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Il fenomeno dello stigma in una popolazione studentesca della Facoltà di Medicina e Chirurgia dell’Università degli Studi di Modena e Reggio Emilia: caratteristiche epidemiologiche, sociologiche e personologiche
No full textINTRODUZIONE. Lo stigma in salute mentale è stato riconosciuto come uno dei fattori maggiormente sfavorenti la guarigione, la riabilitazione e il reinserimento nel contesto sociale di persone affette da un disturbo mentale.
SCOPI DELLO STUDIO. Il presente studio si propone di indagare tre diverse aree legate al fenomeno della stigmatizzazione nel contesto della popolazione studentesca della Facoltà di Medicina e Chirurgia dell’Università degli Studi di Modena e Reggio Emilia: 1) validazione psicometrica della versione italiana dell’Attribution Questionnaire 27 (AQ-27-I), questionario autosomministrato utile per la verifica di presenza di atteggiamenti stigmatizzanti; 2) definizione e analisi delle differenze statisticamente significative relative agli atteggiamenti stigmatizzanti presenti nella popolazione generale e nella popolazione studentesca universitaria oggetto di studio; 3) analisi delle caratteristiche personologiche della popolazione studentesca universitaria come possibili predittori di atteggiamenti stigmatizzanti verso persone affette da un disturbo mentale.
METODOLOGIA. 1) La validità interna dello strumento è stata stimata attraverso il calcolo dell’Alpha di Cronbach. L’Analisi Confermativa Fattoriale è stata utilizzata per verificare l’applicabilità del costrutto teorico del questionario. 2) Le informazioni ottenute dalla popolazione studentesca universitaria sono state confrontate con le medesime informazioni raccolte presso un campione rappresentativo della popolazione generale per verificare la presenza di differenze statisticamente significative per quanto riguarda gli atteggiamenti stigmatizzanti. 3) E’ stato inviato l’AQ-27-I, il Temperament and Character Inventory e una scheda raccolta dati socio-demografici agli studenti della Facoltà di Medicina e Chirurgia dell’Università di UNIMORE. I dati raccolti sono stati descritti ed analizzati tramite l’utilizzo della regressione lineare per individuare un eventuale ruolo predittivo delle caratteristiche personologiche rispetto ad atteggiamenti stigmatizzanti.
RISULTATI. 1) 311 studenti (response rate = 32.81%) hanno restituito il questionario. La validità interna ha dato risultati soddisfacenti (α=.68) e gli indicatori relativi alla path analysis supportano la struttura fattoriale del questionario. 2) Ad eccezione della sottoscala “Aiuto” la popolazione generale (N=222) ha ottenuto, in modo significativo, punteggi medi sempre maggiori nelle diverse sottoscale dell’I-AQ-27 (punteggio totale: 111,77 vs 99,68) . 3) Nel modello della “Pericolosità” è stata definita una maggiore omogeneità dei possibili predittori di atteggiamenti stigmatizzanti fra la componente cognitiva e quella emozionale (“Evitamento del danno”, “Persistenza”, Autodirezionalità” e “Cooperatività”). Al contrario nel modello della “Responsabilità Personale” è stata riscontrata una significativa sovrapposizione fra i predittori del fattore “Rabbia” e quelli del fattore “Segregazione” (“Ricerca della novità”, “Evitamento del danno”, “Autodirezionalità” e “Cooperatività”).
DISCUSSIONE E CONCLUSIONI. 1) L’AQ-27-I dimostrato di poter essere utilizzato nel contesto della popolazione studentesca universitaria. 2) Le differenze di atteggiamento stigmatizzante emerse fra le due popolazioni (studentesca e generale) potranno essere utilizzate per progettare interventi di lotta allo stigma. 3) L’individuazione delle caratteristiche personologiche considerate come predittori di atteggiamenti stigmatizzanti può di fatto essere considerato un importante passo per la definizione dei meccanismi intrinseci che portano un individuo ad assumere atteggiamenti stigmatizzanti.INTRODUCTION. The phenomenon of stigma in mental health has been recognized as one of the most important factors contrasting recovery, rehabilitation and reintegration into the social context of people suffering from a mental disorder.
AIMS OF THE STUDY. The present study aims to investigate three different areas related to the phenomenon of stigma in the context of the student population of the Faculty of Medicine and Surgery at the University of Modena and Reggio Emilia: 1) Psychometric validation of the Italian version of the Attribution Questionnaire 27 (AQ-27-I), a self-administered questionnaire measuring the presence of stigmatizing attitudes. 2) Comparison of stigmatizing attitudes among the university students vs. a representative sample of general population. 3) Analysis of the personological characteristics of the university students as possible predictors of stigmatizing attitudes.
METHODOLOGY. 1) The internal validity was assessed using Cronbach's Alpha. Confirmatory Factor Analysis was used to test the usefulness of the theoretical construct of the questionnaire. 2) The information obtained from the university college student population were compared with the same information collected from a representative sample of the general population to define the presence of statistically significant differences with regard to the stigmatizing attitudes. 3) The students of the Faculty of Medicine and Surgery (UNIMORE) completed the AQ-27-I, the Temperament and Character Inventory, and a socio-demographic form: results were described and analysed to recognize predictive roles of personological characteristics towards stigmatizing attitudes.
RESULTS. 1) 311 students returned the questionnaire (response rate = 32.81%). Internal validity gave satisfactory results (α =0.68) and the indicators related to path analysis supported the factorial structure of the questionnaire. 2) With the exception of the subscale "Help", the general population (N=222) obtained significantly higher average scores corresponding to higher tendency to stigma (total score: 111,77 vs 99.68). 3) In the model of "Dangerousness" the cognitive and the emotional component were defined with greater homogeneity of possible predictors of stigmatizing attitudes ("Harm Avoidance", "Persistence", ”Self Directedness" and "Cooperation"). The model of "Personal Responsibility" was characterised by a significant overlap between the predictors of the factor "Anger" and those of the factor "Segregation" ("Novelty Seeking", "Harm Avoidance", ”Self Directedness" and "Cooperation”).
DISCUSSION AND CONCLUSIONS. 1) Validity of AQ-27-I was confirmed. 2) The differences as to stigmatizing attitudes between university students and general populations are very informative and can be used to develop effective anti-stigma interventions. 3) The identification of the personological characteristics as predictors of stigmatizing attitudes can be considered an important step for the definition of intrinsic mechanisms that lead an individual to adopt stigmatizing attitudes
Lo stigma associato alla malattia mentale: tipologie, conseguenze e strategie per contrastarlo
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Psychiatric comorbidity in end-stage liver disease patients with and without HIV infection
No full textPsychiatric comorbidity in end-stage liver disease patients with and without HIV infectio
Internet as a tool to estimate psychiatrists’ opinions on consultation activity in the Emergency Room: a mix-method survey
No full textOBJECTIVES This study aims at exploring the attitudes of psychiatrists towards their work as consultants in the Emergency Room (ER). Considerations and suggestions concerning the use of Internet-based surveys for research purposes are also offered.
METHODS A quali-quantitative Internet survey was sent to 288 psychiatrists. The 11-item questionnaire was made up of 8 half-structured questions, 2 multiple-choice questions and 1 open question. Surveymonkey was used to collect responses. Data collection went on for two weeks, from June 1st until June 15th 2011. Psychiatric consultation activity in the ER deals with assessing and managing patients with mental health problems in the specific context of urgency/emergency.
RESULTS Out of the 288 invitations sent by e-mail, 132 questionnaires were returned (response rate: 45.8%); of these, 58 provided useful data for the research since they were answered by psychiatrists who usually practice as consultants in the ER. Fifty-three percent of the responders were women. Mean age was 43.6 years ± 7.4. Forty percent of the consultants said they are called in the ER “more than once a week”, mainly due to “acute clinical failures” (31%), “behavioural emergencies” (22%), “acute clinical onsets” (17%) and “self-harm behaviours” (13.8%). Social emergencies were indicated as a rare cause of consultation (1.7%), yet they were considered particularly challenging by the 36.2% of psychiatrists. A large amount of psychiatric assessments in the ER (69%) led “to prescribe a therapy and send the patient to the mental health community centre”. Some critical aspects were pointed out, such as: “lack of suitable setting” (50.9%) for meeting the patient, a “trend to delegate to the psychiatrist” (45.5%) by the ER personnel, “poor autonomy of the personnel working in the ER” (38.2%), and “poor perceived safety” (30.9%) by the consultant. Yet, it is noticeable that the vast majority of psychiatrists (75.9%) reported that they enjoy their activity as consultants in the ER.
CONCLUSIONS The study points out that the majority (75.9%) of psychiatrists like their job as consultants in the ER, even if referrals are not always appropriate and settings sometimes fail to be suitable. Some relevant critical aspects were also addressed that should provide suggestions for improvement of effectiveness, organization and integration within the general hospital, to reduce waste of resources. Internet is useful and feasible as a research tool, due to low costs and easy logistics, particularly when studying younger subjects, though limited external validity might be a problem only partially addressed by adopting mixed-method strategies of research
Views on psychosis and judgment of appropriateness of early interventions in pre-psychotic phase: A survey of members of the International Early Psychosis Association
No full textBackground: The evidence base for preventive interventions in psychosis during the pre-psychotic
phase is still scarce. Professional views on this topic may be influenced by individual and professional
background factors.
Aims: To study factors that possibly influence judgmentsmade bymental health professionals dedicated
to early psychosis on the appropriateness of early interventions during the pre-psychotic phase.
Method: Members of the International Early Psychosis Association (IEPA) were asked general questions
about concepts of psychosis and about three case scenarios describing a client in the pre-psychotic phase.
Results: Views of 325 respondents were collected. About half the respondents thought that psychotic
experiences exist on a continuum with normal experiences. Psychologists were more likely than other
professional groups to endorse this view. A total of 52.6% of respondents (n1⁄4171) believed that
untreated psychotic episodes cause irreversible brain changes. Psychologists were less likely to endorse
this view, which was associated with a willingness to offer pharmacologic interventions in pre-psychotic
phases. More than 80% agreed, in most severe cases, on proposing lifestyle changes and psychological
interventions.
Conclusions: When challenged with case scenarios, mental health professionals with clinical and
research experience with patients with early psychosis expressed varied opinions on the appropriateness
of pre-psychotic interventions, especially concerning pharmacologic treatment. Professional views
on this topic were related not only to the level of symptoms and degree of active request for help from
the client, but also to the professional’s role and different conceptions of psychosis endorsed. These
aspects warrant further study.
Declaration of interest: G. M. Galeazzi and K. Elkins are members of the IEPA. Funding is detailed in
Acknowledgments
Short-term effects of the 2008 Great Recession on the health of the Italian population: an ecological study
No full textPurpose To report on the effects on health that the 2008 Great Recession is producing in Italy, by comparing the consistency of Italian data with general observations reported in the scientific literature, and by pointing out consequences on the rates of all-cause mortality, cardiovascular mortality, male suicidal behaviours, daytime alcohol drinking and traffic fatalities.
Methods This is an ecological study in which MEDLINE, PsycINFO and PubMed were searched for the literature with combinations of the following keywords: economic recession, financial crisis, unemployment, health, suicide and mental health. Data from two Italian government agencies (Italian Institute of Statistics, ISTAT, and Italian Agency of Drugs, AIFA) in the years from 2000 to 2010 were obtained and analysed, by producing models of multiple linear regressions.
Results After the recession onset, all-cause mortality remained stable, and was not associated with the economic fluctuations. Differently, cardiovascular mortality was associated with the rate of unemployment, and showed a significant increase in 2010. Alcohol consumption increased in 2009, the year with the worst real GDP decrease (-5.1 %). Though the total rate of suicide was not associated with the economic situation, male completed and attempted suicides due to financial crisis were significantly associated with the rate of unemployment and the real GDP. The increasing diffusion of antidepressants was not associated with a lowering of the rate of suicide.
Conclusions The data on the Italian situation here discussed are sufficiently reliable to conclude that a link exists between the ongoing economic recession and health and mental health of Italians. Further research is needed to understand more in detail and with stronger reliability such link, to support primary and secondary preventive interventions and orient the development of effective sociopolitical interventions
Early intervention in the pre-psychotic phase: a survey among expert and non-expert psychiatrists and general practitioners
No full textObjectives: This study aimed at exploring views and comparing level of consensus across different groups of mental health professionals regarding the appropriateness of preventive interventions targeted at subjects with risk factors for the development of psychosis. Method: A survey was completed by 135 members of the International Early Psychosis Association ( IEPA), by 110 psychiatrists working in the Italian Region Emilia Romagna, and by 114 general practitioners working in the Province of Modena. The survey used three hypothetical case scenarios where a client, having tested positive for future psychosis to an imaginary infallible screening instrument, presents with either ( a) no symptoms and no interest in intervention; (b) no symptoms but requesting intervention; ( c) with some degree of anxiety and depression and requests assistance. Results: Mixed views prevailed on appropriateness of specific interventions across all groups regarding the hypothetical case scenario presented. Judgments varied according to clients' preferences and level of distress. IEPA members showed more inclination than other professionals to consider appropriate psychological and pharmacological intervention in an asymptomatic pre-psychotic state. The propensity for suggesting drug treatment was related to the belief that untreated psychosis causes neurotoxicity. Conclusions: Experts seem to have a more liberal view on the appropriateness of preventive interventions than community mental health psychiatrists and general practitioners. Further research addressing factors that influence experts' views seems warranted
Mental illness and mass media: review of the literature since 1950 up to date
No full textIntroduction and aims: Mass media have become the main source of information on mental illness.
In recent years, numerous studies documented a relationship between a stigmatizing presentation of
psychiatric disorders and negative perception of mental illness by general population. This paper
aims at analyzing how mental illness is described in scientific articles published by journals and
magazines and delineating the average portrait of a psychiatric patient offered by media to the
general population.
Methods: Scientific articles published from 1957 until August 2010 were reviewed, collecting
positive and negative expressions commonly associated to mental illness; a qualitative assessment
method of these was then applied.
Results: Negative descriptions of mental illness resulted by far more common than positive ones;
generally, the tone and the negative attitude that describes mental illness are in the titles and in
short articles, often sensational and dramatic, put on the front page, referring to stories of crime and
danger. The titles are often inconsistent with the contents of the article. Moreover, there is a
discriminatory and derogative language or a language of derision or pity. If there are positive
descriptions, they are associated with the involvement of mental health experts, the active role of
the psychiatric patient in the mass media or the effect produced by anti-stigma campaigns towards
journalists.
Conclusions: Although negative and stigmatizing depictions predominate, there are still
opportunities for improving media reporting of mental illness, which should be taken up in future
media strategies
Opinions of general hospital ward staff on a consultation-liaison psychiatry service
No full textObjective: Consultation-Liaison Psychiatry is the application area of
psychiatry dealing with psychosocially distressed patients in nonpsychiatric
health care settings and providing integration of the psychosomatic
and bio-psycho-social theories with clinical practice. The
overcoming of sectorialization in contemporary medical care through
the establishment of effective collaboration is its main theoretical
framework. This study collects evaluations of doctors and charge nurses
working in non-psychiatric wards of the Modena General Hospital,
about the Psychiatric and Psychosomatic Consultation Service
(PPCS).
Method: 330 health professionals (medical doctors and charge
nurses) were contacted by e-mail or in person, and required to compile
an anonymous questionnaire over a two-week period, in June
2009.
Results: 109/330 (33.03%) responded to the questionnaire, of these
the vast majority (n=95, 87.20%) were medical doctors. The majority
of respondents (84.39%) estimated a range of frequency of psychiatric
referrals between 1 and 24% of their patients. The most
frequent reasons for referrals were suspected depression (60.55%)
or anxiety (53.21%). The PPCS intervention was rated as “very useful"
particularly for psychopharmacotherapeutic advice (84.40%), to improve
communication with patients and relatives (73.39 and 39.45%
res-pectively) and to facilitate after-discharge care (33.94%). Half of
the sample also recognized an improvement of their own knowledge
and skills in the management of mentally ill patients.
Conclusion: TheModena PPCS is perceived as effective and useful by
its users. It is relevant to assess opinions of consultees and ward staff
on Consultation and Liaison activities, to better focus clinical and
training interventions as well as to improve organisational procedures
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