Mental Health Literacy and Public Stigma: Examining the Link in 17 Countries.

Background: Literacy campaigns stand as the most common approach to raising awareness of mental health problems, increasing the use of services, and reducing stigma. However, research suggests that more informed public beliefs may have little effect or even trigger the stigma backlash. We aim to provide a wider, cross-national examination of how stigma varies globally and to examine whether the ability to recognize a mental health problem and see it as "a disease like any other" is the optimal roadmap for stigma reduction. Methods: Data came from the Stigma in Global Context - Mental Health Study (SGC-MHS), which were collected from non-institutionalized adults 18 years of age or older through face-to-face interviews using vignettes meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition clinical criteria for schizophrenia and major depression in 17 countries (N = 18,342; response rate 65.9%). Analyses of association between the public's endorsement of problem recognition, disease attributions, and severity on the desire for social distance were conducted using multivariate regression models in the structural equation modeling framework. Results: For both depression and schizophrenia, countries fell into three groups of low, medium and high levels of public stigma. Consistently, Brazil and Germany anchored the lowest levels, Bangladesh and Hungary reported the highest levels, with Great Britain, USA, Belgium falling in midrange. Measures of mental health literacy did not have uniform effects, but, where significant, tended to align with expectations under labelling theory's ideas about rejection rather than attribution theory's claims for mental health literacy. Ironically, the most stable factor associated with lower stigma is the assessment that the situation will improve on its own, in direct contradiction to literacy theories. Conclusion: Overall results suggest that anti-stigma efforts should move past a focus on mental health literacy or at least recognize its limitation and potential unintended consequences. Recognizing a situation as a mental illness can change the public's support for mental health services to some extent. The association between seeing the problem resolving on its own and lower stigma levels suggests that newer approaches that focus on connectedness and mental health may hold greater purchase to decrease public stigma and increase recovery.

A network frame offers a promising transdisciplinary tool for understanding complex health and health care system problems like suicide.

As health and health care systems continue to face massive challenges from local to global well-being, understanding the processes that lead to improvement or deterioration in human health has embraced a broad range of forces from genes to national cultures. Despite the many efforts to deploy a common framework that captures diverse drivers at scale, the common missing element is the absence of a flexible mechanism that can guide research within and across levels. This hinders both the cumulation of knowledge and the development of a scientific foundation for multiplex interventions. However, studies across disciplines using a wide variety of methods and measures have converged on "connectedness" as crucial to understanding how factors operate in the health space. More formally, a focus on the critical role of the network structure and content of key elements and how they interact, rather than just on the elements themselves, offers both a generalized theory of active factors within levels and the potential to theorize interactions across levels. One critical contemporary health crisis, suicide, is deployed to illustrate the Network Embedded Symbiome Framework. The wide range of health and health care research where networks have been implicated supports its potential but also cautions against inevitable limits that will require creative theorizing and data harmonization to move forward.

Social Networks, the COVID-19 Pandemic, and Emerging Adults' Mental Health: Resiliency Through Social Bonding and Cohesion.

Objectives. To assess how personal social network characteristics moderated mental health declines during the COVID-19 pandemic in emerging adults compared with other age groups. Methods. The Person to Person Health Interview Study, a representative, probability-based cohort study (n = 2485) in Indiana, collected data through face-to-face (baseline) and phone (follow-up) interviews before and during the pandemic. We used survey-weighted growth curve models to examine network effects on computer-adaptive testing measures of depression and anxiety severity. Results. Respondents reported significantly increased depression and anxiety in 2021, which returned almost to baseline levels for most age groups by 2022 (P < .001). Stronger ties to others and more interconnected ties were significantly associated with lower depression (B = -0.112 [P < .05]; B = -0.086 [P < .001]) and anxiety (B = -0.101 [P < .05]; B = -0.063 [P < .01]) severity across the pandemic. Interaction models revealed disproportionate protective effects of network characteristics on depression (B = -0.456 [P < .001]; B = -0.268 [P < .001]) and anxiety (B = -0.388 [P < .001]; B = -0.284 [P < .001]) for emerging adults. Conclusions. Cohesive and affectively strong personal networks promote resiliency to common mental health challenges during periods of crisis, particularly for emerging adults whose social roles and relationships were disrupted during a critical period of development. (Am J Public Health. 2024;114(S3):S258-S267. https://doi.org/10.2105/AJPH.2023.307426).

Social pathways to care: how community-based network ties shape the health care response of individuals with mental health problems.

PURPOSE: Mental health research has powerfully documented inequities related to characteristics, such as ethnicity and gender. Yet how and where disparities like unmet need occur have been more elusive. Drawing from a now modest body of research that deployed the Network Episode Model (NEM), we examine how individuals create patterns of response to mental health problems, influenced by the culture and resources embedded in their social networks. METHODS: The Person-to-Person Health Interview Study (P2P; N ~ 2,700, 2018-2021) provides representative, community-based, NEM-tailored data. Both descriptive, latent class and multinomial regression analyses mark mental health care-seeking patterns, including individuals consulted and activities used, as well as the influence of the structure and cultural content of social networks. RESULTS: Latent class analysis detected five pathways with good fit statistics. The Networked General Care Path (37.0%) and The Kin General Care Path (14.5%) differ only in whether friends are activated in using the general care sector. The Networked Multi-Sector Care Path (32.5%) and The Saturated Path (12.6%) involve family, friends, and both general and specialty care with only the latter expanding consultation to coworkers and clergy. The Null Path (3.3%), or no contacts, is not used as perceived problem severity increases. Network size and strength are associated with the more complex pathways that activate ties, respectively. Trust in doctors is associated with pathways that include specialty providers but not others at work or church. Race, age, and rural residence have specific pathway effects, while gender has no significant impact. CONCLUSIONS: Social networks propel individuals with mental health problems into action. Tie strength and trust produce care responses that are fuller and more targeted. Considering the nature of homophily, results also suggest that majority status and college education are clearly implicated in networked pathways. Overall, findings support community-targeted rather than individually based efforts to increase service use.

Who has mental health problems? Comparing individual, social and psychiatric constructions of mental health.

PURPOSE: The persistent gap between population indicators of poor mental health and the uptake of services raises questions about similarities and differences between social and medical/psychiatric constructions. Rarely do studies have assessments from different perspectives to examine whether and how lay individuals and professionals diverge. METHODS: Data from the Person-to-Person Health Interview Study (P2P), a representative U.S. state sample (N ~ 2700) are used to examine the overlap and correlates of three diverse perspectives-self-reported mental health, a self/other problem recognition, and the CAT-MH™ a validated, computer adaptive test for psychopathology screening. Descriptive and multinominal logit analyses compare the presence of mental health problems across stakeholders and their association with respondents' sociodemographic characteristics. RESULTS: Analyses reveal a set of socially constructed patterns. Two convergent patterns indicate whether there is (6.9%, The "Sick") or is not (64.6%, The "Well") a problem. The "Unmet Needers" (8.7%) indicates that neither respondents nor those around them recognize a problem identified by the screener. Two patterns indicate clinical need where either respondents (The "Self Deniers", 2.9%) or others (The "Network Deniers", 6.0%) do not. Patterns where the diagnostic indicator does not suggest a problem include The "Worried Well" (4.9%) where only the respondent does, The "Network Coerced" (4.6%) where only others do, and The "Prodromal" (1.4%) where both self and others do. Education, gender, race, and age are associated with social constructions of mental health problems. CONCLUSIONS: The implications of these results hold the potential to improve our understanding of unmet need, mental health literacy, stigma, and treatment resistance.

Selfie Videos to Reduce Stigma and Increase Treatment Seeking Among Youths: Two Noninferiority Randomized Controlled Trials.

OBJECTIVE: Confronting stigma early in life could enhance treatment seeking. In two randomized controlled trials (RCTs), one focused on psychosis and the other on adolescent depression, the efficacy and equivalence of brief social contact-based videos were evaluated and compared with a control condition. The outcomes of interest were changes in illness-related stigma and treatment-seeking intention. The hypotheses were that the intervention videos would show greater efficacy than control conditions and that traditional and selfie videos would demonstrate similar efficacy. METHODS: Young adults (study 1, N=895) and adolescents (study 2, N=637) were randomly assigned to view intervention videos (in traditional or selfie styles) or to a control condition. In short videos (58-102 seconds), young presenters humanized their illness by emotionally describing their struggles and discussing themes of recovery and hope. RESULTS: Repeated-measures analyses of variance and paired t tests showed significant differences in stigma and treatment seeking between the intervention and control groups and similar efficacy of the traditional and selfie videos. Cohen's d effect sizes ranged from 0.31 to 0.76 for changes in stigma from baseline to 30-day follow-up in study 1 and from 0.13 to 0.47 for changes from baseline to postintervention in study 2. CONCLUSIONS: The RCTs demonstrated the efficacy of brief videos, both traditional and selfie, in reducing illness-related stigma among young adults and adolescents and in increasing treatment-seeking intention among adolescents. Future studies should explore the effects of brief videos presented by social media influencers on mental health stigma and treatment engagement.

Functional Status, Mood State, and Physical Activity Among Women With Post-Acute COVID-19 Syndrome.

Objectives: While organ-specific pathophysiology has been well-described in SARS-CoV-2 infection, less is known about the attendant effects on functional status, mood state and leisure-time physical activity (PA) in post-acute COVID-19 syndrome (PASC). Methods: A case-control design was employed to recruit 32 women (n = 17 SARS-CoV-2; n = 15 controls) matched on age (54 ± 12 years) and body mass index (27 ± 6 kg/m2) that did not differ by smoking status or history of cardiopulmonary disease. Participants completed a series of assessments including Profile of Mood States (POMS), Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), and Godin-Shephard Leisure-Time PA. Results: Significant between-group differences were detected for the POMS total mood disturbance with sub-scale analyses revealing elevated tension, confusion, and lower vigor among SARS-CoV-2 participants (all p-values < 0.05). The number of SARS-CoV-2 symptoms (e.g., loss of taste/smell, muscle aches etc.) were associated (r = 0.620, p = 0.008) with confusion. SARS-CoV-2 participants exhibited poorer functional status (p = 0.008) and reduced leisure-time PA (p = 0.004) compared to controls. Conclusion: The sequela of persistent SARS-CoV-2 symptoms elicit clear disturbances in functional status, mood state, and leisure-time PA among women with PASC. Ongoing symptom presentation affects recovery time-course and PA participation.

Public Stigma and Personal Networks: Confronting the Limitations of Unidimensional Measures of Social Contact.

One of the most promising directions for reducing mental illness stigma lies in Allport's contact theory, which suggests that intergroup interactions reduce stigma. Here, we argue that stigmatizing attitudes are driven by the nature, magnitude, and valence of community-based ties to people with mental illness (PMI), not simply their presence. Using the 2018 General Social Survey (N = 1,113), we compare network-based measures of contact to traditional survey indicators. We find that knowing someone with mental illness, or even number of people known, explains little about desire for social distance, perceptions of dangerousness, or endorsement of treatment coercion. However, having stronger relationships with more PMI, having more friends and family (but not more peripheral ties) with mental illness, and knowing people in treatment are associated with less stigma endorsement. In contrast, we find that exposure to PMI who are perceived as dangerous is associated with greater levels of stigma.

Functional status, mood state, and physical activity among women with post-acute COVID-19 syndrome.

OBJECTIVES: While organ-specific pathophysiology has been well-described in SARS-CoV-2 infection, less is known about the attendant effects on functional status, mood state and leisure-time physical activity (PA) in post-acute COVID-19 syndrome. METHODS: A case-control design was employed to recruit 32 women ( n = 17 SARS-CoV-2; n = 15 controls) matched on age (54 ± 12 years), body mass index (27 ± 6 kg/m 2 ), smoking status, and history of cardiopulmonary disease. Participants completed a series of assessments including the Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), Profile of Mood States (POMS), and Godin-Shephard Leisure-Time PA. RESULTS: SARS-CoV-2 participants exhibited poorer functional status ( p = 0.008) and reduced leisure-time PA ( p = 0.004) compared to controls. Significant between-group differences were also detected for the POMS total mood disturbance with sub-scale analyses revealing elevated tension, confusion, and lower vigor among SARS-CoV-2 participants (all p -values < 0.05). The number of SARS-CoV-2 symptoms (e.g., loss of taste / smell, muscle aches etc.) were associated ( r = 0.620, p = 0.008) with confusion. CONCLUSION: The sequela of persistent SARS-CoV-2 symptoms elicit clear disturbances in functional status, mood state, and leisure-time PA among women with post-acute COVID-19 syndrome.

Labeling, causal attributions, and social network ties to people with mental illness.

Evidence supports Allport's (1954) contention that social contact reduces mental illness stigma and promotes symptom recognition. However, an important limitation of existing research is that it typically relies on relatively simplistic measures of contact (e.g., any contact, number of contacts). Here, we build on prior work by examining how contact with persons with mental illness within social networks shapes labeling processes and beliefs about the causes of mental illness. Using egocentric network methods and vignette data from the 2018 General Social Survey (N = 1173), findings reveal that connections to valued ties (e.g., friends, family) that disconfirm commonly held stereotypes about people with mental illness contribute to improved recognition of mental illness and reduce the likelihood of endorsing stigmatizing beliefs about causes of mental illness. By using network theory and methods, this research extends current understanding of the role of contact by revealing not only whether contact matters, but how it matters and under what circumstances it may reduce prejudice and discrimination attached to mental illness in contemporary society.

Trends in Public Stigma of Mental Illness in the US, 1996-2018.

Importance: Stigma, the prejudice and discrimination attached to mental illness, has been persistent, interfering with help-seeking, recovery, treatment resources, workforce development, and societal productivity in individuals with mental illness. However, studies assessing changes in public perceptions of mental illness have been limited. Objective: To evaluate the nature, direction, and magnitude of population-based changes in US mental illness stigma over 22 years. Design, Setting, and Participants: This survey study used data collected from the US National Stigma Studies, face-to-face interviews conducted as 1996, 2006, and 2018 General Social Survey modules of community-dwelling adults, based on nationally representative, multistage sampling techniques. Individuals aged 18 years or older, including Spanish-speaking respondents, living in noninstitutionalized settings were interviewed in 1996 (n = 1438), 2006 (n = 1520), and 2018 (n = 1171). The present study was conducted from July 2019 to January 2021. Main Outcomes and Measures: Respondents reacted to 1 of 3 vignettes (schizophrenia, depression, alcohol dependence) meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria or a control case (daily troubles). Measures included beliefs about underlying causes (attributions), perceptions of likely violence (danger to others), and rejection (desire for social distance). Results: Of the 4129 individuals interviewed in the surveys, 2255 were women (54.6%); mean (SD) age was 44.6 (16.9) years. In the earlier period (1996-2006), respondents endorsing scientific attributions (eg, genetics) for schizophrenia (11.8%), depression (13.0%), and alcohol dependence (10.9%) increased. In the later period (2006-2018), the desire for social distance decreased for depression in work (18.1%), socializing (16.7%), friendship (9.7%), family marriage (14.3%), and group home (10.4%). Inconsistent, sometimes regressive change was observed, particularly regarding dangerousness for schizophrenia (1996-2018: 15.7% increase, P = .001) and bad character for alcohol dependence (1996-2018: 18.2% increase, P = .001). Subgroup differences, defined by race and ethnicity, sex, and educational level, were few and inconsistent. Change appeared to be consistent with age and generational shifts among 2 birth cohorts (1937-1946 and 1987-2000). Conclusions and Relevance: To date, this survey study found the first evidence of significant decreases in public stigma toward depression. The findings of this study suggest that individuals' age was a conservatizing factor whereas being in the pre-World War II or millennial birth cohorts was a progressive factor. However, stagnant stigma levels for other disorders and increasing public perceptions of likely violence among persons with schizophrenia call for rethinking stigma and retooling reduction strategies to increase service use, improve treatment resources, and advance population health.

The Social Roots of Suicide: Theorizing How the External Social World Matters to Suicide and Suicide Prevention.

The past 20 years have seen dramatic rises in suicide rates in the United States and other countries around the world. These trends have been identified as a public health crisis in urgent need of new solutions and have spurred significant research efforts to improve our understanding of suicide and strategies to prevent it. Unfortunately, despite making significant contributions to the founding of suicidology - through Emile Durkheim's classic Suicide (1897/1951) - sociology's role has been less prominent in contemporary efforts to address these tragic trends, though as we will show, sociological theories offer great promise for advancing our understanding of suicide and improving the efficacy of suicide prevention. Here, we review sociological theory and empirical research on suicide. We begin where all sociologists must: with Durkheim. However, we offer a more comprehensive understanding of Durkheim's insights into suicide than the prior reviews provided by those in other disciplines. In so doing, we reveal the nuance and richness of Durkheim's insights that have been largely lost in modern suicidology, despite being foundational to all sociological theories of suicide - even those that have moved beyond his model. We proceed to discuss broadly acknowledged limitations to Durkheim's theory of suicide and review how more recent theoretical efforts have not only addressed those concerns, but have done so by bringing a larger swatch of sociology's theoretical and empirical toolkit to bare on suicide. Specifically, we review how recent sociological theories of suicide have incorporated insights from social network theories, cultural sociology, sociology of emotions, and sociological social psychology to better theorize how the external social world matters to individual psychological pain and suffering. We conclude by making explicit bridges between sociological and psychological theories of suicide; by noting important limitations in knowledge about suicide - particularly regarding the roles of organizations, inequality, and intersectionality in suicide - that sociology is well situated to help address.

Pandemic precarity: COVID-19 is exposing and exacerbating inequalities in the American heartland.

Crises lay bare the social fault lines of society. In the United States, race, gender, age, and education have affected vulnerability to COVID-19 infection. Yet, consequences likely extend far beyond morbidity and mortality. Temporarily closing the economy sent shock waves through communities, raising the possibility that social inequities, preexisting and current, have weakened economic resiliency and reinforced disadvantage, especially among groups most devastated by the Great Recession. We address pandemic precarity, or risk for material and financial insecurity, in Indiana, where manufacturing loss is high, metro areas ranked among the hardest hit by the Great Recession nationally, and health indicators stand in the bottom quintile. Using longitudinal data (n = 994) from the Person to Person Health Interview Study, fielded in 2019-2020 and again during Indiana's initial stay-at-home order, we provide a representative, probability-based assessment of adverse economic outcomes of the pandemic. Survey-weighted multivariate regressions, controlling for preexisting inequality, find Black adults over 3 times as likely as Whites to report food insecurity, being laid off, or being unemployed. Residents without a college degree are twice as likely to report food insecurity (compared to some college), while those not completing high school (compared to bachelor's degree) are 4 times as likely to do so. Younger adults and women were also more likely to report economic hardships. Together, the results support contentions of a Matthew Effect, where pandemic precarity disproportionately affects historically disadvantaged groups, widening inequality. Strategically deployed relief efforts and longer-term policy reforms are needed to challenge the perennial and unequal impact of disasters.

Cross-level sociodemographic homogeneity alters individual risk for completed suicide.

Among deaths of despair, the individual and community correlates of US suicides have been consistently identified and are well known. However, the suicide rate has been stubbornly unyielding to reduction efforts, promoting calls for novel research directions. Linking levels of influence has been proposed in theory but blocked by data limitations in the United States. Guided by theories on the importance of connectedness and responding to unique data challenges of low base rates, geographical dispersion, and appropriate comparison groups, we attempt a harmonization of the National Violent Death Reporting System (NVDRS) and the American Community Survey (ACS) to match individual and county-level risks. We theorize cross-level sociodemographic homogeneity between individuals and communities, which we refer to as "social similarity" or "sameness," focusing on whether having like-others in the community moderates individual suicide risks. While analyses from this new Multilevel Suicide Data for the United States (MSD-US) replicate several individual and contextual findings, considering sameness changes usual understandings of risk in two critical ways. First, high individual risk for suicide among those who are younger, not US born, widowed or married, unemployed, or have physical disabilities is cut substantially with greater sameness. Second, this moderating pattern flips for Native Americans, Alaska Natives, Asians, and Hispanics, as well as among native-born and unmarried individuals, where low individual suicide risk increases significantly with greater social similarity. Results mark the joint influence of social structure and culture, deliver unique insights on the complexity of connectedness in suicide, and offer considerations for policy and practice.

The unique nature of public stigma toward non-medical prescription opioid use and dependence: a national study.

BACKGROUND AND AIMS: Our ability to combat the opioid epidemic depends, in part, on dismantling the stigma that surrounds drug use. However, this epidemic has been unique and, to date, we have not understood the nature of public prejudices associated with it. Here, we examine the nature and magnitude of public stigma toward prescription opioid use disorder (OUD) using the only nationally representative data available on this topic. DESIGN: General Social Survey (GSS), a cross-sectional, nationally representative survey of public attitudes. SETTING: United States, 2018. PARTICIPANTS/CASES: A total of 1169 US residents recruited using a probability sample. MEASUREMENTS: Respondents completed a vignette-based survey experiment to assess public stigma toward people who develop OUD following prescription of opioid analgesics. This condition is compared with depression, schizophrenia, alcohol use disorder (AUD) and subclinical distress using multivariable logistic or linear regression. FINDINGS: Adjusting for covariates (e.g. race, age, gender), US residents were significantly more likely to label symptoms of OUD a physical illness [73%, confidence interval (CI) = 66-80%; P < 0.001] relative to all other conditions, and less likely to label OUD a mental illness (40%, CI = 32-48%; P < 0.001). OUD was significantly less likely to be attributed to bad character (37%, CI = 30-44%; P < 0.001) or poor upbringing (17%, CI = 12-23%; P < 0.001) compared with AUD. Nonetheless, perceptions of competence associated with OUD (e.g. ability to manage money; 41%, CI = 33-49%; P < 0.01) were lower than AUD, depression and subclinical distress. Moreover, willingness to socially exclude people with OUD was very high (e.g. 76% of respondents do not want to work with a person with OUD), paralleling findings on traditional targets of strong stigma (i.e. AUD and schizophrenia). CONCLUSIONS: US residents do not typically hold people with prescription opioid use disorder responsible for their addiction, but they express high levels of willingness to subject them to social exclusion.

Empowering the Next Generation to End Stigma by Starting the Conversation: Bring Change to Mind and the College Toolbox Project.

OBJECTIVE: To examine outcomes in a 4-year college pilot program built on stigma change research. U Bring Change to Mind (UBC2M) was developed and launched at Indiana University (IU) in 2014 as an institutionally supported, student-led organization to make campuses "safe and stigma-free zones." The accompanying College Toolbox Project (CTP) assessed change in student prejudice and discriminatory predispositions as well as perceptions and behaviors at follow-up. METHOD: All entering Class of 2019 students were invited to complete a Web-based survey (N = 3,287; response rate = 44.6%). In their third year, students were sent a follow-up survey. Stigma indicators for 1,132 students completing both waves were analyzed using descriptive statistics and multivariate regressions. Models controlled for social desirability, prior contact, socio-demographics, and self-reported mental illness. Participation was examined for potential biases. RESULTS: Statistically significant positive changes in attitudes and behavioral predispositions emerged. Although fewer students with prior contact endorsed stigma items initially, they reported significant reduction at follow-up. UBC2M active engagement was associated with lowering prejudice. Both passive and active engagement predicted change in discriminatory predispositions as well as current inclusive behaviors and positive perceptions of campus mental health culture. CONCLUSION: A long-term, community-based, student empowerment approach with institutional supports is a promising avenue to reduce stigma on college campuses, to develop the next generation of mental health leaders, and to potentially reduce societal levels of stigma in the long run. CTP provides evidence that both contact and contextual visibility matter, and that UBC2M offers a nationally networked organizational strategy to reduce stigma.

The global use of diverse medical systems.

In 1969, anthropologist Irwin Press introduced the concept of dual use in an attempt to lay to rest the idea that individuals in the real world must choose between allopathic and alternative systems. While providers of medical traditions have a vested interest in seeing the public use one system exclusively, individuals do not. Yet, utilization research generally follows a bifurcated research agenda. thwarting our understanding of how the population uses health care resources. Here, we frame a global analysis of individuals' yearly use of different medical systems. Using the Network Episode Model (NEM), we shift the focus to patterns of care and lay out seven hypotheses, testing whether socio-demographic, cultural, access and health factors are associated with use of one, another, or both system. Data from the 2011 International Social Survey Program's Health Module, reveals that the use of alternative systems alone has virtually disappeared as a pattern of care while dual use remains relevant. Using multilevel models to take into account country differences, we find that being older or younger (i.e., curvilinear effect), female, out-group member, employed, unsatisfied with last allopathic visit; or, reporting barriers to allopathic options, chronic illness, poor health, or positive assessment of alternative options are associated with dual use. Education, income, rural residence, or reporting sufficient insurance coverage are insignificant. Thus, nearly all hypotheses reveal the complexity of contemporary utilization behavior.

Evolving Public Views On The Likelihood Of Violence From People With Mental Illness: Stigma And Its Consequences.

Highly publicized acts of violence routinely spark reactions that place blame on the perpetrator's presumed mental illness. Despite solid evidence that people with mental illness are unlikely to be dangerous, such prejudice can lead to support for inappropriately using legal means to force people into treatment. We examined trends in public perceptions of violence and support for coerced treatment across a twenty-two-year period using data from three National Stigma Studies. The studies gave respondents one of three vignettes describing people who met clinical criteria for mental disorders or one describing a person with nonclinical "daily troubles." Perceptions regarding potential violence and support for coercion generally rose over time-significantly so for schizophrenia. By 2018 over 60 percent of respondents saw people who met criteria for schizophrenia as dangerous to others, and 44-59 percent supported coercive treatment. Sixty-eight percent saw people with alcohol dependence as dangerous to others, and 26-38 percent supported coercion. Lower but substantial percentages were reported for people with depression and, remarkably, for those with nonclinical "daily troubles," who were viewed as dangerous. These findings reflect political discourse, not scientific data, and could lead to policies that would be ineffective and misdirect the search for the underlying roots of violence while unnecessarily increasing stigma toward people with mental illness.

Mental health care and the cultural toolboxes of the present-day Japanese population: Examining suggested patterns of care and their correlates.

An extensive body of literature has documented the under-utilization of mental health services among Asian populations, regardless of where they live. Japan is one Asian country where the mental health care system has improved substantially in the recent decades. Yet, Japan continues to report greater under-utilization of mental health services than other developed countries. One primary reason for this is hypothesized to be the cultural climate, which includes the stock of social, cultural and medical knowledge surrounding mental illness. Previous studies have not examined the cultural toolkit (Swidler, 2001) of the Japanese public, nor have they linked these to public attributions or assessments surrounding mental health. The Stigma in Global Context - Mental Health Study (SGC-MHS), a multi-stage probability sample of Japanese residents aged 18-64 years (N = 994) in 2006 provides data to describe the unprompted care suggestions from the general population regarding case scenarios meeting psychiatric criteria for schizophrenia and depression. Guided theoretically by the Network Episode Model, we analyze if and how respondents socially organize solutions into patterns of culturally acceptable care for mental health problems in Japan. Six cultural utilization patterns appear to be shaped by beliefs about underlying attributions, perceived severity of conditions, and type of mental health problem. Further, women, older individuals and those with differing education levels suggest different care patterns than their counterparts. In sum, the findings indicate unique patterns of mental health care recommendations among the Japanese public, which are culturally and socially constrained.

Challenges and opportunities in examining and addressing intersectional stigma and health.

BACKGROUND: 'Intersectional stigma' is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research. DISCUSSION: Evidence from the existing scientific literature, as well as the examples presented here, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and corresponding health behaviors. As different stigmas are often correlated and interrelated, the health impact of intersectional stigma is complex, generating a broad range of vulnerabilities and risks. Qualitative, quantitative, and mixed methods approaches are required to reduce the significant knowledge gaps that remain in our understanding of intersectional stigma, shared identity, and their effects on health. CONCLUSIONS: Stigmatized identities, while often analyzed in isolation, do not exist in a vacuum. Intersecting forms of stigma are a common reality, yet they remain poorly understood. The development of instruments and methods to better characterize the mechanisms and effects of intersectional stigma in relation to various health conditions around the globe is vital. Only then will healthcare providers, public health officials, and advocates be able to design health interventions that capitalize on the positive aspects of shared identity, while reducing the burden of stigma.