substance use disorders). We performed a multivariate logistic regression analysis to estimate the effect of comorbid major depressive episode/dysthymia and alcohol or substance use disorders on each of the suicide-related cognitions and behaviors. RESULTS: The presence of major depressive episode and dysthymia was significantly associated with suicide-related cognitions and behaviors. In the regression models, suicide-related cognitions and behaviors were predicted by major depressive episode (OR = range 2.3-9.2) and dysthymia (OR = range 5.1-32.6), even in the presence of alcohol use disorders (OR = range 2.3-4.0) or alcohol or substance use disorders (OR = range 2.7-2.8). The interaction effect was observed between major depressive episode and alcohol use disorders, as well as between dysthymia and gender. Substance use disorders were excluded from most of the models. CONCLUSION: Presence of major depressive episode and dysthymia influences suicide-related cognitions and behaviors, independently of the presence of alcohol or substance use disorders. However, alcohol use disorders and gender interact with depressive disorders, displaying a differential effect on suicide-related cognitions and behaviors.
OBJETIVO: Investigar, numa amostra comunitária, a associação entre cognições e comportamentos relacionados ao suicídio ("pensamentos de morte", "desejo de morte", "pensamentos suicidas", e "tentativas de suicídio") e a comorbidade entre transtornos depressivos (episódio depressivo maior ou distimia) e transtornos por uso de álcool ou substâncias. MÉTODO: 1.464 sujeitos foram entrevistados em seus domicílios com o CIDI para gerar diagnósticos DSM-III-R. Estatística descritiva demonstrou a prevalência de cognições e comportamentos relacionados ao suicídio pelas variáveis sociodemográficas e diagnósticos considerados (episódio depressivo maior, distimia, transtornos por uso de álcool ou substâncias). Realizamos também análises de regressão logística multivariada para estimar o efeito da comorbidade entre episódio depressivo maior/distimia e transtornos por uso de álcool ou substâncias em cognições e comportamentos relacionados ao suicídio. RESULTADOS: A presença de episódio depressivo maior e distimia foi significativamente associada a cognições e comportamentos relacionados ao suicídio. Em modelos de regressão multivariada, os preditores de cognições e comportamentos relacionados ao suicídio foram episódio depressivo maior (OR range = 2,3-9,2) e distimia (OR range = 5,1-32,6) mesmo na presença de transtornos por uso de álcool (OR range = 2,3-4,0) ou transtornos por uso de substâncias (OR range = 2,7-2,8). O efeito de interação foi observado entre episódio depressivo maior e transtornos por uso de álcool, bem como entre gênero e distimia. Transtornos por uso de álcool foi excluído da maioria dos modelos. CONCLUSÃO: A presença de episódio depressivo maior e distimia influencia os CCS, independentemente da presença de transtornos por uso de álcool ou substâncias. Contudo, transtornos por uso de álcool e gênero interagem com os transtornos depressivos, demonstrando um efeito diferencial em cognições e comportamentos relacionados ao suicídio.