Stigmatization of psychiatrists and general practitioners: results of an international survey.

The stigma of mental illness affects psychiatry as a medical profession and psychiatrists. The present study aimed to compare the extent and correlation patterns of perceived stigma in psychiatrists and general practitioners. An international multicenter survey was conducted in psychiatrists and general practitioners from twelve countries. Responses were received from N = 1,893 psychiatrists and N = 1,238 general practitioners. Aspects of stigma assessed in the questionnaire included perceived stigma, self-stigma (stereotype agreement), attitudes toward the other profession, and experiences of discrimination. Psychiatrists reported significantly higher perceived stigma and discrimination experiences than general practitioners. Separate multiple regression analyses showed different predictor patterns of perceived stigma in the two groups. Hence, in the psychiatrists group, perceived stigma correlated best with discrimination experiences and self-stigma, while in the general practitioners group it correlated best with self-stigma. About 17% of the psychiatrists perceive stigma as a serious problem, with a higher rate in younger respondents. Against this background, psychiatry as a medical profession should set a high priority on improving the training of young graduates. Despite the number of existing antistigma interventions targeting mental health professionals and medical students, further measures to improve the image of psychiatry and psychiatrists are warranted, in particular improving the training of young graduates with respect to raising awareness of own stigmatizing attitudes and to develop a better profession-related self-assertiveness.

Forensic psychiatry in Chile.

Mental disorders are among the most prevalent of chronic disorders, and a high prevalence of these disorders has been consistently found in jails and prisons. This study was a retrospective case series that described the population of adults charged with a criminal offense who were court ordered to undergo a psychiatric assessment within the Medical Legal Service in Santiago, Chile from 2005 to 2006. Characteristics were explored in order to better understand this population in light of the recent reforms in the judicial and health systems of Chile. Ninety percent of sampled individuals were male, primarily between the ages of 18-39 years. Seventy percent of the evaluations came from the pre-reformed judicial system and 30% were from the reformed system. Approximately 63% of evaluated offenders were considered to have a psychiatric pathology, the most common being the personality disorders. Of the evaluated offenders, approximately 84% were considered by a psychiatrist to be criminally responsible for their crime, 7% were regarded as having diminished criminal responsibility, 4% were considered to be not criminally responsible for their crime, and 4% were cases where criminal responsibility was not applicable. Profession status, municipality of residence, type of residence, ICD-10 diagnosis, treatment recommendation, and criminal responsibility were found to be significantly different between male and female evaluated offenders. Results from this investigation will contribute to knowledge about forensic psychiatry and mental health in Latin America, and will hopefully pave the way for more research and international comparisons.

From sin to science: fighting the stigmatization of mental illnesses.

Our paper provides an overview of current stigma discourse, the origins and nature of the stigma associated with mental illnesses, stigmatization by health providers, and approaches to stigma reduction. This is a narrative review focusing on seminal works from the social and psychological literature, with selected qualitative and quantitative studies and international policy documents to highlight key points. Stigma discourse has increasingly moved toward a human rights model that views stigma as a form of social oppression resulting from a complex sociopolitical process that exploits and entrenches the power imbalance between people who stigmatize and those who are stigmatized. People who have a mental illness have identified mental health and health providers as key contributors to the stigmatization process and worthy targets of antistigma interventions. Six approaches to stigma reduction are described: education, protest, contact-based education, legislative reform, advocacy, and stigma self-management. Stigma denigrates the value of people who have a mental illness and the social and professional support systems designed to support them. It creates inequities in funding and service delivery that undermine recovery and full social participation. Mental health professionals have often been identified as part of the problem, but they can redress this situation by becoming important partners in antistigma work.

Measuring the stigma of psychiatry and psychiatrists: development of a questionnaire.

The stigma of mental illness is a severe burden for people suffering from mental illness both in private and public life, also affecting their relatives, their close social network, and the mental health care system in terms of disciplines, providers, and institutions. Interventions against the stigma of mental illness employ complementary strategies (e.g., protest, education, and contact) and address different target groups (e.g., school children and teachers, journalists, stakeholders). Within this framework, the World Psychiatric Association has adopted an Action Plan with the goal to improve the image of psychiatry and to reduce potential stigmatizing attitudes toward psychiatry and psychiatrists. To evaluate such interventions, a questionnaire has been developed that assesses opinions and attitudes toward psychiatrists and psychiatry in different samples of medical specialists (psychiatrists and general practitioners). The questionnaire comprises scales about perceived stigma in terms of the perception of societal stereotypes, self-stigma in terms of stereotype agreement, perceived stigma in terms of structural discriminations, discrimination experiences, stigma outcomes, and attitudes toward a second medical discipline. It is available in several languages (Arab, English, German, Japanese, Polish, and Spanish) and can easily be adapted for utilization in other medical specialties.

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists.

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force's findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.

[A study of level of knowledge about depressive disorders among general practitioners in Argentina]. / Estudio del conocimiento sobre los Trastornos Depresivos entre los médicos asistenciales en Argentina.

OBJECTIVES: To determine the level of knowledge about depressive disorders including their treatment, comorbidities and suicide potential among a number of general practitioners who agreed to fill out a questionnaire and provided information about their professional activities. METHOD: Exploratory cross-sectional study among a number of general practitioners who answered voluntarily and anonymously to a questionnaire consisting of twelve questions. Data collected from 288 physicians were analyzed. RESULTS: The majority of physicians (97.6%, n=281) considered that depression was a disease, but 39.6% (n=114) believed that it was caused by lack of will power or characterological weaknesses, which create a dissonance with the concept of disease. They also felt that they did not have enough knowledge about Depressive Disorders such as their origins, type of medications and length of treatment, comorbidities and suicide potential. CONCLUSIONS: The results point to the need for continuous medical education about Depressive Disorders among general practitioners.

Estudio del conocimiento sobre los Trastornos Depresivos entre los médicos asistenciales en Argentina / A study of level of knowledge about Depressive Disorders among general practitioners in Argentina

Objetivos: determinar entre los médicos encuestados su especialidad, los años de ejercicio de la profesión, y averiguar el conocimiento que tengan sobre los trastornos depresivos incluyendo su tratamiento, comorbilidad y posibilidad del suicidio. Métodos: el estudio cualitativo se realizó con una entrevista semi-estructurada de doce preguntas, en forma voluntaria, administrada a médicos en actividad asistencial, efectuándose la entrega y recolección de la entrevista por personal entrenado previamente. Se analizaron los datos hallados en los 288 profesionales de distintas especialidades. Resultados: los hallazgos permiten decir que la mayoría de los médicos (97, 6 por ciento, n= 281) consideran que la depresión es una enfermedad, pero de ese total un 39,6 por ciento (n= 114) de ellos piensa que es por falta de voluntad o una debilidad, lo que crea una discordancia en el concepto de enfermedad. Estimaron cuáles son sus falencias frente a los Trastornos Depresivos, cómo y cuánto tiempo medican, su criterio respecto al origen de la misma, el suicidio y la comorbilidad. Conclusiones: los datos encontrados entre los médicos que respondieron el cuestionario permiten deducir que es necesaria la intensificación de los programas de actualización sobre Trastornos Depresivos.(AU)

Objectives: To determine the level of knowledge about depressive disorders including their treatment, comorbidities and suicide potential among a number of general practitioners who agreed to fill out a questionnaire and provided information about their professional activities. Method: Exploratory cross-sectional study among a number of general practitioners who answered voluntarily and anonymously to a questionnaire consisting of twelve questions. Data collected from 288 physicians were analyzed. Results: The majority of physicians (97.6 percent, n=281) considered that depression was a disease, but 39.6 percent (n=114) believed that it was caused by lack of will power or characterological weaknesses, which create a dissonance with the concept of disease. They also felt that they did not have enough knowledge .about Depressive Disorders such as their origins, type of medications and length of treatment, comorbidities and suicide potential. Conclusions: The results point to the need for continuous medical education about Depressive Disorders among general practitioners.(AU)

Estudio del conocimiento sobre los Trastornos Depresivos entre los médicos asistenciales en Argentina / A study of level of knowledge about Depressive Disorders among general practitioners in Argentina

Objetivos: determinar entre los médicos encuestados su especialidad, los años de ejercicio de la profesión, y averiguar el conocimiento que tengan sobre los trastornos depresivos incluyendo su tratamiento, comorbilidad y posibilidad del suicidio. Métodos: el estudio cualitativo se realizó con una entrevista semi-estructurada de doce preguntas, en forma voluntaria, administrada a médicos en actividad asistencial, efectuándose la entrega y recolección de la entrevista por personal entrenado previamente. Se analizaron los datos hallados en los 288 profesionales de distintas especialidades. Resultados: los hallazgos permiten decir que la mayoría de los médicos (97, 6 por ciento, n= 281) consideran que la depresión es una enfermedad, pero de ese total un 39,6 por ciento (n= 114) de ellos piensa que es por falta de voluntad o una debilidad, lo que crea una discordancia en el concepto de enfermedad. Estimaron cuáles son sus falencias frente a los Trastornos Depresivos, cómo y cuánto tiempo medican, su criterio respecto al origen de la misma, el suicidio y la comorbilidad. Conclusiones: los datos encontrados entre los médicos que respondieron el cuestionario permiten deducir que es necesaria la intensificación de los programas de actualización sobre Trastornos Depresivos.

Objectives: To determine the level of knowledge about depressive disorders including their treatment, comorbidities and suicide potential among a number of general practitioners who agreed to fill out a questionnaire and provided information about their professional activities. Method: Exploratory cross-sectional study among a number of general practitioners who answered voluntarily and anonymously to a questionnaire consisting of twelve questions. Data collected from 288 physicians were analyzed. Results: The majority of physicians (97.6 percent, n=281) considered that depression was a disease, but 39.6 percent (n=114) believed that it was caused by lack of will power or characterological weaknesses, which create a dissonance with the concept of disease. They also felt that they did not have enough knowledge .about Depressive Disorders such as their origins, type of medications and length of treatment, comorbidities and suicide potential. Conclusions: The results point to the need for continuous medical education about Depressive Disorders among general practitioners.

Mental patients in prisons.

Mental conditions usually affect cognitive, emotional and volitional aspects and functions of the personality, which are also functions of interest in law, as they are essential at the time of adjudicating guilt, labeling the accused a criminal, and proffering a sentence. A relationship between mental illness and criminality has, thus, been described and given as one of the reasons for the large number of mental patients in prisons. Whether this relationship is one of causality or one that flows through many other variables is a matter of debate, but there is no debating that prisons have become a de facto part, and an important one, of mental health systems in many countries. This paper deals with the issue of the relationship and provides estimates of prevalence of mental patients in prisons culled from many studies in different countries. It also provides some direction for the management of mental patients as they crowd correctional systems.

Mass violence and mental health--a view from forensic psychiatry.

The objectives of this paper are to develop insights into the mind of the terrorist, to conduct a review of health impacts on the health of populations, especially from the point of view of mental health impacts caused by terrorist attacks and to discern the role to be played by forensic psychiatry in emergencies caused by terrorist actions. These objectives are developed at the population level and at the individual level from the point of view of a description of the terrorist and of victim's need for forensic intervention and representation. On entrance, the paper starts with a general frame of definitions and a historical overview of terrorism as an ancient, purposeful, political tool used to change a situation objectionable to the terrorist group via intimidation of a captive population. People are used as expendable pawns and become psychologically captive to the aims of the terrorist group. As well, the paper reviews the new reality of bioterrorism and the use of improved technologies to inflict expensive damage to national infrastructures and massive loss of life.

[Forensic psychiatry ethics: expert and clinical practices and research on prisoners]. / Etica em psiquiatria forense: atividades pericial e clínica e pesquisa com prisioneiros.

OBJECTIVE: Review the most relevant ethical issues of the tripartite aspects on which forensic psychiatry is based: expert activity, treatment of the mentally ill in prisons, and research on prisoner subjects. RESULTS AND DISCUSSION: The principles of General Medical Ethics and those of Forensic Medical Ethics are discriminated and confronted and the steps the psychiatrist should take both as an expert and as a clinician to follow the ethical principles of his profession are indicated. A succinct résumé of the research on prisoners is offered and the basic principles, which, if respected, would keep a balance between the need for carrying out research in prisonal environments and the safeguard of prisoners' rights are suggested. CONCLUSION: It is fundamental for the forensic psychiatrist the knowledge and implementation of the ethical principles that govern his practice so that he will effectively respect the basic rights of the individuals he treats or researches with.

[Canadian mental health rights in an international perspective]. / Les droits en santé mentale au Canada: une perspective internationale.

This article surveys the status of people with mental disorders in the light of international human rights law and assesses if their rights are respected in the Canadian context. The authors recognize that although the national systems of countries such as Canada provide significant civil and constitutional protections on the positive rights of its citizens, including those who suffer from intellectual disability, the same cannot be said with respect to entitlements to the provision of social services. The authors argue that this shortcoming must be remedied. Finally, the authors conclude that it is paramount to closely monitor the apparent dissonance between internationally recognized rights to adequate healthcare and freedom from discrimination and their strict application in the Canadian context.

Twelve-month psychiatric disorder among single and married mothers: the role of marital history.

OBJECTIVE: To examine differences between single and married mothers in the 12-month prevalence of psychiatric disorders. METHODS: The analysis uses data from the National Comorbidity Survey, collected in 1992-1993, and focuses on women aged 15 to 55 years with children (n=1346). Psychiatric disorders are assessed with the University of Michigan Composite International Diagnostic Interview, a survey instrument based on DSM-III-R criteria. RESULTS: Compared with married mothers, previously married mothers have elevated rates of disorders. Prevalences among single mothers who were never married are similar to those among married mothers, but they are generally lower than prevalences among mothers who experience a marital disruption. CONCLUSIONS: These results indicate that marital separation and divorce may be markers for elevated risk for psychiatric disorder among women with children. It is important to consider the impact of marital history on the relation between family structure and psychiatric outcomes.