Bringing Lived Lives to Swift’s Asylum: a psychiatric hospital perspective

Background: Few “interventions” around suicide and stigma have reached into psychiatric institutions. Lived Lives is a science-arts approach to addressing suicide and stigma, informed by a psychobiographical and visual arts autopsy. The resulting artworks and mediated exhibition ( Lived Lives), has facilitated dialogue, response and public action around stigma-reduction, consistent with a community intervention. Recent evidence from Lived Lives moved us to consider how it may situate within a psychiatric hospital. Methods: Lived Lives manifested in St. Patrick’s University Hospital (Ireland’s oldest and largest psychiatric hospital) in November 2017. A mixed-methods approach was used to evaluate the exhibition as a potential intervention to address stigma around suicide, with quantitative and qualitative data collected via written questionnaire and oral data collected via video documentation. Bereavement support was available. A Clinician and an artist also provided independent evaluation. Results: 86 participants engaged with the exhibition, with 68 completing questionnaire data. Audiences included service users, policy makers, health professionals, senior hospital administrators and members of the public. 62% of participants who completed questionnaires were suicide-bereaved; 46% had experienced a mental health difficulty, and 35% had been suicidal in the past. 91% thought Lived Lives could be of benefit in the aftermath of a suicide death. Half of participants thought Lived Lives could help reduce suicidal feelings, whereas 88% thought it could benefit those with Mental Health difficulties. The emotional response was of a visceral nature, including fear, anger, sadness, disgust and anxiety. Conclusions: Lived Lives sits comfortably in discomfort, unafraid to call out the home-truths about stigma and its pervasive and pernicious impact, and with restoring identity at its core. Lived Lives can operate within a psychiatric hospital, as well as in community. The challenge is to move it forward for greater exposure and impacts in at-risk communities.

Corona virus fear among health workers during the early phase of pandemic response in Nepal: A web-based cross-sectional study

Health workers involved in the COVID-19 response might be at risk of developing fear and psychological distress. The study aimed to identify factors associated with COVID-19 fear among health workers in Nepal during the early phase of the pandemic. A web-based survey was conducted in April-May 2020 among 475 health workers directly involved in COVID-19 management. The Fear Scale of COVID 19 (FCV-19S) was used to measure the status of fear. Multivariable logistic regression was performed to identify factors associated with COVID fear. The presence of COVID-19 fear was moderately correlated with anxiety and depression, and weakly correlated with insomnia. Nurses, health workers experiencing stigma, working in affected district, and presence of family members with chronic diseases were significantly associated with higher odds of developing COVID-19 fear. Based on the study findings, it is recommended to improve the work environment to reduce fear among health workers, employ stigma reduction interventions, and ensure personal and family support for those having family members with chronic diseases.

Reducing Stigma Toward Schizophrenia: An Investigation into what Information is Most Effective at Decreasing Negative Attitudes to Schizophrenia

<p>Schizophrenia is a chronic mental illness that manifests psychotic symptoms and largely affects an individual’s day to day functioning (Silva et al., 2017). In addition to the incapacitating symptoms of this disorder, patients with schizophrenia face another central concern: stigma (Stuart, 2016). In light of this, an abundance of previous research has been dedicated to discerning the most effective and feasible methods to reduce stigma towards mental illness (Corrigan, 2001). In particular, a large body of research has suggested that education - or more specifically, educating people about the causes of schizophrenia - may be an effective way to achieve this goal (e.g. Boysen & Vogel, 2008). So far, two causal explanations have dominated the literature; psychosocial causal explanations and biogenetic causal explanations. However, only a small number of experimental studies have directly compared the teaching of these opposing two models on levels of stigma (Lincoln, Arens, Berger, & Rief, 2008; Schlier, Schmick, & Lincoln, 2014; Walker & Read, 2002). The findings from these studies show that the effects of causal explanations on stigma are contradictory, thus highlighting the need for another experiment to discern the actual successfulness of these methods at reducing negative attitudes towards schizophrenia. Additionally, due to the mixed findings in the literature regarding the effectiveness of etiological information at lowering stigma, it seems warranted that further exploration into novel, educational teachings is conducted to establish whether causal information really is the most appropriate educational explanation to enlist if stigma reduction is the end goal. In the current research, two experiments were conducted where participants were provided different explanations for schizophrenia (both causal and non-causal in nature) or no explanation at all. Participants received either a biogenetic causal explanation of schizophrenia, a psychosocial causal explanation of schizophrenia, or a creative explanation for schizophrenia, (Experiment One). Comparatively, in Experiment Two participants were provided either a causal explanation for schizophrenia (biogenetic, psychosocial, epigenetic) or, no information at all. Findings from both experiments suggested there were no significant differences between the levels of prejudice and discrimination of participants who saw information which was causal in nature, and those who did not. Further, no evidence was found to support the hypothesis that different causal explanations have varying effects on stigma. Moreover, the previously untested explanations for schizophrenia did not produce stigma reducing effects. Strengths, limitations, implications and future directions are discussed.</p>

Reducing Stigma Toward Schizophrenia: An Investigation into what Information is Most Effective at Decreasing Negative Attitudes to Schizophrenia

<p>Schizophrenia is a chronic mental illness that manifests psychotic symptoms and largely affects an individual’s day to day functioning (Silva et al., 2017). In addition to the incapacitating symptoms of this disorder, patients with schizophrenia face another central concern: stigma (Stuart, 2016). In light of this, an abundance of previous research has been dedicated to discerning the most effective and feasible methods to reduce stigma towards mental illness (Corrigan, 2001). In particular, a large body of research has suggested that education - or more specifically, educating people about the causes of schizophrenia - may be an effective way to achieve this goal (e.g. Boysen & Vogel, 2008). So far, two causal explanations have dominated the literature; psychosocial causal explanations and biogenetic causal explanations. However, only a small number of experimental studies have directly compared the teaching of these opposing two models on levels of stigma (Lincoln, Arens, Berger, & Rief, 2008; Schlier, Schmick, & Lincoln, 2014; Walker & Read, 2002). The findings from these studies show that the effects of causal explanations on stigma are contradictory, thus highlighting the need for another experiment to discern the actual successfulness of these methods at reducing negative attitudes towards schizophrenia. Additionally, due to the mixed findings in the literature regarding the effectiveness of etiological information at lowering stigma, it seems warranted that further exploration into novel, educational teachings is conducted to establish whether causal information really is the most appropriate educational explanation to enlist if stigma reduction is the end goal. In the current research, two experiments were conducted where participants were provided different explanations for schizophrenia (both causal and non-causal in nature) or no explanation at all. Participants received either a biogenetic causal explanation of schizophrenia, a psychosocial causal explanation of schizophrenia, or a creative explanation for schizophrenia, (Experiment One). Comparatively, in Experiment Two participants were provided either a causal explanation for schizophrenia (biogenetic, psychosocial, epigenetic) or, no information at all. Findings from both experiments suggested there were no significant differences between the levels of prejudice and discrimination of participants who saw information which was causal in nature, and those who did not. Further, no evidence was found to support the hypothesis that different causal explanations have varying effects on stigma. Moreover, the previously untested explanations for schizophrenia did not produce stigma reducing effects. Strengths, limitations, implications and future directions are discussed.</p>

HIV stigma reduction interventions among health care providers and students in different countries: a systematic review

Background: Health care providers’ stigmatizing attitudes are obstacles to patients’ well-being and quality of life. Dealing with HIV-related stigma and understanding the impact of feasible interventions on reducing stigmatizing attitudes among health care providers are considered important strategies to improve the quality of HIV care, patient-provider relationships, and provide supportive and safe care services. Objectives: The aim of this study was to systematically review interventions to reduce HIV-related stigma among health care providers. Methods: This systematic review was performed using Medline, CINAHL, ERIC, and APA PsycInfo, Health Source: Nursing/Academic Edition to search for quasi-experimental studies and randomized controlled trials (RCTs) designed to reduce HIV stigma among health care providers. The quality of eligible research studies was independently appraised by two reviewers. Results: A total of 774 studies were screened, 100 articles were assessed for the eligibility, and 10 studies met the inclusion criteria. All interventions effectively reduced HIV-related stigma. Elements of successful interventions including knowledge modules, peer education, patients’ testimonials, Photovoice-informed stigma reduction training, stigma-free space intervention, and popular opinion leaders. Interventions were assessed and compared in terms of contents, delivery modes, HIV stigma measurements, follow-up, and limitations. Conclusions: This systematic review supports the effectiveness of in-person educational interventions at reducing HIV-related stigma among health care providers across countries. Comparisons of delivery modes of interventions indicated that educational interventions delivered by patients’ testimonials and peer education strategies are more promising than lecture-based teaching methods. Further studies are needed to assess long-term effects of interventions on clinical behaviors and practices.

Determinants of HIV Testing Uptake among Women (aged 15-49 years) in the Philippines, Myanmar, and Cambodia

Background: Many countries have been trying to eliminate Mother-to-Child transmission of the Human Immunodeficiency Virus (HIV) and achieve the 90-90-90 target goals. The targets mean that 90% of People Living with HIV (PLWHIV) know their HIV status, 90% of those who are infected receive Antiretroviral treatment (ART), and 90% of those achieve viral suppression. Despite some progress, the goals have not been met in the Philippines, Myanmar, and Cambodia, countries with relatively high or growing HIV prevalence. This study identifies the sociodemographic determinants of testing among women in these countries so that better health education and stigma reduction strategies can be developed. Methods: Descriptive and multivariable analyses were conducted using Demographic and Health Survey data conducted in the Philippines (2017), Myanmar (2015/2016), and Cambodia (2014). The outcome variable was having ever been tested for HIV. Independent variables included knowledge and attitudes about HIV and social determinants of health. Results: A significant difference in testing rates among women was observed (the Philippines: 5%, Myanmar: 19%, Cambodia: 42%). In Myanmar and Cambodia, women who had more HIV knowledge and less stigma towards PLWHIV were more likely to get tested for HIV than those who did not. Marital status, education, wealth were strong predictors for HIV testing among women. Younger women aged 15-19 and those who live in the rural areas were less likely to get HIV tested than older and those living in urban areas. Employed women were less likely to seek an HIV test than the unemployed in Myanmar and Cambodia, whereas, in the Philippines, the opposite relationship was found. Conclusion and Global Health Implications: Women with less education and those less familiar with HIV should be targeted for HIV testing interventions. Stigma reduction and different testing strategies could facilitate early screening leading to improved HIV testing among women. Copyright © 2021 Myint et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

A Comparison of COVID-19 Stigma and AIDS Stigma During the COVID-19 Pandemic: A Cross-Sectional Study in China

Objective: To understand the current situation of stigmatizing attitudes toward Coronavirus Disease 2019 (COVID-19) in China and compare it with acquired immunodeficiency syndrome (AIDS).Methods: Convenient sampling and vignette-based methods were used to recruit participants on WeChat. A demographic form and adopted stigma scale were used to collect participants' demographic information and stigmatizing attitudes toward COVID-19 and AIDS.Results: A total of 13,994 questionnaires were included in this study. A high portion of participants tend to avoid contact with individuals affected with COVID-19 (74.3%) or AIDS (59.0%), as well as their family members (70.4% for COVID-19 and 47.9% for AIDS). About half of the participants agreed that affected persons could not only cause problems to their own family but also have adverse effects on others (59.6% and 55.6% for COVID-19, 56.9 and 47.0% for AIDS). The agreements with statements about perceived stigma were similar but slightly higher than those about personal stigma in both COVID-19 and AIDS. Participants' agreements with all statements regarding personal and perceived stigma attitudes between COVID-19 and AIDS were all statistically significant (p &lt; 0.001). Participants obtained COVID-19-related information mainly from social media (91.3%) and newspaper or television (77.1%) during the epidemic, and 61.0% of them thought information from newspapers or television was the most reliable.Conclusion: Several similarities and differences of people's attitude toward COVID-19 and AIDS were found. Avoidance, blame, and secondary discrimination to diagnosed persons and their surrounding persons were the main representations of COVID-19-related stigma. Stigma of COVID-19 had less moral link but more public panic. Experience from HIV-related stigma reduction and prevention can be applied to reduce COVID-19-related stigma.

Multi-level intersectional stigma reduction intervention to increase HIV testing among men who have sex with men in Ghana: Protocol for a cluster randomized controlled trial

Background Men with have sex with men (MSM) in Africa face high levels of stigma due to elevated HIV exposure (actual or perceived), same-sex practices, and gender non-conformity. These stigmas are documented barriers to HIV prevention and treatment. Most stigma-reduction interventions have focused on single-level targets (e.g., health care facility level [HCF]) and addressed one type of stigma (e.g., HIV), without engaging the multiple intersecting stigmas that MSM encounter. Determining the feasibility and acceptability of multi-level intervention of reducing intersectional stigma and estimating its efficacy on increasing HIV testing are needed. Methods We proposed a mixed method study among MSM in Ghana. First, we will develop the intervention protocol using the Convergence Framework, which combines three interventions that were previously implemented separately in Ghana for reducing stigma at the HCF-level, increasing HIV testing at the peer group-level, and increasing peer social support at the individual-level. Then, we will conduct a cluster randomized controlled trial with four pairs of HCFs matched on staff size. HCFs within each pair are randomized to the HCF-level stigma-reduction intervention or control arm. MSM (n = 216) will be randomized to receive the group-level and individual-level interventions or standard of care control arm. MSM will be assigned to receive HIV testing at one of the HCFs that match their study assignment (intervention or control facility). The frequency of HIV testing between MSM in the study arms at 3 and 6 months will be compared, and the predictors of HIV testing uptake at the HCF, peer group and individual-levels will be assessed using multi-level regression models. Discussion These findings from this study will provide important evidence to inform a hybrid implementation-effectiveness trial of a public health intervention strategy for increasing HIV case detection among key populations in sub-Saharan African communities. Accurate information on HIV prevalence can facilitate epidemic control through more precise deployment of public health measures aimed at HIV treatment and viral load suppression, which eliminates risk of transmission. Trial registration This study was prospectively registered on ClinicalTrials.gov, Identifier: NCT04108078, on September 27, 2019.

Destigmatising Schizophrenia: An Investigation into the Effects of Different Causal Explanations upon Stigma

<p>While many people with mental illnesses are stigmatised, those with schizophrenia are the most severely stigmatised group (Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000; Marie & Miles, 2008; Pescosolido et al., 1999). A vast body of psychology research has been devoted to investigating how education – particularly education about the causes of schizophrenia – can reduce this stigma that is attached to schizophrenia. While there is great support for the notion that education in general can reduce stigma (e.g. Costin & Kerr, 1962; Griffiths, Christensen, Jorm, Evans, & Groves, 2004; Ritterfeld & Jin, 2006), there is still disagreement regarding exactly which set of causal factors the general public should be educated about – biogenetic or psychosocial? Until now, only three previous studies (Lincoln, Arens, Berger, & Rief, 2008; Schlier, Schmick, & Lincoln, 2014; Walker & Read, 2002) have experimentally compared teaching a purely biogenetic causal explanation to teaching a purely psychosocial causal explanation. The results of this research appear to be somewhat contradictory leading to the need for another, more robustly designed experiment. In the present research, two experiments were conducted in which participants’ level of stigma was measured after they were given a biogenetic causal explanation of schizophrenia, a psychosocial explanation, or given no causal explanation. It was predicted that participants given a causal explanation would show reduced levels of stigma compared to participants given no causal information, and that there would be a significant difference in the stigma reduction effectiveness between types of causal explanation. Contrary to these expectations, the results of Experiment One showed no reduction in stigma when participants were given a causal explanation compared to no causal explanation, and revealed no significant differences in stigma reduction efficacy between the biogenetic and psychosocial causal explanations. Experiment Two utilised the same basic paradigm as Experiment One but with the addition of more convincing causal explanations and a manipulation check. The results of Experiment Two gave evidence that both a biogenetic and psychosocial causal explanation successfully reduces discrimination compared to giving no information on the causes of schizophrenia. In addition, a purely biogenetic causal explanation was also found to successfully reduce belief in other stereotypes compared to a psychosocial causal explanation or no causal explanation. Thus, I conclude that stigma can be effectively reduced by providing education about the causes of schizophrenia, and that a biogenetic causal explanation is a more effective stigma reduction tool as it reduces multiple types of stigma. Strengths, limitations, implications and future directions are discussed.</p>

Destigmatising Schizophrenia: An Investigation into the Effects of Different Causal Explanations upon Stigma

<p>While many people with mental illnesses are stigmatised, those with schizophrenia are the most severely stigmatised group (Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000; Marie & Miles, 2008; Pescosolido et al., 1999). A vast body of psychology research has been devoted to investigating how education – particularly education about the causes of schizophrenia – can reduce this stigma that is attached to schizophrenia. While there is great support for the notion that education in general can reduce stigma (e.g. Costin & Kerr, 1962; Griffiths, Christensen, Jorm, Evans, & Groves, 2004; Ritterfeld & Jin, 2006), there is still disagreement regarding exactly which set of causal factors the general public should be educated about – biogenetic or psychosocial? Until now, only three previous studies (Lincoln, Arens, Berger, & Rief, 2008; Schlier, Schmick, & Lincoln, 2014; Walker & Read, 2002) have experimentally compared teaching a purely biogenetic causal explanation to teaching a purely psychosocial causal explanation. The results of this research appear to be somewhat contradictory leading to the need for another, more robustly designed experiment. In the present research, two experiments were conducted in which participants’ level of stigma was measured after they were given a biogenetic causal explanation of schizophrenia, a psychosocial explanation, or given no causal explanation. It was predicted that participants given a causal explanation would show reduced levels of stigma compared to participants given no causal information, and that there would be a significant difference in the stigma reduction effectiveness between types of causal explanation. Contrary to these expectations, the results of Experiment One showed no reduction in stigma when participants were given a causal explanation compared to no causal explanation, and revealed no significant differences in stigma reduction efficacy between the biogenetic and psychosocial causal explanations. Experiment Two utilised the same basic paradigm as Experiment One but with the addition of more convincing causal explanations and a manipulation check. The results of Experiment Two gave evidence that both a biogenetic and psychosocial causal explanation successfully reduces discrimination compared to giving no information on the causes of schizophrenia. In addition, a purely biogenetic causal explanation was also found to successfully reduce belief in other stereotypes compared to a psychosocial causal explanation or no causal explanation. Thus, I conclude that stigma can be effectively reduced by providing education about the causes of schizophrenia, and that a biogenetic causal explanation is a more effective stigma reduction tool as it reduces multiple types of stigma. Strengths, limitations, implications and future directions are discussed.</p>