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PubMed1995

Assessing and treating anxiety in elderly persons.

Although anxiety disorders appear to occur less frequently in elderly persons, subsyndromal anxiety and anxiety associated with other medical and psychiatric disorders are significant sources of morbidity. Theories of etiology of anxiety range from the psychodynamic to the neurobiologic. Treatment of anxiety syndromes hinges on a thorough diagnostic evaluation, with attention to the tendency of older adults to prefer somatic descriptors and to view psychiatric illness as stigmatizing. The efficacy of nonpharmacologic treatment strategies such as relaxation training and psychotherapy for elderly anxious patients has not been well researched, but these interventions have been reasonably successful with younger adult populations and avoid the potential for harmful side effects of medication. Pharmacologic treatment strategies can be effective when used with appropriate caution.

Aged↗
PubMed1996

Issues in the treatment of lesbian women and gay men with chronic mental illness.

A growing theoretical and practical body of knowledge recognizes the common clinical concerns of chronic psychiatric patients who are homosexual and promotes their affirmative inclusion in psychiatric programs for other persons with chronic mental illness. This paper provides a clinical context for understanding essential issues in the inpatient and outpatient treatment of chronic psychiatric patients who are gay men or lesbian women. Such patients are largely an ignored or invisible subgroup in long-term psychiatric programs and in the gay and lesbian community. They are dependent on therapeutic communities, residences, and families that are heterosexually acculturated and often unaware of their needs. Most have experienced antihomosexual prejudice and the stigmatizing effects of mental illness. Affirmative models of treatment can be adapted to this population but must be modified to accommodate their psychiatric deficits. Increased efforts to destigmatize both mental illness and homosexuality are needed.

Chronic Disease↗
PubMedDate not supplied

Genetic screening for susceptibility to depression: can we and should we?

OBJECTIVE: To summarize current knowledge about genetic susceptibility to mood disorders and examine ethical and policy issues that will need to be addressed if robustly replicated susceptibility alleles lead to proposals to screen and intervene with persons at increased genetic risk of developing mood disorders. METHOD: Empirical studies and reviews of the genetics of unipolar and bipolar depression were collected via MEDLINE and psycINFO database searches. RESULTS: A number of candidate genes for depression have been identified, each of which increases the risk of mood disorders two- or threefold. None of the associations between these alleles and mood disorders have been consistently reported to date. CONCLUSIONS: Screening the population for genetic susceptibility to mood disorders is unlikely to be a practically useful policy (given plausible assumptions). Until there are effective treatments for persons at increased risk, screening is arguably unethical. Screening within affected families to advise on risks of developing depression would entail screening children and adolescents, raising potentially serious ethical issues of consent and stigmatization. Genetic research on depression should continue under appropriate ethical guidelines that protect the interests of research participants.

Adolescent↗
PubMed1981

Immigrants into society. Children with craniofacial anomalies.

Some of the adaptive coping styles of children with craniofacial anomalies are discussed. Three cases of children with microtia are described to illustrate developmental pathways used in adapting to their deformities. The complexity of the chronic medical and psychological challenges these children face is illustrated and discussed. In contrast to previous frameworks dealing with the problems of deviance and stigmatization, we use a psychological historical framework, drawing an analogy to Handlin's work on immigration. These children are born into a world that considers them strange and abhorent. They can be considered aliens entering a society of normal, non-disfigured people. The craniofacial center is conceptualized as a "naturalization" office where highly valued health care professionals are counted upon to reconstruct facial appearance and function. An enduring attachment and bonding process to the staff takes place, and the center becomes of considerable importance to the craniofacial patient's identity. The craniofacial patient often has to carry the pain of social isolation and stigma. Physicians caring for these children should be cognizant of their coping styles; so that development can be directed to move away from deviance to successful "immigration into the country of normals" and adaptation to life.

Adaptation, Psychological↗
PubMed2001

Labeling effect of Seishin-bunretsu-byou, the Japanese translation for schizophrenia: an argument for relabeling.

Stigma attached to individuals with schizophrenia may be derived from its diagnostic label. Two forms of a questionnaire were distributed to 189 Japanese university students. Each questionnaire contains case vignettes of schizophrenia and major depression. In one form, the students were told at the close of each vignette the diagnostic label assigned to that case (the label group) whereas in another form, they were not done so (the control group). The students were also asked to rate negative image of the case in four items each. The label group was significantly higher than the control group in three of the four negative image items for the vignette of schizophrenia. They did not differ in any of the negative image items for the vignette of depression. This suggests that the label of schizophrenia (the Japanese translation Seishin-bunretsu-byou) has stigmatizing effect. We discussed these findings in the light of the implications of a relabeling, and argued for a change of name.

Adult↗
PubMed2004

Coping with infertility among Kuwaiti women: cultural perspectives.

BACKGROUND: Although previous studies conducted in western countries have reported that psychological factors are part of the experience of infertility, no study has assessed this relationship in Arab women. AIMS: To examine psychological distress among Kuwaiti women with infertility problems and explore the perceived causes of infertility. METHODS: An Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to examine the psychological status of 120 Kuwaiti infertile women and an age-matched sample of 125 healthy pregnant women as a control group. RESULTS: Compared with age-matched pregnant control sample. The infertile women exhibited a significant higher psychopathology in all HADS parameters in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation. The illiterate group attributed the causes of their infertility to supernatural causes such as evil spirits, witchcraft and God's retribution, while the educated group blamed nutritional, marital and psychosexual factors for their infertility. Faith and traditional healers were considered as the first treatment choice among illiterate women, while the educated women opted for an infertility clinic for treatment. Childlessness results in social stigmatization for infertile women and places them at risk of serious social and emotional consequences. CONCLUSIONS: The prevalence and severity of psychological distress in this sample of infertile Kuwaiti women indicates the appropriateness of referring these patients for psychological evaluation. Successful programmes in dealing with infertility in Kuwait need to include the establishment of a community based intervention strategy to educate people about infertility and to give guidelines for treatment options.

Adaptation, Psychological↗
PubMed1975

Degree of pathology as related to readiness to accept labels in process and reactive schizophrenics.

Two experiments were performed in order to determine whether readiness to accept deviant labels, as measured by acquiescence set, interacts with type of schizophrenia (process vs. reactive) to influence level of pathology. It was found on both a behavioral measure and a psychometric measure of psychopathology that high acquiescent process schizophrenics manifested more pathology than did either low acquiescent process or reactive schizophrenics, both of whom showed more pathology than high acquiescent reactive schizophrenics. The results suggest that one's acceptance of deviant labels as well as one's past history of being assigned social and evaluative labels may influence the patient's level of pathology. Scheff (1966), in viewing the mental patient from a sociological perspective, suggests that an important determinant of mental disorder is the acceptance by the deviant individual of the various labels which stigmatize him as mentally ill. If this is the case, then individual differences in readiness to accept or agree with labels about oneself may be related to the degree of pathology manifested in a psychiatric population. The present authors sought to determine if acquiescence set, as measured by the Agreement Response Scale (Couch & Keniston, 1960), is related to degree of pathology in schizophrenic patients. The Agreement Response Scale was used as a measure of the general tendency to acquiesce to or agree with personality statements or labels. The investigators performed two experiments, in Experiment 1 a behavioral measure of pathology was used and in Experiment 2 a psychometric measure of pathology was used. In addition, the schizophrenic Ss were grouped according to the process-reactive distinction as the reactive schizophrenic may be expected to have a more favorable history of labeling than would the process schizophrenic.

Adult↗
PubMed1998

A historical review of mental health services in Hong Kong (1841 to 1995).

This paper is a historical review of mental health services in Hong Kong. The development of mental health services in Hong Kong can be roughly divided into several stages: the pre-asylum period (1841-1924), the asylum period (1925-1948), the organization period (1 948-1965), the initial rehabilitation period (1966-1973), the centralized rehabilitation period (1974-1981) and the civic control vs community care period (1982-1995). From the development of mental health services in Hong Kong, it is clearly demonstrated that the aims and the trends of mental health services had gradually progressed from a detention model, to a treatment model and finally to a rehabilitation model. Nevertheless, under a shortage of governmental resources and the severe opposition of public stigmatization, community based rehabilitation existed in the form of institution-like service units. In comparison with the international de-institutionalization and community care movement, mental health services in Hong Kong are not affected by any de-institutionalization movement. Instead, the unique political and social context nurtured a parallel development of both institutional care and community care for mental patients.

Community Mental Health Services↗
PubMed1998

Psychiatric labelling, sex role stereotypes and beliefs about the mentally ill.

This study aimed to investigate the effect of two main variables on specific attitudes and beliefs about mental illness. The first variable tested the labelling theory proposal that the label of mental illness per se is stigmatizing for those so labelled. The second tested the proposal of Rosenfield (1982) that males and females receive a more severe societal reaction for deviance when the deviant behaviour is inconsistent with traditional sex role norms. Questionnaires with vignettes describing four behaviour types were given to young adult respondents. The expected effect of a psychiatric diagnosis and of deviance from sex role stereotypes were not confirmed. It was concluded that while several variables combine to influence specific attitudes and beliefs about the mentally ill, the type of behaviour displayed is the crucial factor.

Adolescent↗
PubMed1999

Help-seeking preference of college students in urban China after the implementation of the "open-door" policy.

A sample of 466 college students (228 males, 238 females) in urban China completed a questionnaire to indicate their help-seeking preferences with respect to 8 types of problem. The results indicated that our subjects, particularly male students, preferred to rely on their own in resolving their problems, although this self-reliant tendency was less obvious for problems of future employment and severe psychological distress. When help was sought, the tendency to rely on parents was found to be stronger among females than males. Male students were more likely than their female counterparts to seek help from friends and psychiatric consultation. Nevertheless, there was still great reluctance among the college students to use mental health services, particularly psychiatric consultation. Lack of credibility of the professionals was a barrier more negative than stigmatization which prevented students from seeking psychiatric consultation. Moral rather than psychosocial attribution of psychiatric illness was most predictive of the tendency to use mental health services. Findings inconsistent with those reported in other Chinese communities are discussed.

Adolescent↗
PubMed1990

The self-perception of a learning disability and its relationship to academic self-concept and self-esteem.

Eighty-seven children with learning disabilities, aged 9 through 11 years 11 months, completed measures of self-esteem, academic self-concept, and self-perception of their learning disability. The Self-Perception of Learning Disability (SPLD) instrument measures the extent to which children with learning disabilities perceive their disability as (a) delimited rather than global, (b) modifiable rather than permanently limiting, and (c) not stigmatizing. It was hypothesized that self-perception of one's learning disability would be related positively to both academic self-concept and self-esteem, and that each of these relationships would remain significant when controlling for sex, ethnicity, age, reading and math achievement, self-contained versus mainstreamed classroom setting, and age at diagnosis. Correlations and multiple regression analyses confirmed these hypotheses. Results were discussed in terms of helping children to develop less negative self-perceptions of their disabilities.

Achievement↗
PubMed1996

Students with learning disabilities in education: managing a disability.

The purpose of this study was to examine factors that have contributed to the success of students with learning disabilities (LD) in schools and to explore how these students manage their disabilities from kindergarten through college. The study followed a qualitative research methodology consisting of reviewing academic records and conducting interviews and classroom observations over a 6-month period. The subjects were 9 students with learning disabilities enrolled in a public 4-year university. It was found that the students experienced labeling, stigmatization, and gatekeeping throughout their school years. Furthermore, the students employed a variety of positive and negative coping techniques in an effort to successfully manage their disabilities in school. Positive coping techniques included relying on benefactors, implementing self-improvement techniques, and utilizing particular strategies and management skills to assist with academics. Negative coping techniques were described as "passing" and created tension for the students. Students employed passing techniques to avoid disclosure of their disability and to make it through school. The results of this study have significant implications for school administrators and university educators who provide services for students with LD under current federal laws, and further underscore the need for such students to self-advocate.

Achievement↗
PubMed1992

An approach to the patient with skin disease.

We practise an integrated approach to the management of skin diseases, leprosy and sexually transmitted diseases because the latter diseases are still stigmatized and patients are unwilling to attend clinics so labelled. When approached by a patient with skin disease it is advisable to see the patient promptly, because any further delay encourages the use of assorted remedies which may lead to undesirable complications, physically, emotionally and financially. Since there is no health insurance scheme, it is also prudent to manage the patient as much as possible without admission to hospital and with minimal laboratory investigations, to save cost, so that the patient still has sufficient money to buy the required drugs. Family health workers treat patients at the primary health care (PHC) level. At this level, patients are managed by the use of specially prepared standing orders (SO), where checklists and flow charts are grouped by problems or complaints, to facilitate usage by an individual with minimal training in morphology. The SO presents, so far as is possible, the best treatment available for each condition, but which cannot be misused by the primary health care personnel. Before discussing the management of individual diseases, it is important for the reader to appreciate the milieu in which we practise which determines our approach to the patient with skin disease. Some of its features will be highlighted before the management of individual disorders is discussed.

Humans↗
PubMed1999

Family support in general practice.

At a time when social services are overburdened in Britain, family support in general practice offers one way to fill the gap. In the Well Family Project, a 'family support coordinator' worked within a general practice in Hackney, London. In the first eighteen months she saw 113 clients. Evaluation was by semistructured interviews with a sample of these clients and with professional workers. Comments from those interviewed indicate that the family support was valued. The general practice base was convenient and non-stigmatizing. By adopting a proactive approach, the project was able to work with clients who had previously 'slipped through the net'. Some of the professionals interviewed would have liked to provide the same help, but were unable to do so because of time and other constraints. Family support provided through general practice was well received by vulnerable families. Although there was overlap with the remit of health visitors and social workers, the protected time and the independence of the coordinator enabled clients to obtain the help they wanted. The replicability of this strategy now needs to be assessed.

Adult↗
PubMed1990

Behavioral family treatment for patients with bipolar affective disorder.

Techniques of behavioral family management (BFM), which have been found to be highly effective in delaying relapse for schizophrenic patients when used as adjuncts to medication maintenance, are also applicable in the outpatient treatment of recently hospitalized bipolar, manic patients. The authors describe their adaptation of the educational, communication skills training, and problem-solving skills training modules of BFM to families containing a bipolar member. The observations that families of bipolar patients are often high functioning, and that these families seem to enjoy interchanges that are highly affective and spontaneous, led to certain modifications in the original BFM approach. The authors found it necessary to be (a) more flexible and less didactic, (b) more oriented toward dealing with affect and resistance to change, and (c) more focused on the patient's and family members' feelings about labeling, stigmatization, and medication usage. Research issues relevant to testing the efficacy of this approach are also discussed.

Adult↗
PubMed2003

Assessing anti-White attitudes and predicting perceived racism: the Johnson-Lecci scale.

Five studies are herein reported to describe the development and preliminary validation of the Johnson-Lecci Scale (JLS), a multicomponent self-report measure of anti-White attitudes held among Blacks. Items were generated from the everyday experiences of Black respondents using an act-frequency approach, and the scale configuration was derived using factor analysis. The factor structure was shown to be robust because it was cross-validated in an independent sample. The resulting JLS factors (subscales) were ingroup-directed stigmatization and discriminatory expectations, outgroup-directed negative beliefs, negative views toward ingroup-outgroup relations, and negative verbal expression toward the outgroup. These subscales were shown to predict the interpretations of ambiguously racist scenarios (i.e., perceived racism) and converged with peer evaluations of the target's anti-White attitudes. The subscales also demonstrate both convergent and discriminant validity with other self-report assessments of bias relating to age, gender, education, socioeconomic status, and race.

Black People↗
PubMed2005

Stereotyping, self-affirmation, and the cerebral hemispheres.

The authors used the processing characteristics of the left and right cerebral hemispheres to gain some insight into the relation between self-affirmation and stereotyping. In Study 1, self-affirmation led to greater stereotyping (of a librarian) and to greater left hemisphere activation, which in turn mediated the self-affirmation/stereotyping relationship. Study 2 replicated these results but also found that self-affirmation decreased stereotyping for a stigmatized target. However, relative hemisphere activation did not mediate this self-affirmation/stereotyping relationship. These studies showed that self-affirmation can either increase or decrease stereotyping depending on the status of the target and that relative hemisphere activation may provide clues as to underlying processes of stereotyping. In both studies, relative hemisphere activation was assessed using a line bisection task. Discussion focuses on possible mechanisms of different kinds of stereotyping and on the ways in which a consideration of relative hemisphere activation could help researchers gain insights into those mechanisms.

Brain↗
PubMed1992

Graduate nursing students' attitudes toward gay and hemophiliac men with AIDS.

Subjects were 180 registered nurses enrolled in a master's nursing program. By random assignment, each read one of six versions of a vignette about a male patient. Vignettes differed in terms of patient's diagnosis (AIDS of unspecified origin, AIDS in a hemophiliac infected by blood transfusion, and leukemia) and sexual preference (gay or heterosexual). Nurses evaluated the patient on two scales, one involving judgments of patients and the other concerning willingness to interact socially with them. The hemophiliac/AIDS and leukemia patients were judged significantly less responsible for and less deserving of their illnesses than was the patient with AIDS of unspecified origin (p less than .001). However, all three diagnostic categories were considered equally deserving of the best possible care. Both categories of AIDS patients were stigmatized in terms of certain social interactions. There was also some weak evidence of antigay bias. Implications for theory and practice are discussed.

Acquired Immunodeficiency Syndrome↗