How are various aspects of personal stigma related to secrecy about mental health problems among people diagnosed with psychotic disorders? A cross-sectional analysis.

OBJECTIVE: Service users commonly keep their mental illness secret in order to avoid rejection. However, this stigma-coping orientation is not necessarily effective and may lead to a number of negative psychological consequences. The purpose of the present study was to investigate the roles of various aspects of personal stigma in predicting secrecy about mental health problems among persons with psychosis. METHODS: A sample of 147 individuals diagnosed with psychotic disorders was recruited for the study. They were administered a set of questionnaires to gather data about sociodemographic and illness-related background characteristics, levels of social functioning, depressive symptoms, and overall psychopathology, elements of personal stigma (i.e., perceived stigma, experienced discrimination, self-stigma, and stigma-related stress), as well as the endorsement of secrecy as a way of coping with stigma. Hierarchical linear regression was utilized for data analysis. RESULTS: Personal stigma measures were entered into the regression equation as a block and explained as much as 29% of variance in the dependent variable over and above sociodemographic and clinical features. After accounting for all controls, higher perceived stigma (ß = 0.47, p < .01) and higher stigma stress (ß = 0.19, p < .05) were found to be independent predictors of secrecy, whereas experienced discrimination and self-stigma were not. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Perceived stigma and stigma stress appraisal should be considered as targets of interventions aiming to reduce the shame and fear of rejection associated with mental illness and to guide and support people's everyday decisions about coming out. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Practice of prescribing antipsychotics in schizophrenia during 2013-2018 based on data from the National Health Fund. / Praktyka preskrypcyjna w zakresie leków przeciwpsychotycznych w schizofrenii w latach 2013­2018 na podstawie danych Narodowego Funduszu Zdrowia.

AIM: The aim of the study was to analyse the prescribing pattern of antipsychotic drugs in patients with schizophrenia during the years 2013-2018. METHOD: Schizophrenia is analysed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In this study, the unitary data of the National Health Fund (NFZ) reported in the years 2013-2018 were used. Adult patients were identified by their Personal Identification Number (PESEL), and the antipsychotics were identified by the European Article Number (EAN). The study included 209,334 adults who were diagnosed with F20 to F20.9 (according to ICD-10) and were prescribed at least one antipsychotic within a year. The active substances of prescribed antipsychotic medication have been divided into typical (first generation), atypical (second generation) and long-acting injectable antipsychotics (both first and second generation). The statistical analysis contains descriptive statistics for selected sections. A linear regression, one-way analysis of variance and t-test were used in the study. All statistical analyses were performed using R, version 3.6.1 and Microsoft Excel. RESULTS: In the years 2013-2018, the number of patients in the public sector diagnosed with schizophrenia increased by 4%. The largest increase was recorded among persons diagnosed with other schizophrenia (F20.8). In the analysed years, the number of patients who were prescribed second-generation oral antipsychotics increased significantly as well as the number of patients who were prescribed long-acting antipsychotics, especially the secondgeneration agents (risperidone LAI, olanzapine LAI). The most prescribed first-generation antipsychotics included: perazine, levomepromazine and haloperidol with a downward trend for each; and the most common second-generation drugs included: olanzapine, aripiprazole and quetiapine. A noteworthy finding was an extremely high increase in the frequency of prescribing haloperidol in the form of depot. CONCLUSIONS: Extending the study to include information on applied prescriptive practice in the private sector would provide a fuller picture of the studied phenomenon.

Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009-2018. / Analiza swiadczen psychiatrycznych dla pacjentów z rozpoznaniem schizofrenii sprawozdanych do Narodowego Funduszu Zdrowia w latach 2009­2018.

AIM.: Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009-2018. MATERIAL AND METHODS: Schizophrenia is analyzed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In the study, the unitary data of the National Health Fund (NFZ) was used, reported in the years 2009-2018. Patients were identified by the Personal Identity Number (PESEL). The services for adults were analyzed, i.e., people who were at least 18 years old in the year when the services were discontinued, for whom the main disease was schizophrenia classified by ICD-10 codes: F20 to F20.9. Provided services were analyzed according to those specified in the ordinance of the President of the National Health Fund of June 28, 2019 - organizational units and billing product codes. RESULTS: Between 2009 and 2018, the number of patients diagnosed with schizophrenia treated in the public sector increased by 5%. In the analyzed years, the number of in-patients decreased by 9%, while the number of people using out-patient services and community treatment increased by 6%. In forensic psychiatry departments, a very high increase (by 212%) in the number of hospitalized patients was observed. In 2018, the average number of hospitalization days in a general psychiatric ward was 43, in the forensic ward 279. A very low percentage of patients (less than 3%) used day therapy. In out-patient treatment, the mainstay of therapy was a medical consultation; less than 10% of patients used other types of services. In 2018, an average of four visits/consultations per patient was reported. There has been a very high decrease in the number of patients (by 77%) using group therapy, family therapy and support. CONCLUSIONS: In 2009-2018, most patients diagnosed with schizophrenia in the public sector were treated using the traditional model of care: medical consultation and psychiatric hospitalization. It is advisable to reorganize the system - implementation and development of comprehensive care coordinated within the community care model. Extending the study with information from the non-public sector would give a full picture of system functioning and facilitate service needs estimation for this group of patients.

The self-disclosure of mental health problems: Its extent, predictors and consequences for people with psychotic disorders. / Ujawnianie problemów ze zdrowiem psychicznym: zakres, predyktory i konsekwencje dla osób z rozpoznaniem zaburzen psychotycznych.

OBJECTIVES: The analysis of the extent, sociodemographic and clinical predictors, and consequences of disclosing mental health problems for people with psychotic disorders. METHODS: 147 individuals with a diagnosis of psychotic disorder (ICD-10 categories F20-F29) were examined with questionnaires to assess the extent and consequences of their disclosing of mental health problems to others, as well as their social functioning, depressive symptoms, and the global severity of psychopathological symptoms. RESULTS: The majority of respondents talked openly about their mental health problems to their parents, spouses or life partners, as well as physicians and other non-psychiatric health care professionals, while a substantial minority (less than one-fifth) talked about these issues to casual acquaintances, neighbors, teachers and lecturers, co-workers, police officers and municipal guards, representatives of the court system, or public officials. Multiple regression analysis showed that the older the respondents were, the less willing they were to disclose their mental problems to others (ß = -0.34; p <0.05). In contrast, the longer they were ill, the more inclined they were to disclose their mental health issues (ß = 0.29; p <0.05). Disclosure of mental health problems had varying effects on the subjects' social relationships, with a significant proportion reporting no difference in the way they were treated by others, while others reported either deterioration or improvement in this area. CONCLUSIONS: The results of the study provide clinicians with practical guidance on supporting and assisting patients with psychotic disorders in the process of making informed decisions about "coming out".

Disentangling the relationships between interpersonal competence, social network, social support and the experience of being stigmatized among people with psychotic disorders: A path modeling approach.

BACKGROUND: Deficits in social skills are common among people with psychosis and may contribute to the severity of the stigmatization they experience. The aim of the present research was to shed light on the mechanisms through which lack of interpersonal competence may lead to an increased exposure to stigma by investigating the mediating effects of social network and social support. METHODS: A sample of 207 patients diagnosed with psychotic disorders was recruited for the study. The pattern of relationships between interpersonal competence, social network, social support and experienced stigma was analyzed using path modeling. RESULTS: The level of interpersonal competence was found to be directly negatively related to the intensity of experienced stigma (ß = -0.20, SE = 0.08; P < 0.05) and directly positively related to the scope of social network (ß = 0.36, SE = 0.08, P < 0.01) and social support (ß = 0.36, SE = 0.08, P < 0.01). The analysis of mediation pathways between interpersonal competence and stigma experiences revealed significant indirect effect through social support (ßIND = -0.08, 95% CI: -0.16 to -0.02) and sequential effect through social network and social support (ßIND = -0.03, 95% CI: -0.06 to -0.01). The indirect pathway from interpersonal competence to stigma via social network alone turned out to be non-significant. CONCLUSIONS: The findings indicate that poor interpersonal competence may increase the extent of the stigma experienced by people with psychotic illness both directly and indirectly, with social support being the key mediator. Since interpersonal competence, social network and social support are potentially modifiable factors, they should be considered as possible targets of anti-stigma interventions.

Factors Predicting Response to the Recovery-Oriented Cognitive Behavioural Workshop for Persons Diagnosed with Schizophrenia.

A recovery-oriented, cognitive behavioural workshop for service users diagnosed with schizophrenia was developed, implemented and evaluated in a pilot study. Further analysis is required regarding factors which contribute to better treatment response, as this will provide useful information for workshop adaptation. Secondary multilevel model analyses were performed to determine whether workshop and booster session attendance, as well as sociodemographic variables such as gender, age, education, and duration of illness, predicted workshop responsiveness. Results showed that completers had lower responsiveness to the workshop in terms of confidence and hope, whereas those who attended an online booster session demonstrated better responsiveness as to psychosocial functioning. Longer duration of illness and older age generally predicted lower intervention responsiveness. In conclusion, adaptations utilising more booster sessions and accommodating older participants with longer duration of illness are required, as is further workshop evaluation in a randomised controlled study.

Analysis of psychiatric services provided to children and youth in 2010-2016 based on the National Health Fund data. / Analiza swiadczen psychiatrycznych udzielonych populacji rozwojowej w latach 2010­2016 na podstawie danych Narodowego Funduszu Zdrowia.

OBJECTIVES: In Poland, there is no systematic epidemiological research on mental disorders of children and adolescents in the general population, as well as a register dedicated to mental disorders. The aim of the presented study is to analyze psychiatric services reported to the National Health Fund that were provided to children and adolescents in the years 2010-2016. METHODS: The starting point of this study was report entitled Maps of health needs in mental disorders published by the Ministry of Health. The analysis concerns all mental health services provided to children and adolescents in the years 2010-2016. The analysis covers seven largest, in terms of the number of patients, groups of mental disorders according to ICD-10 in children and adolescents. RESULTS: In the years 2010-2016, both the number of psychiatric service users under the age of 18 years and the total number of healthcare services have increased in almost all of analyzed areas. Unusually high increase in the number of services provided in the ad hoc mode in A&E department was registered, with a very small share of services provided in home environment. In almost all analyzed groups of mental disorders, there was a greater number of boys, as well as residents of a town/city. Only in the group of neurotic disorders associated with stress and in the somatic form a slightly higher number of girls was noticed. CONCLUSIONS: In the years 2010-2016, an increase in the number of registered cases in the population of children and adolescents and the number of services in almost all of the analyzed areas was observed. High increase in services provided in the ad hoc mode in A&E department and a small share of services provided in the home environment indicates significant discrepancy between the needs and the availability of resources.

Organisational units providing psychiatric services for adults - an analysis based on National Health Fund data for 2010-2016. / Jednostki organizacyjne psychiatrycznej opieki zdrowotnej dla doroslych ­ analiza na podstawie danych Narodowego Funduszu Zdrowia z lat 2010­2016.

OBJECTIVES: The aim of this publication is to analyze the organizational units of mental healthcare for adults based on the data on the services reported to the National Health Fund in 2010-2016. METHODS: The following organizational forms of care were analyzed: mental health outpatient clinics, general psychiatric wards, general day care psychiatric wards, community mental health teams, and psychiatric emergency rooms. These organizational units were analyzed in terms of their number, utilization and accessibility. In addition, a preliminary simulation of the expected Mental Health Centers was carried out. RESULTS: In Poland, in 2010-2016, the number of mental health service providers under contracts with the National Health Fund increased by 5%. The most robust growth was observed for community mental health teams, whose number increased by 282%. However, this organizational form was used by a marginal (1.9%) percentage of patients. The highest rate of admission to general psychiatric wards was observed in districts where a general psychiatric ward and a mental health clinic were available with no day care psychiatric wards or community mental health teams. Asmall number of entities providing comprehensive care was in operation in 2016. The preliminary simulation has shown that in 2016 a total of 156 MentalHealth Centers should have been in operation, assuming that each of them would have provided care for 200,000 inhabitants. CONCLUSIONS: It would be advisable to analyze the exact geographic distribution of units, human resources in individual organizational units, and to take financial outlays for mental healthcare in their various forms into consideration.

International classification of diseases/disorders diagnosis and International Classification of Functioning, Disability and Health activity/participation limitation among psychiatric patients: a cross-sectional and exploratory study.

To explore the relationships between international classification of diseases/disorders (ICD)-10 diagnoses and International Classification of Functioning, Disability and Health (ICF) disability dimensions - activity and participation restriction among mental health service users. Three hundred sixty patients from different health services diagnosed with diverse mental disorders (ICD-10) participated in the study. Functioning restrictions were evaluated by use of the Mini-ICF-APP. Selected sociodemographic and clinical variables were also analysed. The Mini-ICF-APP scores correlated positively with the clinical impression of disease severity and negatively with general functioning. As independent factors determining the Mini-ICF-APP score, regression analysis suggests diagnosis and severity of disorder but also contextual factors such as general functioning and active occupation. Percentage and percentile distributions of activity and participation restrictions in diagnostic sections and categories revealed noticeable variability regardless of diagnosis-related differences. The diagnosis determines them neither in an ambiguous nor an absolute manner. There is a need to further explore the covariability between clinical diagnosis and ICF activity and participation restriction, particularly in regard the rationalization of social welfare benefits.

Development and Evaluation of a Recovery-Oriented Cognitive Behavioural Workshop for People Diagnosed with Schizophrenia.

BACKGROUND: There is a need to develop culturally adapted interventions that support the personal recovery and real-world functioning of people diagnosed with schizophrenia. AIMS: This study reports on the development and evaluation of a culturally adapted, recovery-oriented, cognitive behavioural workshop for service users with schizophrenia. METHOD: The feasibility and acceptability were assessed, as were changes over time in personal recovery and psychosocial functioning (primary outcomes) along with psychopathology and health-related behaviours (secondary outcomes), using multi-level modelling. It was also assessed whether personal recovery predicts psychosocial functioning. RESULTS: The workshop was feasible and was received favourably. Participants improved over time regarding confidence and hope, feeling less dominated by symptoms, psychosocial functioning, and psychopathology. Personal recovery predicted decreased psychosocial difficulties. CONCLUSIONS: The workshop is a promising intervention. It shows potential in terms of both improving personal recovery as well as real-life functioning of people diagnosed with schizophrenia. Further workshop evaluation in a randomized controlled study is required.

Hope and its dimensions in relation to clinical recovery: A cross-sectional study among people with psychotic disorders.

OBJECTIVE: Hope is a key component of personal recovery. There is limited evidence regarding the association of hope with the level of functioning in individuals with psychosis. It is also not clear which dimensions of hope are most strongly related to clinical recovery. Thus, this study aims to explore the relationships of hope and its dimensions with various indicators of clinical recovery such as overall psychopathology, depression and global functioning among people with psychotic disorders. METHOD: The Integrative Hope Scale (IHS; Schrank, Woppmann, Sibitz, & Lauber, 2011) was administered to 110 people with psychotic disorders. Multiple regression analysis was used to investigate the associations of the IHS total score and its four subscales (i.e., Trust and Confidence, Lack of Perspective, Positive Future Orientation, and Social Relations and Personal Value) with overall psychiatric symptoms, depression, and general functioning. RESULTS: A total level of Hope was not associated with overall psychopathology or global functioning; however, it showed a significant negative relationship with severity of depression. A stronger feeling of a Lack of Perspective turned out to be associated with more severe depression and a greater intensity of psychopathological symptoms. The relationships of the remaining dimensions of Hope with the indicators of clinical recovery were found to be nonsignificant. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The findings suggest that combining Hope-enhancement strategies with interventions targeting symptoms may increase the effectiveness of rehabilitation programs for people with psychosis. They also point to the sense of a Lack of Perspective as the aspect of Hope most strongly related to clinical recovery. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The evaluation of the impact of anti-stigma training led by "experts by experience" on participants' attitudes towards persons with mental illness. / Ocena wplywu szkolen antystygmatyzacyjnych prowadzonych przez "ekspertów przez doswiadczenie" na postawy uczestników wobec osób chorujacych psychicznie.

OBJECTIVES: The purpose of this study was to evaluate the impact of anti-stigma training led by people who had previously experienced mental health crises (i.e., "experts by experience") on various aspects of participants' attitudes towards the people with mental illness. METHODS: The three-hour workshops were attended by 185 people; the training was held in 17 groups, with 3-19 people in each (11 on average). Almost half of the participants (45.4%) were employees of the mental health care system. The participants were asked to fill out a set of questionnaires immediately before and after the training, which evaluated the following aspects of their attitudes: social distance, stigmatizing attributions, beliefs about self-determination/ ability to attain important life goals by people with mental illness, and also beliefs about the social value of people with mental illness. The respondents were asked to complete the same set of questionnaires again online a month and six months after the training. The data were analyzed based on a piecewise latent trajectory model. RESULTS: Out of the 185 people who participated in the workshops, 115 (62.2%) filled out the questionnaires a month after, and 87 (47.0%) six months after the training. The analyses showed an improvement in all four measures of attitudes expressed directly after the training. In three out of the four examined aspects of attitudes (intensity of social distance, stigmatizing attributions and beliefs about self-determination of people with mental illness) the positive impact of the training continued after six months. CONCLUSIONS: The results provide preliminary empirical evidence that the structured antistigma intervention under evaluation, using the elements of education and interpersonal contact can be an effective tool for improving social attitudes towards people with mental illness.

An analysis of psychiatric services provided to adults in 2010-2014 based on the National Health Fund data. / Analiza swiadczen psychiatrycznych udzielonych osobom doroslym w latach 2010-2014 na podstawie danych Narodowego Funduszu Zdrowia.

OBJECTIVES: Analyzing the indices that allow to improve population health by, for example, improving the quality of healthcare services and increasing accessibility to these services is among the priorities of the World Health Organization (WHO). This is of particular importance in Poland, as the psychiatric care reform is being carried out in accordance with the National Mental Healthcare Program guidelines. The aim of the study is to analyze mental health services provided to adults and reported to the National Health Fund in 2010-2014. METHODS: In the present study, we expanded the information included in the second part of the maps of health needs. In addition to the evaluation of services provided to adults in 2014, we presented an analysis of services in 2010-2014. According to these data, there was a continuous increase both in thenumber of individuals provided with services for psychiatric disorders and in the total number of provided services. There was an increase in the number of patients treated for mood disorders, neurotic disorders, stress-related and somatic disorders, as well as addictions. RESULTS: The increase in the total number of services was mainly seen for outpatient types of care. The reasons why in 2014 there was a resurgence in psychiatric hospitalizations and in the hospitalization rate per 100 thousand adults remains unclear. CONCLUSIONS: Our results indicate the need for further support of the development of psychiatric care using multidirectional efforts within an integrated model for solving health problems. An overall analysis of services provided in psychiatric care requires access to information on services funded from non-public sources and expanding the reported information.

Investigating the roles of loneliness and clinician- and self-rated depressive symptoms in predicting the subjective quality of life among people with psychosis.

PURPOSE: To examine the roles of loneliness and clinician- and self-rated depressive symptoms as predictors of the subjective quality of life (QoL) in psychosis. METHODS: This cross-sectional study was conducted on a sample of 207 patients diagnosed with psychotic disorders. They were assessed with self-reported measures of QoL, loneliness and depression and with clinician-rated measures of depression and overall psychopathology. Multiple indicators multiple causes (MIMIC) modeling was used to analyze the data. RESULTS: Both loneliness and depression turned out to be independent predictors of impaired QoL. However, once loneliness was accounted for, the effect of depression on QoL was markedly reduced and the effect of loneliness proved to be visibly larger. Self-rated depression was found to be more strongly associated with QoL than clinician-rated depression. Each type of depression measure explained a unique amount of variance in QoL. Depression moderated the relationship between loneliness and QoL in such a way that the negative effect of loneliness on QoL weakened with the increasing intensity of depressive symptoms. CONCLUSIONS: Therapeutic programs aiming to enhance the QoL of people with psychotic disorders should incorporate interventions targeting both loneliness and depression and need to be tailored to the clinical status of patients. The emphasis on alleviating loneliness should be placed first of all in the case of those with low levels of depression, among whom the negative impact of loneliness on QoL is especially strong. Researchers should be aware that the method chosen for assessing depressive symptoms in models predicting QoL in psychosis matters.

The relationship between internalized stigma and quality of life among people with mental illness: are self-esteem and sense of coherence sequential mediators?

PURPOSE: To elucidate the mechanism through which internalized stigma reduces the quality of life (QoL) of people with mental illness by exploring the mediating roles of self-esteem and sense of coherence (SOC). METHODS: A cross-sectional analysis of 229 patients diagnosed with schizophrenia or affective disorders was undertaken to test a sequential mediation model assuming that more severe internalized stigma is related to lower self-esteem, which is associated with weaker SOC, which in turn relates to worse QoL. RESULTS: The proposed model was supported by the data. A sequential indirect effect from internalized stigma to QoL via self-esteem and SOC turned out to be significant [beta = -0.06, SE = 0.02; 95% CI (-0.11, -0.03)]. Support was also found for simple mediation models with either self-esteem or SOC as single mediators between internalized stigma and QoL. CONCLUSIONS: Self-esteem and SOC are personal resources that should be considered as potential targets of interventions aiming to prevent the harmful consequences of internalized stigma for the QoL of people receiving psychiatric treatment.

A Qualitative Study of the Subjective Appraisal of Recovery Among People with Lived Experience of Schizophrenia in Poland.

The objective of this study was to explore definitions of recovery among Polish service users with lived experience of schizophrenia and to hear their recommendations regarding elements that should be considered in the planning of a recovery oriented psychosocial intervention. Four semi-structured focus groups were conducted in the Institute of Psychiatry and Neurology in Warsaw, Poland. A total of 28 service users' narratives were examined using the inductive thematic analysis approach. Five main recovery themes emerged from the combined users accounts, listed in order of frequency: psychological dimension of recovery, relationships with others, wellness strategies, clinical understanding of recovery and support systems. Service user recommendations referred to the above identified recovery themes as well as indications that the intervention should be flexible, individualized, and facilitative of personal growth. The findings indicate that for service users with lived experience of schizophrenia in Poland it is culturally feasible to embrace the person-oriented approach to practice and develop a recovery-oriented psychosocial intervention emphasizing psychological domains of recovery such as positive identity, personal strengths, or meaning and purpose in life alongside the other relevant recovery dimensions. Actions regarding the system level of change are also required.

Disability and recovery in schizophrenia: a systematic review of cognitive behavioral therapy interventions.

BACKGROUND: Schizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. Therefore, this study aimed to systematically review the extent to which traditional and "third wave" cognitive - behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO's International Classification of Functioning, Disability and Health (ICF) as a frame of reference. It also explores if current CBT interventions focus on recovery and what is their impact on disability domains. METHODS: Medline and PsycINFO databases were searched for studies published in English between January 2009 and December 2015. Abstracts and full papers were screened against pre-defined selection criteria by two reviewers. Methodological quality of included studies was assessed by two independent raters using the Effective Public Health Practice Project Quality assessment tool for quantitative studies (EPHPP) guidelines. RESULTS: A total of 50 studies were included, 35 studies evaluating traditional CBT interventions and 15 evaluating "third wave" approaches. Overall, traditional CBT interventions addressed more disability domains than "third wave" approaches and mostly focused on mental functions reflecting schizophrenia psychopathology. Seven studies met the inclusion criteria of recovery-oriented interventions. The majority of studies evaluating these interventions had however a high risk of bias, therefore evidence on their effectiveness is inconclusive. CONCLUSIONS: Traditional CBT interventions address more disability domains than "third wave" therapies, however both approaches focus mostly on mental functions that reflect schizophrenia psychopathology. There are also few interventions that focus on recovery. These results indicate that CBT interventions going beyond symptom reduction are still needed. Recovery-focused CBT interventions seem to be a promising treatment approach as they target disability from a broader perspective including activity and participation domains. Although their effectiveness is inconclusive, they reflect users' views of recovery and trends towards improvement of mood, negative symptoms and functioning are shown.

Factors Related to Social Support in Neurological and Mental Disorders.

Despite the huge body of research on social support, literature has been primarily focused on its beneficial role for both physical and mental health. It is still unclear why people with mental and neurological disorders experience low levels of social support. The main objective of this study was to explore what are the strongest factors related to social support and how do they interact with each other in neuropsychiatric disorders. The study used cross-sectional data from 722 persons suffering from dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson's disease, schizophrenia, stroke, and substance use disorders. Multiple linear regressions showed that disability was the strongest factor for social support. Extraversion and agreeableness were significant personality variables, but when the interaction terms between personality traits and disability were included, disability remained the only significant variable. Moreover, level of disability mediated the relationship between personality (extraversion and agreeableness) and level of social support. Moderation analysis revealed that people that had mental disorders experienced lower levels of support when being highly disabled compared to people with neurological disorders. Unlike previous literature, focused on increasing social support as the origin of improving disability, this study suggested that interventions improving day-to-day functioning or maladaptive personality styles might also have an effect on the way people perceive social support. Future longitudinal research, however, is warranted to explore causality.

Exploring Factors Associated with the Psychosocial Impact of Stigma Among People with Schizophrenia or Affective Disorders.

Stigmatization can exert a variety of pernicious effects on the lives of persons with mental illnesses. The purpose of this study was to explore factors related to the psychosocial impact of stigma among 229 people receiving psychiatric treatment: 123 with schizophrenia [International Classification of Diseases, 10th Revision (ICD-10): F20] and 106 with affective disorders (ICD-10: F31-F33). In the whole sample, the factors most prominently associated with a greater impact of stigma on personal and family life were schizophrenia diagnosis, current inpatient treatment, actually experienced stigma and self-stigma. However, the patterns of predictors varied between the two diagnostic categories. For the schizophrenia group, only self-stigma significantly contributed to a stronger stigma impact. In the affective group, a more severe impact of stigma was significantly predicted by inpatient status and experienced stigma. Anti-stigma programs should address the specific features of stigmatization associated with various psychiatric diagnoses.

Psychosocial difficulties from the perspective of persons with neuropsychiatric disorders.

PURPOSE: The objective of this study is to determine whether persons with neuropsychiatric disorders experience a common set of psychosocial difficulties using qualitative data from focus groups and individual interviews. METHOD: The study was performed in five European countries (Finland, Italy, Germany, Poland and Spain) using the focus groups and individual interviews with persons with nine neuropsychiatric disorders (dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson's disease, schizophrenia, stroke and substance dependence). Digitally recorded sessions were analysed using a step-by-step qualitative and quantitative methodology resulting in the compilation of a common set of psychosocial difficulties using the International Classification of Functioning, Disability and Health (ICF) as a framework. RESULTS: Sixty-seven persons participated in the study. Most persons with neuropsychiatric disorders experience difficulties in emotional functions, sleeping, carrying out daily routine, working and interpersonal relationships in common. Sixteen out of 33 psychosocial difficulties made up the common set. This set includes mental functions, pain and issues addressing activities and participation and provides first evidence for the hypothesis of horizontal epidemiology of psychosocial difficulties in neuropsychiatric disorders. CONCLUSIONS: This study provides information about psychosocial difficulties that should be covered in the treatment and rehabilitation of persons with neuropsychiatric disorders regardless of clinical diagnoses. IMPLICATIONS FOR REHABILITATION: Emotional problems, work and sleep problems should be addressed in all the treatments of neuropsychiatric disorders regardless of their specific diagnosis, etiology and severity. Personality issues should be targeted in the treatment for neurological disorders, whereas communication skill training may also be useful for mental disorders. The effects of medication and social environment on patient's daily life should be considered in all the neuropsychiatric conditions.