Effectiveness of programs for reducing the stigma associated with mental disorders. A meta‐analysis of randomized controlled trials

The stigma associated with mental disorders is a global public health problem. Programs to combat it must be informed by the best available evidence. To this end, a meta‐analysis was undertaken to investigate the effectiveness of existing programs. A systematic search of PubMed, PsycINFO and Cochrane databases yielded 34 relevant papers, comprising 33 randomized controlled trials. Twenty‐seven papers (26 trials) contained data that could be incorporated into a quantitative analysis. Of these trials, 19 targeted personal stigma or social distance (6,318 participants), six addressed perceived stigma (3,042 participants) and three self‐stigma (238 participants). Interventions targeting personal stigma or social distance yielded small but significant reductions in stigma across all mental disorders combined (d=0.28, 95% CI: 0.17‐0.39, p<0.001) as well as for depression (d=0.36, 95% CI: 0.10‐0.60, p<0.01), psychosis (d=0.20, 95% CI: 0.06‐0.34, p<0.01) and generic mental illness (d=0.30, 95% CI: 0.10‐0.50, p<0.01). Educational interventions were effective in reducing personal stigma (d=0.33, 95% CI: 0.19‐0.42, p<0.001) as were interventions incorporating consumer contact (d=0.47, 95% CI: 0.17‐0.78, p<0.001), although there were insufficient studies to demonstrate an effect for consumer contact alone. Internet programs were at least as effective in reducing personal stigma as face‐to‐face delivery. There was no evidence that stigma interventions were effective in reducing perceived or self‐stigma. In conclusion, there is an evidence base to inform the roll out of programs for improving personal stigma among members of the community. However, there is a need to investigate methods for improving the effectiveness of these programs and to develop interventions that are effective in reducing perceived and internalized stigma.     

Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates,correlates, impact and interventions

A systematic electronic PubMed, Medline and Web of Science database search was conducted regarding the prevalence, correlates, and effects of personal stigma (i.e., perceived and experienced stigmatization and self‐stigma) in patients with schizophrenia spectrum disorders. Of 54 studies (n=5,871), published from 1994 to 2011, 23 (42.6%) reported on prevalence rates, and 44 (81.5%) reported on correlates and/or consequences of perceived or experienced stigmatization or self‐stigma. Only two specific personal stigma intervention studies were found. On average, 64.5% (range: 45.0–80.0%) of patients perceived stigma, 55.9% (range: 22.5–96.0%) actually experienced stigma, and 49.2% (range: 27.9–77.0%) reported alienation (shame) as the most common aspect of self‐stigma. While socio‐demographic variables were only marginally associated with stigma, psychosocial variables, especially lower quality of life, showed overall significant correlations, and illness‐related factors showed heterogeneous associations, except for social anxiety that was unequivocally associated with personal stigma. The prevalence and impact of personal stigma on individual outcomes among schizophrenia spectrum disorder patients are well characterized, yet measures and methods differ significantly. By contrast, research regarding the evolution of personal stigma through the illness course and, particularly, specific intervention studies, which should be conducted utilizing standardized methods and outcomes, are sorely lacking.     

JUSTICE, STIGMA, AND THE NEW EPIDEMIOLOGY OF HEALTH DISPARITIES

Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking behaviour and indirectly through the internalization of negative interpersonal judgments. I then argue that social arrangements that foster self-respect can reduce the impact of stigmatization on health disparities. I conclude by showing how John Rawls' conception of justice can be used to address the intersection of stigma, health, and self-respect, in contrast to critics of his position, who have seen him as excessively focused on the allocation of material goods.     

Lessons learned from unintended consequences about erasing the stigma of mental illness

Advocates and scientists have partnered to develop and evaluate programs meant to erase the egregious effects of the different forms of stigma. Enough evidence has been collected to yield lessons about approaches to stigma change. Some of the most insightful of these lessons emerge from unintended consequences of good intentioned approaches, and are the focus of this paper. They include the limited benefits of education especially when compared to contact, beating stigma is more than changing words, beware pity as a message, understand the competing agendas of stigma change, replace ideas of normalcy with solidarity, and avoid framing self‐stigma as the problem of people with mental illness and not of society. The paper ends with consideration of the back seat role that psychiatrists and other mental health providers should have in stigma change.     

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force’s findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.     

The functional significance of a stigma color polymorphism in Acer pictum subsp. mono (Aceraceae)

Aims Exploring the characteristics and function of a flower color polymorphism contributes to our understanding of floral evolution in angiosperms. However, little information is available on stigma color polymorphisms in flowering plants despite their important functional role in plant reproduction.Methods We studied a stigma color polymorphism at the individual level in Acer pictum subsp. mono (aka A. mono) by investigating stigma-color morph proportion and comparing stigma performance and components of female fitness (pollen adhesion, pollen germination, fruit set, seed set and fruit weight) between the two morphs (red and greenish-yellow stigma) within natural populations at Dongling Mountain in the north of China. In the flowering period, we conducted hand pollination in natural populations and then made microscopic observations using the aniline blue fluorescence method.Important findings Individuals in the studied populations did not change their stigma color between years, and flowers produced by a single tree were uniform in their stigma color. This strongly suggests that stigma color variation is genetically controlled. The percentage of the red stigma flowers with germinated pollen grains was significantly higher than that of the greenish-yellow stigma flowers when hand pollination was conducted in the early flowering period, but not so in the late flowering period. There was no significant difference in the percentage of flowers with pollen adhesion to the stigma between the two morphs. Fruit set of the red morph was significantly higher than that of the greenish-yellow morph. Our findings suggest that the red morph may be more advantageous for pollen germination and fruit set than the greenish-yellow morph, which may provide a functional explanation for the high incidence of the red stigma morph in the studied populations. Alternative explanations for the stigma color polymorphism are discussed to stimulate further work.     

美国凌霄柱头行为--一种促进传粉的机制

引起美国(Campsis radicans(L.)Seem.ex Bureau.)柱头开合行为的原因迄今未知.在本研究中,机械刺激、自花授粉、异花授粉以及不同授粉数量分别给予美国凌霄的柱头,以期找到影响其柱头行为的原因.研究结果表明,单纯的机械剌激可以使柱头闭合,但不能使之水永久闭合;只有柱头表明落置了足够量的花粉(>350)时柱头才会最终闭合.美国凌霄的柱头对换自花或者花粉没有差异,两种花粉授于柱头后花粉管都能成功萌发并生长.研究结果表明:美国凌霄的柱头行为不是一种异交机制,而是一种促进传粉进而增强繁殖成功的机制.     

美国凌霄柱头行为——一种促进传粉的机制(英文)

引起美国凌霄(campsis radicans(L.)Seem.ex Bureau.)柱头开合行为的原因迄今未知。在本研究中,机械刺激、自花授粉、异花授粉以及不同授粉数量的授粉分别给予美国凌霄的柱头,以期找到影响其柱头行为的原因。研究结果表明,单纯的机械刺激可以使柱头闭合,但不能使之永久闭合;只有柱头表面落置了足够量的花粉(>350)时柱头才会最终闭合。美国凌霄的柱头行为对自花或者异花花粉没有差异,两种花粉授于柱头后花粉管都能成功地萌发并生长。研究结果说明:美国凌霄的柱头行为不是一种异交机制,而是一种促进传粉进而增强繁殖成功的机制。     

烟台甜樱桃柱头的可授性、形态特征与坐果率

采用数码照相、电镜扫描、联苯胺-过氧化氢测试及去雄套袋等技术手段, 对烟台甜樱桃(Cerasus avium)花期不同发育阶段柱头的可授性、形态特征和坐果状况进行了观察。结果表明, 烟台甜樱桃在套袋状态下, 柱头可授期从开花前1天开始可持续5–7天。从杯状花期到花瓣平展期, 柱头逐渐有乳突细胞破裂并呈现分泌液, 出现渐强的可授性; 从花瓣平展期到花瓣脱落期, 柱头由暗黄渐变至暗黑, 逐渐萎缩并丧失可授性。去雄套袋及人工授粉实验结果显示, 在大蕾期、杯状花期、花瓣展放期、花瓣平展期和花瓣脱落期进行人工授粉, 烟台甜樱桃的坐果率分别为60.50%、58.33%、62.08%、57.14%和39.13%。在自然条件下烟台甜樱桃的坐果率一般为30%–42%, 传粉成功的最佳期主要发生在杯状花期至花瓣平展期。     

有花植物触敏柱头的闭合行为及其适应意义

有花植物触敏柱头的闭合行为一直是传粉生态学和进化生物学研究的热点问题之一。植物花的多裂片柱头在传粉者接触后迅速闭合的现象主要存在于玄参目的一些类群中。早在上个世纪初,植物学家就对花的柱头闭合现象进行过初步的研究,认为柱头闭合主要是由于花粉在柱头上萌发时吸收水分导致柱头细胞膨压降低而引起的;并对柱头闭合的适应性提出了一些假说。近年来,许多学者研究证实柱头闭合能促进花粉萌发及花粉管伸长,或减少花粉散出与柱头接受花粉间的相互干扰,提高传粉者访问过程中花粉的散播量,并且柱头的状态会直接影响传粉者的取食行为。到目前为止,对柱头闭合的机制及其避免自交的假说还存在许多争议。关于触敏柱头的闭合行为,尤其是其适应机制及其生态学意义还有待更加系统和深入的研究。本文概述了触敏柱头的研究进展,并对研究中尚存在的一些问题进行了讨论。     

Personality disorder: a new global perspective

Personality disorder is now being accepted as an important condition in mainstream psychiatry across the world. Although it often remains unrecognized in ordinary practice, research studies have shown it is common, creates considerable morbidity, is associated with high costs to services and to society, and interferes, usually negatively, with progress in the treatment of other mental disorders. We now have evidence that personality disorder, as currently classified, affects around 6% of the world population, and the differences between countries show no consistent variation. We are also getting increasing evidence that some treatments, mainly psychological, are of value in this group of disorders. What is now needed is a new classification that is of greater value to clinicians, and the WPA Section on Personality Disorders is currently undertaking this task.     

Examining Effects of Anticipated Stigma,Centrality, Salience,Internalization, and Outness on Psychological Distress for People with Concealable Stigmatized Identities

Understanding how stigmatized identities contribute to increased rates of depression and anxiety is critical to stigma reduction and mental health treatment. There has been little research testing multiple aspects of stigmatized identities simultaneously. In the current study, we collected data from a diverse, urban, adult community sample of people with a concealed stigmatized identity (CSI). We targeted 5 specific CSIs – mental illness, substance abuse, experience of domestic violence, experience of sexual assault, and experience of childhood abuse – that have been shown to put people at risk for increased psychological distress. We collected measures of the anticipation of being devalued by others if the identity became known (anticipated stigma), the level of defining oneself by the stigmatized identity (centrality), the frequency of thinking about the identity (salience), the extent of agreement with negative stereotypes about the identity (internalized stigma), and extent to which other people currently know about the identity (outness). Results showed that greater anticipated stigma, greater identity salience, and lower levels of outness each uniquely and significantly predicted variance in increased psychological distress (a composite of depression and anxiety). In examining communalities and differences across the five identities, we found that mean levels of the stigma variables differed across the identities, with people with substance abuse and mental illness reporting greater anticipated and internalized stigma. However, the prediction pattern of the variables for psychological distress was similar across the substance abuse, mental illness, domestic violence, and childhood abuse identities (but not sexual assault). Understanding which components of stigmatized identities predict distress can lead to more effective treatment for people experiencing psychological distress.     

Stigmatization in the long-term treatment of psychotic disorders

Stigma is linked to negative prejudices without examining whether there is any justification for such behaviour. Over time, various efforts have been made to reduce prejudice toward people with mental illness. Yet, the World Health Organization (WHO) World Health Report still describes stigma as one of the greatest obstacles to the treatment of mental illness. While schizophrenia, among other mental illnesses, is the most stigmatized even to the point that some want the name of the illness to be hidden or changed, patients with bipolar illness may also be exposed to stigma. The degree of stigmatization has been found to be positively associated with the severity of the mental disorder, and stigma is carried out not only by patients but also by their families in correlation with the severity. Tragically, people with mental illness themselves are as negative in their opinions about mental illness as is the general public, and concerns about stigma adversely affect self-esteem and adaptive social functioning. There are many programmes worldwide for the fight against stigmatization, and there is clear recognition of the fact that stigma can only be successfully eliminated if the programme becomes a normal part of health service rather than of campaigns of limited duration.     

芍药花粉活力和柱头可授性的研究

用TTC法测定了芍药花粉的活力和寿命,用联苯胺—过氧化氢法测定了其柱头的可授期。结果表明,栽培芍药单瓣花植株的花粉活力和重瓣花植株的花粉活力在开花初期(1～2d)无明显差别,但重瓣花植株的花粉活力比单瓣花植株的花粉活力下降快;通常情况下,花粉寿命约为7d。栽培品种的柱头有个体差异,单瓣花植株有的开花后2h即可分泌粘液,而重瓣花植株的柱头在开花后,有的一直不分泌粘液,有的在开花后两天才分泌粘液;单瓣花植株的柱头可授性比重瓣花植株的强,一般分别在开花后6d和3d之内具可授性。移栽的野生芍药植株的花粉活力比栽培品种下降的慢,其寿命也较长,一般为15d;柱头的可授性和粘液分泌比栽培植株强。     

Internalization of weight bias: Implications for binge eating and emotional well-being

Objective: This study examined the relationship between internalization of negative weight‐based stereotypes and indices of eating behaviors and emotional well‐being in a sample of overweight and obese women. Research Method and Procedures: The sample was comprised of 1013 women who belonged to a national, non‐profit weight loss organization. Participants completed an on‐line battery of self‐report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias and symptoms of depression and self‐esteem, attitudes about weight and obesity, and binge eating behaviors. In addition, participants were asked to list the most common weight‐based stereotypes and whether they believed them to be true or false. Results: Participants who believed that weight‐based stereotypes were true reported more frequent binge eating and refusal to diet in response to stigma experiences compared with those who reported stereotypes to be false. The degree to which participants believed stereotypes to be true or false was not related to types or amount of stigma experiences reported, self‐esteem, depression, or attitudes toward obese persons. In addition, engaging in weight loss strategies as a response to bias was not predicted by stereotype beliefs or by actual stigma experiences, regardless of the amount or types of stigma reported. Discussion: These findings suggest that obese individuals who internalize negative weight‐based stereotypes may be particularly vulnerable to the negative impact of stigma on eating behaviors and also challenge the notion that stigma may motivate obese individuals to engage in efforts to lose weight. This study highlights a new area of research that warrants attention to better understand weight stigma and its potential consequences for health.     

Relationship of stigma behaviors and breeding system in three Mazus (Phrymaceae) species with bilobed stigma

Sensitive stigma has been recognized to facilitate outcrossing. We hypothesized that species with different levels of sensitivity might have corresponding differences in components of their breeding system. In this study, three Mazus species with bilobed stigmas were used to test the hypothesis. We explored stigma behaviors of the species in reaction time, recovery time, permanent closing time, and the minimum pollen load causing permanent closure. We investigated floral traits, pollinator type and behavior, pollination intensity, and natural schedule of pollen deposition on stigma. Moreover, we evaluated the mating system of the species by checking seed set after controlled pollination treatments, namely, natural flowers with open pollination, enclosed flowers without pollination, and enclosed flowers with self and outcross hand pollination. Results indicated that stigma of M. pumilus (N. L. Burman) Steenis was not sensitive, whereas stigmas of M. miquelii Makino and M. stachydifolius (Turcz.) Maxim. closed and reopened quickly in response to pollination. Accordingly, hand pollination treatments revealed that seed set of self-spontaneous pollination in M. pumilus was similar to the other treatments. For M. miquelii, outcross pollen resulted in significantly higher seed set than self-pollen.Mazus stachydifolius was self-incompatible. Additionally, the corresponding characteristics in other components of the breeding system for each species were found. Our study indicated that the sensitivity of bilobed stigma might be linked with floral traits and the mating system in a given species. Sensitive stigma should be regarded as an evolutionary mechanism for enhancement of outcrossing.     

宁夏枸杞柱头和萌发花粉中钙分布特征

用焦锑酸钾沉淀法对宁夏枸杞柱头和花粉中的钙离子分布进行了研究.结果显示,宁夏枸杞柱头表皮有一覆盖层,其中有许多含钙沉淀颗粒的小泡,当花粉落到柱头后从覆盖层中吸水,在萌发孔的表面上聚集了较多的钙沉淀颗粒.同时,花粉内部出现许多含钙的小液泡,使花粉体积增大,内部产生膨压,花粉萌发;生长在覆盖层中的花粉管顶端穿过覆盖层小泡时,附近聚集了较多的钙沉淀颗粒,在花粉管壁上也附着较多的细小钙沉淀颗粒.萌发的花粉粒中由大液泡占据,在其亚顶端的细胞质中,聚集较多钙沉淀颗粒的线粒体膨大形成了一些含钙沉淀颗粒的小液泡,由这些小液泡融合形成的大液泡,将花粉管细胞质挤到其顶端,使其极性生长.这是首次发现在植物柱头覆盖层中有钙离子的现象,从体内证明了钙离子在花粉萌发过程中的现象.讨论了枸杞柱头组织中钙的分布和花粉管的萌发与生长的关系.     

Standardised measures of needs,stigma and informal care in schizophrenia using a bottom-up,cross-cultural approach

Background There is a lack of instruments to measure the needs, stigma and informal care of people with schizophrenia that take account of sociocultural variation and patients'' and formal and informal carers'' opinions and experiences.Aims To develop questionnaires to measure stigma, needs and informal (non-professional) care for people with schizophrenia.Method We undertook the study in seven countries and in English, Spanish and Portuguese. We first held focus group discussions with patients, formal carers (professionals) and informal carers (family and friends) in Spain, the UK, Argentina, Brazil, Chile and Venezuela to elicit the main dimensions of needs, stigma and informal care. We then held nominal group discussions about these dimensions with patients, family members and professionals in Spain, Portugal and the UK, to develop the instruments.Results Three hundred and three people participated in 46 focus groups and results were discussed in three nominal groups, each involving eight participants. Three instruments were developed in this iterative process: needs for care (46 items), stigma (38 items) and informal care (20 items).Conclusions These instruments are based on service users'' and carers'' views and experiences and have cross-cultural validity. They will have application in assessment of outcomes for people with schizophrenia and their families.