Stigmatizing Attitudes Toward Patients With Psychiatric Disorders Among Medical Students and Professionals.

INTRODUCTION: Stigma attached to mental health encompasses discrimination and exclusion of psychiatric patients and hinders their opportunities to have more productive and fulfilling lives. Moreover, stigma also exists among health professionals, and therefore, it hampers the provision of treatment and care and the promotion of mental well-being. This manuscript intends to assess and compare the levels of stigmatization toward patients with mental illness between medical students and doctors from different specialties. METHODS: The Portuguese version of Attribution Questionnaire (AQ-27) was used to assess the attitudes of medical students (n = 203), non-psychiatry doctors (n = 121), and psychiatry specialists (n = 29) from the University of Minho and three hospitals in the region of Braga, Portugal (Hospital de Braga, Hospital Senhora da Oliveira, and Hospital de Fafe). RESULTS: Psychiatrists were the group that displayed lower levels of stigmatizing attitudes in all the items of the AQ-27, followed by the students. The regression analyses revealed that professional group and presence of a relative with mental illness were the factors that have a significant impact on the levels of stigmatization. CONCLUSIONS: Mental illness stigma is widely spread in community and reaches not only general population but also health professionals. Psychiatrists presented lower levels of stigma compared with non-psychiatry physicians and medical students. We found that stigma is related with age and the presence of relatives with psychiatric disorders. These findings highlight the critical relevance of raising awareness on this topic and, therefore, break stereotypes to reduce the negative consequences of stigma.

Is It Possible to "Find Space for Mental Health" in Young People? Effectiveness of a School-Based Mental Health Literacy Promotion Program.

Lack of knowledge regarding, and the stigma associated with, mental disorders have been identified as major obstacles for the promotion of mental health and early intervention. The present study aimed to evaluate the effectiveness of a school-based intervention program focused on the promotion of mental health literacy (MHL) in young people (“Finding Space for Mental Health”). A sample of 543 students (22 classes), aged between 12 and 14 years old, participated in the study. Each class of students was randomly assigned to the control group (CG; n = 284; 11 classes) or the experimental group (EG; n = 259; 11 classes). MHL was assessed using the Mental Health Literacy questionnaire (MHLq), which is comprised of three dimensions—Knowledge/Stereotypes, First Aid Skills and Help Seeking, and Self-Help Strategies. The scores on these dimensions can also be combined to give an overall or total score. Participants from the EG attended the MHL promotion program (two sessions, 90 min each) delivered at one-week intervals. Sessions followed an interactive methodology, using group dynamics, music, and videos adapted to the target group. All participants responded to the MHLq at three points in time: pre-intervention assessment (one week prior to the intervention), post-intervention assessment (one week after the intervention) and follow-up assessment (six months after the intervention). The intervention effectiveness and the differential impact of sociodemographic variables on the effectiveness of the program were studied using a Generalized Estimation Equation (GEE). Results revealed that participants from the EG demonstrated, on average, significantly higher improvement in MHL from pre-intervention to follow-up when compared to participants from the CG. Different sociodemographic variables affected the effectiveness of the program on distinct dimensions of the MHLq. Overall, “Finding Space for Mental Health” showed efficacy as a short-term promotion program for improving MHL in schools.

Mental Health Literacy in Young Adults: Adaptation and Psychometric Properties of the Mental Health Literacy Questionnaire.

Mental health literacy (MHL) is considered a prerequisite for early recognition and intervention in mental disorders, and for this reason, it has become a focus of research over the past few decades. Assessing this construct is relevant for identifying knowledge gaps and erroneous beliefs concerning mental health issues, to inform the development of interventions aimed at promoting mental health literacy as well as the evaluation of these interventions. Recently, we developed a new self-reporting measure (MHLq) for assessing mental health literacy in young people (12⁻14 years-old), meeting the need to assess MHL from a comprehensive perspective of the construct instead of focusing on a restricted number of mental disorders or specific dimensions (e.g., knowledge concerning specific disorders; stigma). The present study aimed to adapt the MHLq for the young adult population and to examine its psychometric properties, according to the following steps: (1) item adaptation, using a think aloud procedure (n = 5); (2) data collection (n = 356, aged between 18 and 25 years old; and (3) psychometric analyses (exploratory factor analysis and internal consistency analysis). The final version of the questionnaire included 29 items (total scale α = 0.84), organized by four dimensions: (1) knowledge of mental health problems (α = 0.74); (2) erroneous beliefs/stereotypes (α = 0.72); (3) help-seeking and first aid skills (α = 0.71); and (4) self-help strategies (α = 0.60). The results suggest that the MHLq-adult form is a practical, valid, and reliable screening tool for identifying gaps in knowledge, beliefs, and behavioral intentions related to mental health and mental disorders, planning promotion programs, and evaluating intervention effectiveness.

Portuguese Adaptation and Input for the Validation of the Views on Inpatient Care (VOICE) Outcome Measure to Assess Service Users'Perceptions of Inpatient Psychiatric Care.

INTRODUCTION: Patient satisfaction is an important measure of health care quality. Patients' views have seldom been considered in the construction of measures addressing satisfaction with inpatient facilities in psychiatry. The Views on Inpatient Care - VOICE - is a first service-user generated outcome measure relying solely on their perceptions of acute care, representing a valuable indicator of service users' perceived quality of care. The present study aimed to contribute to the validation of the Portuguese version of VOICE. MATERIAL AND METHODS: The questionnaire was translated into Portuguese and applied to a sample of eighty-five female inpatients of a psychiatric institution. Data analysis focused on assessing reliability and exploring the impact of demographic and clinical variables on participants' satisfaction. RESULTS: Internal consistency of the questionnaire was high (α = 0.87). Participants' age and marital status were associated with differences in scores, with older patients and patients who were married or involved in a close relationship presenting higher satisfaction levels. DISCUSSION: The questionnaire demonstrated good internal consistency and acceptability, as well as construct validity. Further studies should expand the analysis of the psychometric properties of this measure e.g., test-retest reliability. CONCLUSION: The Portuguese version of VOICE is a promising tool to assess service users' perceptions of inpatient psychiatric care in Portugal.

Introdução: A satisfação com os serviços de saúde é uma medida importante da qualidade dos cuidados formais prestados. Os doentes raramente têm sido envolvidos na construção de instrumentos para avaliar a satisfação com estruturas de internamento psiquiátrico. A medida Views on Inpatient Care (VOICE) recorre, pela primeira vez, às perceções dos próprios doentes sobre um internamento em cuidados agudos, apresentando-se como um indicador valioso da qualidade dos cuidados tal como percebida pelos utentes. O presente estudo visou contribuir para a validação da versão portuguesa desta medida. Material e Métodos: O questionário foi traduzido e adaptado para português, e aplicado a uma amostra de 85 mulheres admitidas num serviço de internamento psiquiátrico. A análise focou-se na consistência interna da medida e no impacto das variáveis demográficas e clínicas nos níveis de satisfação. Resultados: A consistência interna foi elevada (α = 0,87). Encontrámos associações entre a idade e o estado civil e as pontuações obtidas: doentes mais velhos e doentes casados, ou vivendo maritalmente, apresentaram níveis mais elevados de satisfação. Discussão: O questionário apresentou boa consistência interna e aceitabilidade entre os participantes, bem como validade de constructo. As propriedades psicométricas da escala deverão ser exploradas em vertentes adicionais, como a fiabilidade teste-reteste. Conclusão: A versão portuguesa da medida VOICE é um instrumento promissor para avaliar a perspectiva dos doentes sobre o internamento psiquiátrico em Portugal.

Development and Psychometric Properties of a New Questionnaire for Assessing Mental Health Literacy in Young People / Desarrollo y propiedades psicométricas de un nuevo cuestionario de evaluación de alfabetización en salud mental en jóvenes

Objectives: Several instruments assess constructs related to mental health lite -racy and to the stigma associated with mental health problems. However, most of them have conceptualisations that may limit the assessment of the mental health literacy concept in a more up-to-date and comprehensive perspective. Furthermore, some of the instruments' structure may limit their use in large scale samples, in a short period of time and with repeated measures. This article presents the development of the Mental Health Literacy questionnaire (MHLq) and the studies to assess its psychometric properties. Methods: After item-pool generation, content validity was assessed by experts and a think aloud procedure. The MHLq was tested in two samples of students (study 1 n=239; aged between 12 and 15 years old; study 2 n=737; aged between 11 and 17 years old) to determine its psychometric properties. Results: Factor analysis procedures favoured a three-factor solution (with 33 items) of the MHLq. The questionnaire showed good internal consistency (total score a=0.84; Factor 1 first aid skills and help seeking - a=0.79; Factor 2 knowledge/stereotypes - a=0.78; Factor 3 self-help strategies - a=0.72); and excellent test-retest reliability, the ICC for the total score of MHLq was 0.88 and for the three dimensions of MHLq was 0.80 (Factor 1), 0.90 (Factor 2) and 0.86 (Factor 3). Conclusions: The MHLq is a practical, valid and reliable tool for identifying gaps in knowledge, beliefs and behavioural intentions, in large samples, allowing the development and evaluation of interventions aimed at promoting mental health in young people.

Objetivos: Varios instrumentos evalúan constructos relacionados con conocimientos sobre la salud mental y al estigma asociado con problemas de salud mental. Sin embargo, la mayoría de ellos tienen conceptualizaciones que pueden limitar la apreciación del concepto de alfabetización de la salud mental de una manera más actual y exhaustiva. Por otra parte, la estructura de algunos de los instrumentos puede limitar su uso en muestras a gran escala, en un corto período de tiempo y con medidas repetidas. Este artículo presenta el desarrollo del cuestionario de alfabetización en salud mental (MHLq) y los estudios para evaluar sus propiedades psicométricas. Método: Después de la generación de ítems, la validez de contenido fue evaluada por expertos y por un procedimiento think aloud. El MHLq ha sido testado en dos muestras de estudiantes (estudio 1 n = 239; con edades comprendidas entre los 12 y 15 años de edad; estudio 2 n = 737; edades comprendidas entre los 11 y 17 años de edad) para determinar sus propiedades psicométricas. Resultados: los procedimientos de análisis factorial indicaron una solución de tres factores (con 33 elementos) del MHLq. El cuestionario mostró una buena consistencia interna (puntuación total a = 0,84; Factor 1 técnicas de primeros auxilios y la búsqueda de ayuda - a = 0.79; Factor 2 de conocimientos / estereotipos - a = 0.78; Factor 3 estrategias de autoayuda - a = 0,72); y una excelente fiabilidad test-retest, la CCI para la puntuación total de MHLq fue de 0,88 y para las tres dimensiones del MHLq fue de 0,80 (factor 1), 0,90 (factor 2) y 0,86 (factor 3). Conclusiones: El MHLq es una herramienta práctica, válida y fiable para la identificación de lagunas en los conocimientos, las creencias y las intenciones de comportamiento, en muestras grandes, lo que permite el desarrollo y la evaluación de las intervenciones destinadas a promover la salud mental en los jóvenes.

Fighting stigma of mental illness in midsize European countries.

PURPOSE: Stigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published. METHODS: The review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible. RESULTS: The anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country. CONCLUSIONS: Although much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

Acções de sensibilização pró-saúde mental em escolas / Mental health awareness intervention in schools

A escassez de informação e o estigma associado às perturbações mentais são importantes obstáculos à promoção da saúde mental. O projecto "UPA Faz a Diferença: Acções de sensibilização pró-saúde mental", que pretende contribuir para o aumento de conhecimentos sobre questões de saúde mental junto de jovens, faz parte do movimento UPA "Unidos Para Ajudar", destinado a combater o estigma e a discriminação associados às perturbações mentais.OBJETIVOS: descrever as características psicométricas do questionário UPA (Unidos Para Ajudar) e verificar a adequabilidade da ação de promoção de saúde mental construída.MÉTODO: o estudo envolveu 26 alunos (15-17 anos). A acção de promoção de saúde mental consistiu em 2 sessões. O questionário foi aplicado no início da 1ª e no final da 2ª sessão.RESULTADOS: a avaliação da consistência interna (alpha de Cronbach) indicou níveis mínimos e satisfatórios em 2 secções do "Questionário UPA" (secção percepções estigmatizantes e percepções de conhecimentos, respectivamente). Após a implementação da acção observou-se um aumento significativo das percepções de conhecimentos, não se verificando diferenças significativas nas percepções estigmatizantes; e uma diminuição significativa da intenção do próprio procurar ajuda se confrontado com um problema de saúde mental, embora a maioria dos participantes tenha passado a considerar diferentes tipos de ajuda.CONCLUSÃO: os resultados sugerem a necessidade de rever a estrutura da secção "percepções estigmatizantes" do questionário e de se proceder a novas análises numa amostra mais expressiva; e revelam a adequação da acção de promoção de saúde mental, especialmente ao nível do aumento dos conhecimentos.

Mental health awareness intervention in schools / Acções de sensibilização pró-saúde mental em escolas

The lack of information and stigma associated with mental disorders are major obstacles to the promotion of mental health. The "UPA Makes the Difference: Mental health awareness intervention in schools" project aims to contribute to increase young people knowledge regarding mental health issues. This project is part of the "United to Help Movement", focusing on the combat of mental illness stigma and discrimination. OBJECTIVES: to describe the psychometric characteristics of the questionnaire UH (United to Help) and to verify the adequacy of action to promote mental health. METHODS: this study was conducted with 26 students (15-17 year-olds). The mental health intervention is composed by 2 sessions. The questionnaire was administered at the beginning of the 1st session and in the end of the 2nd session. RESULTS: cronbach'salpha regarding 2 sections of the "Questionnaire UPA" stated poor and acceptable levels of internal consistency (stigmatizing perceptions and perceptions of knowledge, respectively). The post intervention assessment showed a significant increase in the total score of the perceptions of knowledge; no significant differences in stigmatizing perceptions; and a significant decrease in help-seeking intentions when facing a mental health problem, although most participants have come to consider different types of help. CONCLUSION: the results suggest the need to review the structure of the "stigmatizing perceptions" section of the questionnaire, as well as to conduct new analyses with a larger sample. Furthermore, results show the adequacy of the methodology used in the intervention, particularly in the capacity showed to promote the increase of knowledge regarding mental health issues.(AU)