Public Stigma towards Older Adults with Depression: Findings from the São Paulo-Manaus Elderly in Primary Care Study.

This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants read a vignette describing a 70-year-old individual (Mary or John) with a depressive disorder and answered questions measuring stigma. The prevalence of the three stigma domains was between 30.2 and 37.6% among older participants from São Paulo and between 27.6 and 35.4% among older participants from Manaus. Older adults from both cities reported similar prevalence of perceived stigma. Key factors associated with stigmatizing beliefs among older participants were reporting depressive symptoms, having physical limitations, and identifying the case of the vignette as a case of mental disorder. Among health professionals, the prevalence of the three stigma domains was between 19.8 and 34.8% in São Paulo and 30.2 and 44.6% in Manaus. The key factor associated with stigma among primary health care professionals was city, with consistently higher risk in Manaus than in São Paulo. Findings confirm that public stigma against older adults in Brazil is common. It is important to educate the public and primary health care providers in Brazil on stigma related to mental illness in order to reduce barriers to adequate mental health treatment.

Knowledge and beliefs about help-seeking behavior and helpfulness of interventions for Alzheimer's disease.

OBJECTIVE: We investigated the lay public's attitudes toward help seeking and preferences for treatment of Alzheimer's disease (AD) in the city of Sao Paulo, Brazil. METHOD: Cross-sectional population-based random sample of 500 household residents over 18 years old participated in face-to-face interviews in Sao Paulo, which included a case vignette depicting AD and a structured questionnaire. RESULTS: Public opinion rests firmly in the lay support system. Psychologists and self-help groups and close relatives were often rated as helpful. Many alternative treatments (such as vitamins, physical exercise, vacation) were often rated as helpful. Limited education, younger age and experience with psychiatric problems are associated with the 'medical' intervention model. Female sex and middle age are associated with 'alternative' interventions. CONCLUSION: Our results suggest that attitudes and belief systems have an important impact on help-seeking and treatment recommendations.