When mental health care is stigmatizing: A participative study in schizophrenia.

OBJECTIVES: Mental health care has been identified as a major source of mental illness stigmatization. Detailed information about these stigmatization experiences is thus needed to reduce stigma in mental health practices. The study aimed to (a) identify the most relevant stigmatizing situations in mental health care encountered by users with schizophrenia and their families; (b) characterize the relative importance of these situations in terms of frequency, experienced stigmatization, and associated suffering; and (c) identify contextual and individual factors associated with these experiences. METHOD: An online survey was conducted in France among users and family members to characterize situations of stigmatization in mental health care and identify associated factors. The survey content was first developed from a participative perspective, through a focus group including users. RESULTS: A total of 235 participants were included in the survey: 59 participants with schizophrenia diagnosis, 96 with other psychiatric diagnoses, and 80 family members. The results revealed 15 relevant situations with different levels of frequency, stigmatization, and suffering. Participants with a diagnosis of schizophrenia experienced more situations of stigmatization, with a higher frequency. Moreover, contextual factors were strongly associated with experienced stigmatization, including recovery-oriented practices (negatively associated) and measures without consent (positively associated). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These situations, as well as associated contextual factors, could be targeted to reduce stigmatization and related suffering in mental health practices. Results strongly underscore the potential of recovery-oriented practice as an instrument to fight stigma in mental health care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Part of the solution yet part of the problem: factors of schizophrenia stigma in mental health professionals.

BACKGROUND: Stigma is highly prejudicial to persons with schizophrenia, their families, the society and the health care system. Mental health professionals (MHP) are considered to be one of the main sources of schizophrenia stigma. OBJECTIVES: The aim of the study was to identify individual and contextual factors associated with stigma in MHP in its three dimensions (stereotypes, prejudices, discrimination, Fiske, 1998). METHODS: An online survey was conducted with specific measures of MHP stigma (stereotypes, prejudices and discrimination). Four categories of potential associated factors were also measured: sociodemographic characteristics, contextual characteristics (e.g., Work setting), individual characteristics (e.g., Profession, Recovery-oriented practices) and theoretical beliefs (e.g., Biological beliefs, Perceived similarities, Continuum versus Categorical beliefs). RESULTS: Responses of 357 MHP were analysed. Factors that were the most strongly associated with MHP stigma were Perceived similarities, Categorical beliefs, Biological beliefs, Recovery-oriented practice and Work setting (independent practice). Conversely, Gender, Specific trainings in stigma or recovery and Cognitive aetiology beliefs showed no association with any of MHP stigma dimension. Remaining factors show associations with a weak effect size. CONCLUSIONS: The survey results suggest that MHP stigma is more influenced by individual factors such as theoretical beliefs and recovery-oriented practices than contextual factors. These original results provide perspectives for reducing stigma in mental health practices.Key pointsMental health professionals (MHP) considering they share similarities with persons with schizophrenia or believing that schizophrenia is not a discrete social category but rather the extreme on a continuum between 'normal' and 'pathologic' reported less stigmatisation.MHP holding higher professional utility beliefs and using recovery-oriented practice reported fewer stereotypes, prejudice and discrimination.Other factors such as age, academic level, contact frequency, familiarity and multidisciplinary practice show associations with a weak effect size.

Psychosocial risks in small enterprises: the mediating role of perceived working conditions in the relationship between enterprise size and workers' anxious or depressive episodes.

Purpose. The relationship between enterprise size and psychosocial working conditions has received little attention so far but some findings suggest that conditions are more favorable in small enterprises. This could have a positive impact on workers' mental health. The objective of this study was to test the mediating effect of perceived working conditions in the relationship between enterprise size and anxious or depressive episodes. Methods. Data from the 2010 SUMER - Surveillance Médicale des Expositions aux Risques professionnels (French periodical cross-sectional survey) were analyzed; N = 31,420 for the present study. Anxious or depressive episodes were measured with the hospital anxiety and depression scale and the perceived working conditions were psychological demand, decision latitude and social support as assessed with Karasek's job content questionnaire. The indirect effect was tested according to the method proposed by Preacher and Hayes. Results. In a multivariate logistic regression, the risk of anxious or depressive episodes was found to be lower in micro enterprises (2-9 employees). Formal tests pointed to a significant indirect effect of enterprise size on mental health through perceived working conditions, with a larger effect for psychological demand. Conclusion. This study highlights perceived working conditions as an explanation of the effects of enterprise size.

[Representations of Mental Disorders and Employment Fit Perceived by Employers of the Regular Labour Market in France]. / Représentations du « trouble psychique ¼ et adéquation à l'emploi perçue par des employeurs du milieu ordinaire de travail en France.

Introduction People with mental disorders face stigma and discriminatory hiring practices in the competitive labour market. This study on employers' representations of mental disorders provides knowledge regarding the specifics of their negative perceptions for this population, which appears to be an important barrier to their inclusion in the workplace. Heilman's lack of fit model (1983) enabled to show that recruiters seek to match the characteristics they perceive in candidates with those they deem necessary to succeed in the organization. A lack of fit between the two components-candidates and the selection criteria-would explain the non-selection of the applicant. This psychological process can be applied to the recruitment of people with psychiatric disabilities.Objectives The goal of this study was to identify employers' representations towards mental disorder in general and in the workplace particularly, as well as to determine the prerequisites for hiring this population. As such, this would allow to better understand the psychological processes involved in the exclusion of people with psychiatric disabilities.Method In a qualitative study, 29 semi-structured interviews were conducted with employers and HR Department representatives of organizations in France that were under the French legal obligation to hire people with a disability (organizations having more than 20 employees). We used the free association technique to identify representational contents concerning mental disorder. Qualitative data on the essential prerequisites for recruitment were collected through open-ended questions. The data were processed by a categorical content analysis conducted independently by three researchers. The structure of the representation was identified by distinguishing the components of the central nucleus from those of the peripheral nucleus according to the two criteria of the method of Moliner (1994): the index of popularity of each element and the co-occurrence between each element of the representation.Results Results revealed negative representations of people with mental disorders, focusing on social deviance and harm to society, believing that people with mental disorders would have non-standard skills and behaviours and would be socially disruptive and burdensome, particularly in the workplace. The analysis of the prerequisites for hiring persons with psychiatric disabilities showed how these representations towards mental disorders are barriers for their recruitment, mainly linked to a perceived lack of employment fit.Conclusion Future avenues of research and actions are suggested. They are as follows: learning, education on mental disorders, training and specific techniques to reduce organizational stakeholders' stereotypes and prejudice. Also, supporting stakeholders for the inclusion of people with mental disorders in the workplace appears fundamental, especially by improving recruitment and integration practises.

[Return to Work Strategies of Employees who Experienced Depression: Employers and HR's Perspectives]. / Stratégies de retour au travail d'employés ayant fait l'expérience d'une dépression : perspectives des employeurs et des cadres des ressources humaines.

Major depression is one of the leading causes of work disability across the world. In Canada, the lifetime prevalence of depression varies from 10 to 12%. Depression impacts not only the employee who is often stigmatized and can lose his professional identity, but also has consequences on colleagues and supervisors in organizations. In the literature, four models are described from which employers and managers use in their organizations to make decisions regarding the work disability of employees on sick leave: biomedical, financial management, personnel management, and organizational development. These models can also be supported by economic, legal and ethical interests. Even though these models are essential to better understand the decision of employers and HR regarding work disability, information remains scarce regarding the concrete strategies used by these stakeholders to facilitate the return to work for employees on sick leave due to depression.Objectives the aim of this paper is to document, considering employers' and human resources' perspectives, the best strategies to put in place to facilitate the return to work of employees on sick leave due to depression.Method This study was part of a larger study carried out in Canada to assess factors influencing the return to work after a depression-related sick leave, taking into account the viewpoint of four types of stakeholders: employers/human resources, supervisors, unions and people diagnosed with depression. 219 employers (68.5%) and human resources directors (31.5%) from 82.6% organizations having more than 100 employees accepted to answer a telephone semi-structured interview. The question of interest in this study is: In your opinion, what are the best strategies to help an employee who has had a depression to return to work? Coding was influenced by empirical findings and theories related to psychosocial risk factors that the authors use in their respective disciplines as well as return to work principles/steps mentioned in the literature. The main objective was to keep all the strategies mentioned by participants, and analyzing them with major principles of return to work.Results 24 return to work strategies spread on six principles emerged: 1) Contact with the employee during his sick leave (10 strategies); 2) Evaluate and plan the return to work without precipitating it (6); 3) Training for managers and colleagues regarding mental health in the workplace (4); 4) Concertation between key return to work stakeholders (4); 5) Progressive return to work with work accommodations (4); 6) Health and work follow-up regarding the employee (6).Conclusion These six principles including 34 strategies are usually related to the timeframe process of the return to work, though they can be implemented sometimes in parallel. This possible overlap reinforces the idea to consider the return to work as sustainable in order to prevent potential relapses and improve the performance at work. Next steps will be to systematically implement these principles and strategies in organizations in order to evaluate their impact on return to work of employees on sick leave due to depression.

Psychological transition and adjustment processes related to retirement: influence on cognitive functioning.

OBJECTIVE: To investigate the relationship between psychological transition and adjustment to retirement and cognitive performances in older adults. METHODS: The study's sample was taken from the Approche Multidisciplinaire Intégrée cohort, a French prospective study of retirees from agriculture, aged 65 and over, living in rural settings in southwestern France. The cross-sectional analyses were conducted on a sample of 590 elderly people without dementia at baseline and for whom information on perception of the work setting, experience of the retirement transition and adaptation to retirement life (nine variables) as well as neuropsychological measures (global cognitive functioning, episodic memory, verbal fluency, attention and psychomotor speed) were available at first visit. RESULTS: Multivariable linear regression analyses, including nine variables related to retirement and adjusted for potential confounding factors, indicated that three of them - positive consideration of former work situation, development of new activities during retirement and good adaptation to free time - were associated with better cognitive performances. CONCLUSIONS: We found that several factors proved to be determinants of good cognitive functioning at retirement and could serve as a basis for the development of more efficient intervention programs aimed at helping retirees to maintain good cognitive functioning after retirement.

Health and aging in elderly farmers: the AMI cohort.

BACKGROUND: The health of the agricultural population has been previously explored, particularly in relation to the farming exposures and among professionally active individuals. However, few studies specifically focused on health and aging among elders retired from agriculture. Yet, this population faces the long-term effects of occupational exposures and multiple difficulties related to living and aging in rural area (limited access to shops, services, and practitioners). However, these difficulties may be counter-balanced by advantages related to healthier lifestyle, richer social support and better living environment. The general aim of the AMI cohort was to study health and aging in elderly farmers living in rural area through a multidisciplinary approach, with a main focus on dementia. METHODS/DESIGN: The study initially included 1 002 participants, randomly selected from the Farmer Health Insurance rolls. Selection criteria were: being 65 years and older; living in rural area in Gironde (South-Western France); being retired from agriculture after at least 20 years of activity and being affiliated to the Health Insurance under own name. The study started in 2007, with two follow-up visits over 5 years. Baseline visits were conducted at home by a neuropsychologist then by a geriatrician for all cases suspected of dementia, Parkinson's disease and depression (to confirm the diagnosis), and by a nurse for others. A large panel of data were collected through standardised questionnaires: complete neuropsychological assessment, material and social living environment, psychological transition to retirement, lifestyle (smoking, alcohol and diet), medications, disability in daily living, sensory impairments and some clinical measures (blood pressure, depression symptomatology, anxiety, visual test, anthropometry...). A blood sampling was performed with biological measurements and constitution of a biological bank, including DNA. Brain MRI were also performed on 316 of the participants. Finally, the three-year data on health-related reimbursements were extracted from the Health System database (medications, medical and paramedical consultations, biological examinations and medical devices), and the registered Long-Term Diseases (30 chronic diseases 100% covered by the Insurance System). DISCUSSION: AMI is the first French longitudinal study on health and aging set up in a population of elderly farmers living in rural area through a multidisciplinary approach.