Development and Validation of the Psychotherapeutic Effectiveness Attribution Questionnaire (PEAQ-12) in a Spanish Population

In recent decades, the study of psychotherapy effectiveness has been one of the pillars of clinical research because of its implication for therapeutic cure. However, although many studies have focused their interest on the patient’s perception, there are no instruments oriented to the study of psychotherapists’ attributions of effectiveness: to what factors psychotherapists attribute responsibility for the cure of the therapies they provide. The present study aimed to develop and validate an instrument for assessing the attribution of the effectiveness of psychotherapy in a population of 69 psychotherapists of different theoretical orientations. After an initial process of inter-judge content validation, 12 items were selected for validation in the targeted population, adequately fulfilling the quality requirements in the validity–reliability tests, and grouped into four factors after principal component analysis. These factors were as follows: (1) therapeutic alliance enhancers; (2) psychotherapist emotional characteristics; (3) therapy-specific variables; and (4) facilitators of patient engagement with therapy. This four-factor structure also showed a good fit for the fit indices checked in confirmatory factor analysis. In summary, we can conclude that the Psychotherapeutic Effectiveness Attribution Questionnaire (PEAQ-12) developed in our research can be helpful if tested on a larger number of individuals. The results can be replicated in other populations of psychotherapists.

“attitudes of the Spanish Police Towards Patients With Schizophrenia or Depressive Disorders”

Background: Police officers have become an important part of psychiatric patients´ care; however, few studies have assessed the Police´s attitudes toward these patients. Our aim is to analyze the effect of the stigma associated with different mental illnesses on police officers.Methods: the attitudes of 927 officers of the Spanish National Police Force towards a person with schizophrenia or depressive disorder in the role of person in need of assistance, victim, witness, or suspect, were assessed by means of the Attribution Questionnaire adapted to the police context. Different socio-demographic variables were also collected. Results: Police officers expressed more willingness to help, felt more pity and considered psychiatric patients to be less responsible for their situation than people who were not described as being mentally ill. They also showed increased feelings of anger and avoidance, greater danger perception and need for segregation and coercion for medical treatment, especially in schizophrenia. Being a woman, the elderly and having more working experience, are associated with less stigmatizing attitudes among officers. Conclusions: Police officers have certain attitudes about mental illness particularly schizophrenia, that require special attention, as they may disrupt police action. We found several factors associated with the persistence of these stigmatizing attitudes in the Police that can guide us to implement training programs to promote attitude changing especially at the beginning of the professional career.

Effects of Renaming Schizophrenia on Destigmatization among Medical Students in One Taiwan University

The stigma associated with serious mental illnesses causes a huge burden on patients, their families, and society. In October 2012, in Taiwan, schizophrenia was renamed to reduce the stigma associated with this disease. The aim of this study was to compare the differences of public stigma, self-stigma, and social distance associated with schizophrenia between old and new name of schizophrenia in medical students. A cross-sectional survey was administered to 180 medical students of Taipei Medical University from October 2014 to February 2015. In total, 123 complete questionnaires were included in this study. Participants completed the modified attribution questionnaire, the perceived psychiatric stigma scale, and modified social distance scale to assess public stigma, self-stigma, and social distance, respectively. We also collected basic demographic data and previous experience of contact with people with mental illness. In total, 52 and 71 of the first- and fourth-year medical students, respectively, participated in the study. Among them, there were 51 females and 72 males. A significant difference in age was observed between the first- and fourth-year groups (20.2 ± 1.7 years vs. 22.7 ± 0.9 years, p < 0.001). After renaming schizophrenia, we noted significant differences in the scores in the modified attribution questionnaire, the perceived psychiatric stigma scale, and the modified social distance scale in all participants and the fourth-year students, respectively. Female gender (Beta = 0.230, p = 0.018) was significantly associated with the difference in the score of the modified attribution questionnaire after name change. The difference in the score of the perceived psychiatric stigma scale after the name change (Beta = 0.277, p = 0.004) and age (Beta = −0.186, p = 0.049) were significantly associated with the difference in the score of the modified social distance scale after name change. In conclusion, renaming was associated with the changes in the scores of the modified attribution questionnaire, the perceived psychiatric stigma scale, and the modified social distance scale toward individuals with schizophrenia in medical students of one Taiwan university. Further studies with large sample sizes, diverse participant backgrounds, and that monitor the subsequent behavioral changes are warranted.

Stigma about mental disease in Portuguese medical students: a cross-sectional study

Background The stigma about mental diseases is common in the population and also in medical students, where it may condition their future practice and the way they deal with these patients. Aim To evaluate and characterize the stigma on mental diseases in Portuguese sixth-year medical students, based on a clinical scenario of a classmate suffering from a mental disorder. Methods Observational cross-sectional study, involving sixth-year students of all Portuguese medical schools. We applied an online self-response questionnaire, using the Portuguese version of the Attribution Questionnaire AQ-9, and a vignette of a classmate colleague, presenting mental illness symptoms. Stigma scores were calculated. We used logistic regression to estimate the effect of social determinants on stigma pattern, and we analysed the correlation between 9 variables evaluated by the AQ-9 and total stigma. Results A total of 501 participants were included for analysis (69.5% females, median age of 24 years old). Medical students were available to help in the proposed clinical scenario (6.93/9.00; 95%CI:6.77–7.10), if necessary using coercion for treatment (3.85; 95%CI:3.63–4.07), because they felt pity (6.86; 95%CI:6.67–7.06) and they perceived some kind of dangerousness (4.06; 95%CI:3.84–4.28). Stigma was lower in students having a personal history of mental illness (OR:0.498; 95%CI:0.324–0.767; p = 0.002) and in those with positive familial history (OR: 0.691; 95%CI:0.485–0.986; p = 0.041). Conclusion Our results show the importance of implementing anti-stigma education, to improve medical students’ attitudes towards peers living with mental diseases.

Public Stigma Toward Female and Male Opium and Heroin Users. An Experimental Test of Attribution Theory and the Familiarity Hypothesis

Drug abuse and addiction exist around the world. People addicted to drugs such as opium or heroin often encounter dehumanizing discriminatory behaviors and health-care systems that are reluctant to provide services. Experiencing discrimination often serves as a barrier to receiving help or finding a home or work. Therefore, it is important to better understand the mechanisms that lead to the stigmatization of drug addiction and who is more prone to stigmatizing behaviors. There is also a dearth of research on whether different patterns of stigma exist in men and women. Therefore, this study investigated factors affecting gender-specific stigmatization in the context of drug addiction. In our vignette study (NMensample = 320 and NWomensample = 320) in Iran, we experimentally varied signals and signaling events regarding a person with drug addiction (i.e., NVignettes = 32 per sample), based on Attribution Theory, before assessing stigmatizing cognitions (e.g., blameworthiness), affective responses (e.g., anger), and discriminatory inclinations (e.g., segregation) with the Attribution Questionnaire. We also tested assumptions from the Familiarity Hypothesis by assessing indicators of respondents' familiarity with drug addiction (e.g., knowledge about addiction). Results, for example, show higher stigma if the person used “harder” drugs, displayed aggressive behavior, or had a less controllable drug urge. Self-attributed knowledge about addiction or prior drug use increased some forms of stigma, but diminished others. These findings only partially converged between men and women. We suggest that anti-stigma initiatives should consider information about the stigmatized person, conditions of the addiction, and characteristics of stigmatizers.

Usability of a Psychotherapeutic Interactive Gaming Tool Used in Facial Emotion Recognition for People with Schizophrenia

The objective of the study was to test the usability of ‘Feeling Master’ as a psychotherapeutic interactive gaming tool with LEGO cartoon faces showing the five basic emotions, for the assessment of emotional recognition in people with schizophrenia in comparison with healthy controls, and the relationship between face affect recognition (FER), attributional style, and theory of mind (ToM), which is the ability to understand the potential mental states and intentions of others. Nineteen individuals with schizophrenia (SZ) and 17 healthy control (HC) subjects completed the ‘Feeling Master’ that includes five basic emotions. To assess social cognition, the group with schizophrenia was evaluated with the Personal and Situational Attribution Questionnaire (IPSAQ) for the assessment of attributional style and the Hinting Task (ToM). Patients with SZ showed significant impairments in emotion recognition and their response time appeared to be slower than the HC in the recognition of each emotion. Taking into account the impairment in the recognition of each emotion, we only found a trend toward significance in error rates on fear recognition. The correlations between correct response on the ‘Feeling Master’ and the hinting task appeared to be significant in the correlation of surprise and theory of mind. In conclusion, this study demonstrated that the ‘Feeling Master’ could be useful for the evaluation of FER in people with schizophrenia. These results sustain the notion that impairments in emotion recognition are more prevalent in people with schizophrenia and that these are related with impairment in ToM.

Cultural adaptation and validation of the Attribution Questionnaire for stigma towards disability pension applicants for use among psychiatrists and general practitioners in Sweden

Background This study aimed to culturally translate the Attribution Questionnaire (AQ) to the Swedish language and examine the reliability and validity of the new Swedish version to measure stigma towards disability pension applicants in the Swedish context among psychiatrists and general practitioners. Methods The AQ was translated from the original English version into Swedish using the recommended guidelines for cultural translation of questionnaires. Steps included forward/back-translation, use of expert committee and pretesting. Cronbach’s alpha was used to determine internal consistency and structural equation modelling (SEM) was used to test the responsibility model of stigma compared to the original English version. Results 1,414 physicians completed the questionnaire (23.6%). Cultural translation resulted in many modifications to the original questionnaire to increase the external validity. Internal reliability of the AQ Swedish version (AQ-S) was 0.733 and is considered acceptable. Pity and Segregation-coercion sub-scales showed limited consistency. SEM findings show that the responsibility model of stigma is an acceptable fit for the Swedish setting. Conclusion Findings show that the AQ-S is comparable to the other versions of the AQ and is a reliable measure to assess and monitor stigma among physicians in the Swedish setting. Our study shows that cultural translation does not significantly impact the validity of the questionnaire.

Perception of internal medicine residents regarding psychiatric patients’ care

Introduction: Mental disorders are accountable for the segregation of patients in many diverse cultures and historical moments worldwide. The evolution of neuroscience, technologies and advances in the psychosocial sphere have not been enough to change this paradigm. Many people still fear having social relations with someone with a psychiatric disorder, despite scientific progress and efforts to reduce prejudice in recent decades. Objective: The aim of this study was to assess the training in mental health during the undergraduate course offered to residents in Internal Medicine and analyze the feelings, perceptions, and stigmas of these physicians regarding the care offered to patients with mental disorders. Method: This study has a qualitative, quantitative approach and descriptive, cross-sectional design. Thirty-two residents in Internal Medicine participated and, for comparison, the questionnaires were also answered by 8 residents in Psychiatry. Two instruments were applied: one for the characterization of the participants’ sociodemographic profile and the attribution questionnaire (AQ-26B). Qualitative data were obtained through a focus group with 14 residents and the content analysis was used for categorization. The most frequent categories were illustrated with Pareto charts. Results: The results demonstrated that residents in internal medicine showed higher indexes of stigma regarding aspects such as fear and intolerance. It was also possible to infer gaps related to training in mental health, low perception of care responsibility, in addition to the difficulty in legitimizing complaints and showing negative feelings. Conclusion: One can conclude the need for educational interventions that promote the decrease of the stigma and the search for training regarding comprehensive and empathic care for patients with mental disorders.