Pioneering an Innovative Intervention to Reduce Mental Health Related Stigma in Muslim Communities: A Protocol.

Despite the prevalence of mental health related stigma in Muslim communities, there are only a limited number of intervention studies reported in the literature. Digital interventions (i.e., YouTube clips, videos) are relatively cheap, highly accessible and easily disseminated and are increasingly being used to improve mental health literacy and reduce mental health related stigma. However, as far as the authors are aware, there are no stigma reduction programmes targeting Muslim communities that leverage digital interventions reported in the literature. This paper outlines a protocol for a digital intervention to challenge mental health related stigma in Muslim communities. The proposed intervention will be a 5 to 10-minute YouTube clip/video the active ingredients of which will be: [1] an interview with a Muslim expert by lived/living experience, [2] an Imam (Muslim faith leader) and [3] a psychiatrist. We will recruit members of Muslim communities living in Muslim minority countries in the Global North (United Kingdom, Unites States of America, Canada, Australia and New Zealand) to participate in the study (inclusion criteria: adults aged 18 years and over, Muslim background). The study will be comprised of two groups: an active group that will be exposed to the Muslim faith appropriate digital intervention and a control group that will be exposed to a digital intervention that is not Muslim faith appropriate. We will administer validated psychometric stigma scales on participants in both groups before and after exposure to the interventions. We hypothesize that viewing an anti-stigma clip/video that is Islamic faith appropriate will be associated with greater reductions in mental health related stigma in members of Muslim communities compared to viewing an anti-stigma clip/video that is not Islamic faith appropriate.

Innovative Interventions to Reduce the Stigma Attached to Intellectual Disabilities: A Narrative Review.

The stigma attached to intellectual disabilities (ID) can have profoundly adverse effects on the lives of people who suffer from these conditions. Stigma is also a major barrier to accessing specialist services and consequently many people with ID continue to suffer in silence. A confidential inquiry into the premature deaths of people with ID in England and Wales revealed the median age at death of individuals with this condition was 13 years (for males) to 20 years (for females) younger than the median age at death of the general population. It has been posited that stigma is a factor that contributes to the mortality gap between those with ID and those who don't have this condition. The COVID-19 pandemic has created new challenges for people with ID and has further fortified the barriers to specialist services. To reduce stigma, improve the quality of healthcare that is provided to people with this condition and to break down the barriers to specialist services, we must pioneer innovative interventions that leverage the power of technology and 'virtual' contact with people who live with these conditions.

Patriarchal Upbringing in the 21st Century: The Impact Emotional Abuse Related to Parental Styles Has on the Genesis of Gender Inequality and the Development of Unresolved Trauma in Children.

BACKGROUND: Violence Against Women and Girls (VAWG) (physical, sexual, and psychological/emotional) is a type of structural discrimination that violates the basic human rights of females on a global scale. Cultural norms that glorify male dominance, power imbalances, and abuse of authority are the most encountered reasons for VAWG. Emotional abuse, which can start in childhood, is widely recognised as the most prevalent form of VAWG. However, although victims of emotional abuse usually suffer terribly, perpetrators often evade accountability. Emotional abuse is underestimated in part because it is normalized by victims who are mostly women and girls. The normalization of VAWG is contributing to the propagation and perpetuation of biased perceptions of sexism. The intergenerational transmission of parenting styles - which is an important contributory factor for child development - often includes gender-stereotyping norms, or patriarchy. Hitherto, limited focus has been directed towards the consequences that emotional abuse related to patriarchal upbringing has on children. Aim - to investigate if emotional abuse related to patriarchal upbringing influences the perception of sexism and gender stereotyping across genders, and the development of unresolved trauma in children. METHODS: Participants were recruited via social media platforms to complete online questionnaires assessing parental emotional abuse, control, trauma, misogyny, and perceptions of sexism. Parametric analyses were conducted on the 188 participants (158 women and 30 men) recruited. Trauma and perceptions of sexism were statistically analysed using correlation and multiple linear regression. RESULTS: Our findings show that parental emotional abuse and control in females predicted for unresolved traumatic experiences (16.6%). Misogynistic culture and male gender predicted for hostile sexism (9.9%), whereas emotional abuse predicted for benevolent sexism (40%). CONCLUSION: Emotional abuse related to patriarchal upbringing contributes to the genesis of gender inequality and unresolved trauma in children. Given that parental styles are transmitted from one generation to the next, to reduce sexism and improve mental health outcomes, the patriarchal parental cycle must be broken.

'Paris Thin': The Mental Health of Models.

Surprising it may seem, the mental health issues remains largely overlooked in the highly competitive and unforgiving industry of modelling and fashion. A substantial number of models experience mental health issues due to the nature of their occupation, however, most avoid speaking out due to fear of stigma and losing out on future work. Moreover, problematic eating behaviours in attempts to improve body image can have profoundly adverse effects on mental and physical health, even leading to death in extreme cases, yet these behaviours are being reinforced and rewarded with success and career progression. Indeed, the term 'Paris Thin' was used in relation to the deaths of models from starvation who were in pursuit of 'the perfect body' whilst working in France, the epicentre of the fashion world. Although improvements have been made over the past decade, conversations surrounding common mental disorders such as depression and anxiety remain minimal at best and discussions about other serious mental illnesses such as schizophrenia and bipolar affective disorder are virtually absent. Campaigns that amplify the voices of models living with a mental health condition must therefore be supported to reduce mental health related stigma in the industry and encourage those who are suffering and struggling to seek professional help. Research in this area is urgently needed to yield new insights that will help to improve the mental health of models.

Emotional Abuse in Women and Girls Mediated by Patriarchal Upbringing and Its Impact on Sexism and Mental Health: A Narrative Review.

Sexism is a type of structural discrimination that can manifest as the subjugation of woman in familial and social roles. Gender-based violence often occurs in societies where patriarchal norms exist. Violence against women and girls (VAWG) includes physical, sexual and psychological/emotional abuse directed towards females. Emotional violence against women and girls is usually underestimated, if not overlooked. Patriarchal upbringing can predominantly result in the emotional abuse of female children. This narrative review will discuss the impact emotional abuse in women and girls mediated by patriarchal upbringing has on sexism and mental health. This paper will also explore how gendered upbringing can contribute to the normalization of VAWG and the victim-blaming of females.

Reducing Mental Health Stigma in Medical Students and Doctors towards their Peers with Mental Health Difficulties: A Protocol.

Mental health problems are over-represented in doctors and medical students. However, stigma and 'a culture of shame' are formidable barriers to mental health services and consequently many doctors and medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment. Indeed, a recent study on over 2100 female physicians who met the diagnostic criteria for a mental disorder revealed that 50% were reluctant to seek professional help due to fear of exposure to stigma. Left untreated or undertreated, mental health problems in doctors can result in impairment of occupational functioning, compromise patient safety and place considerable strain on the economy (by increasing the amount of sick leave taken). Moreover, the consequences of mental health stigma in the medical profession can be fatal. Dr Daksha Emson, a psychiatrist with bipolar affective disorder, tragically killed herself and her baby daughter during a psychotic episode. An independent inquiry into Dr Emson's death concluded that she was the victim of stigma in the National Health Service. The mental health of medical students and doctors, in all of its aspects, must therefore be addressed with the urgency that it demands. Stephanie Knaak and colleagues conducted a data synthesis of evaluative studies on anti-stigma programmes for healthcare providers and identified six key ingredients one of which was a personal testimony from a trained speaker who has lived experience of mental illness. In this paper we outline a study protocol with the aim of answering the following research question, 'Does attending an anti-stigma programme comprised of a medic with first-hand experience of a mental health condition cause immediate and sustained reductions in mental health stigma from medical students and doctors towards their peers with mental health difficulties?'

A World Psychiatric Association Initiative to Increase Interest in Psychiatry as a Career in Qatar Medical Students: A Pilot Study.

INTRODUCTION: The World Health Organization identified a chronic shortage of psychiatrists in Low- Middle- and High-Income Countries. In Qatar, the situation is dire with reports there is one psychiatrist per 170,000 people in the population. A one-day, student-led mental-health conference was held in Doha, Qatar under the auspices of the World Psychiatric Association with the aim of increasing interest in psychiatry as a career. SUBJECTS AND METHODS: In this single-arm, pre-post comparison study, a questionnaire assessing interest in psychiatry as a career was administered on participants before and after attending the conference. Demographic information was obtained and response items were on a 5-point Likert scale. Statistical analysis was performed using a two-sample t-test with a significant p-value set at <0.05. RESULTS: The conference was attended by 102 individuals. Fifty-four attendees completed the pre-conference survey (53% response rate) and 36 participants completed the post-conference survey (35% response rate). Data for the 36 matched pre-post responses were included in our analyses. The average age of respondents was 22 years and 81% were female. There was improvement in post-conference results however these changes were not statistically significant. CONCLUSION: To the best of our knowledge this is the first intervention study on increasing interest in psychiatry as a career carried out in Qatar. It is likely that psychiatry enthusiasts attended the conference and therefore their interest in this medical specialty was already high as corroborated by the favorable pre-conference survey results. This might explain why there was a lack of statistical significance in comparison to post- intervention scores. We recommend that such an event be integrated into the medical school curricula throughout Qatar to include students with low baseline interest in psychiatry. Further research in this area with more robust methodology is urgently needed to help narrow the pervasive treatment gap.

Lifestyle Factors and Mental Health.

A number of lifestyle factors have been recognised to play an important role in positively modifying medical and psychiatric diseases and their associated morbidity and mortality. These include, eating healthy food, greater physical activity, cessation of smoking, avoidance of alcohol and illicit substances. Additional lifestyle factors for healthy living include, safe and peaceful environment, optimal sleep, de-stressing and enjoyable activities, social connections/support and healthy mental activities. Physicians from the ancient times, through the middle ages to the early 20th century have recommended adoption of healthy lifestyle factors such as diet and exercise to manage medical and psychiatric disorders without really understanding their scientific basis. In this short paper, we discuss the important role lifestyle factors play in morbidity and mortality related to many important and common medical and psychiatric diseases. We explore how and if positively modifying lifestyle factors can help to improve and or prevent medical and psychiatric disorders with particular emphasis on food, diet and exercise.

Using Experts by Personal and Professional Experience (EPPE) to increase interest in Psychiatry as a Career at Sixth-Form Level.

BACKGROUND: Psychiatrists play a multifaceted and critical role in improving the lives of people with mental illness. However, despite how rewarding, important and thrilling a career in mental health is, there continues to remain a shortage of psychiatrists in Low-, Middle- and High-Income Countries. There has been resurgence in interest in improving the image of psychiatry over recent years and several initiatives have been launched to increase recruitment into the specialty at Sixth Form level in the UK. DESIGN: We conducted a single-arm, pre-post, comparison study with Sixth Form students at an inner-city school in London. Students were invited to complete a survey before and after exposure to an assembly on mental health that was delivered by an Expert by Personal and Professional Experience (EPPE). Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if there was an increase in interest in pursuing this profession as a career in this group. RESULTS: 63 out of 123 participants completed the before and after survey (51% response rate). Following exposure to the assembly, there were statistically significant improvements between the pre- and post- intervention means for, "Psychiatry has a positive impact on peoples' lives" (p value <0.0001), "People with mental illness can achieve success and be the best at what they do" (p value <0.0001) and, "I would consider psychiatry as a career" (p value <0.0001). CONCLUSION: Notwithstanding the limitations of this pilot study, our findings suggest that an assembly on mental health delivered by an EPPE (i.e. 'Wounded Healer') might be effective at increasing interest in psychiatry as a career at Sixth Form level. We suggest that assemblies on mental health and psychiatry be delivered by 'Wounded Healers' in schools and colleges nationwide to help drive recruitment into psychiatry.

Hajj and the Mental Health of Muslim Pilgrims: A review.

Mass gatherings occur in different situations and settings around the world. A mass gathering can range in size from thousands to millions and in nature from recreation (i.e. concerts) to religious festivals (i.e. the Hajj pilgrimage). Such mass gatherings can result in high rates of morbidity and mortality from communicable and non-communicable diseases, 'accidents' and, over recent years, terror attacks. Disproportionately lower consideration has been given to the mental health and wellbeing of people during mass gatherings compared to that given to physical health during such events. Hajj is a religious pilgrimage to Mecca in Saudi Arabia that all Muslims are Islamically obliged to fulfil at least once in their lifetime. With up to 3 million pilgrims attending Hajj annually, it has been described as, 'The largest and longest-standing mass gathering event on Earth'. Although Hajj is a spiritual experience that is considered enlightening by many pilgrims, it can also be highly stressful which can have adverse effects on both physical and mental health. Few studies have been published hitherto on the impact that Hajj has on the mental health of pilgrims. This review article provides a narrative summary of studies conducted on Hajj and the relationship that this mass gathering has with the mental health of pilgrims.

A King's College London Global Health Society Event discussing Global Mental Health to increase interest in Psychiatry as a Career: A Pilot Study.

INTRODUCTION: Despite the launching of multiple initiatives to increase recruitment into psychiatry, the profession continues to remain undersubscribed. Studies have shown that teaching on global mental health can improve attitudes toward psychiatry in medical students. To the best of our knowledge, no studies have been published hitherto that evaluate if a brief teaching session (i.e. 60 minutes in duration) on global mental health improves perceptions of psychiatry and increases interest in this specialty as a career. SUBJECTS AND METHODS: We conducted a single-arm, pre- post- comparison study on participants who attended a King's College London Global Health Society event on Global Mental Health. Participants completed a survey before and after exposure to the event. Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if a brief teaching session on global mental health would increase interest in pursuing psychiatry as a career. RESULTS: 71 out of 90 participants responded (77.8% response rate). Following exposure to the event, there were statistically significant improvements in the scores for, "Psychiatry is interesting" (pre-event score 4.41, post-event score 4.66 p value <0.001), "I would talk positively about psychiatry to other people" (pre-event score 4.02, post-event score 4.48 p value <0.00001), and, "I would consider psychiatry as a career" (pre-event score 3.24, post-event score 3.72 p value <0.001). CONCLUSION: The results of our pilot study suggest that a brief lecture on global mental health may improve perceptions of psychiatry and increase interest in this specialty as a career. We recommend that global mental health be introduced into the medical school curriculum since this may help to increase recruitment into psychiatry.

The prevalence of Lyme disease and associated co-infections in people with a chronic post-concussive syndrome.

INTRODUCTION: There is increasing awareness that Lyme borreliosis (LB) and traumatic brain injury (TBI) may cause mental health symptoms. TBI and Lyme disease compromise the health and activities of millions of patients per year. The chronic symptoms and disability of TBI and Lyme disease share a similar clinical presentation. We have identified an alarming number of individuals suffering from post-concussion syndrome (PCS) that are refractory to care and that have serologically tested positive for Lyme disease. SUBJECTS AND METHODS: A single-center retrospective review of patient charts that were symptomatic a minimum of one year after a TBI that were tested for Lyme disease to ascertain if there was a relationship. RESULTS: 217 PCS patient records (93 females with a mean age of 34 years, 120 males with a mean age of 40 years and 4 individuals with unknown gender) were included in the review. 38% had a positive Western Blot Igenex IgM. There was a statistically significant relationship of a positive Western Blot Igenex IGM predicting chronic PCS Pearson χ2(1)=6.8866, P=0.009, Fisher's exact score p=0.015 and φ=0.2813 representing a moderate effect size. CONCLUSIONS: Long term PCS over one year's duration is associated with undiagnosed Lyme disease. There was statistical and substantive significance between individuals with chronic PCS having a positive Western Blot Igenex IgM. Males were more likely to have a positive Western Blot Igenex IgM than females.

Leveraging Digital Technology to Challenge Mental Health Stigma in West Bengal: A Protocol.

Mental health related stigma is a pernicious phenomenon that permeates and pervades our world. As stigma continues to evolve so too must our approach to reduce it. This paper outlines a protocol that leverages the power of virtual contact and digital technology to challenge mental health related stigma in West Bengal, India.

The Federation of Student Islamic Societies Programme to Challenge Mental Health Stigma in Muslim communities in Scotland: The FOSIS Glasgow Study.

INTRODUCTION: A recent study commissioned by the Scottish Government on the prevalence of mental disorders in Muslims in Scotland revealed that over 50% of the sample met the diagnostic criteria for a mental illness. Stigma is a major barrier to mental health services and despite the availability of effective treatment, many Muslims in Scotland with mental health difficulties continue to suffer in silence. The Federation of Student Islamic Societies (FOSIS) Scotland branch organized a mental health conference in Glasgow to improve Mental Health Literacy and challenge mental health related stigma in the Scottish Muslim community. The conference was comprised of: A counsellor with a background of Islamic psychology, a psychiatrist and an Imam (a Muslim religious leader). DESIGN: We conducted a single-arm, pre- post- comparison study on Muslims who attended the FOSIS mental health conference in Glasgow, Scotland. Validated psychometric stigma scales measuring knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviours (Reported and Intended Behaviour Scale (RIBS)) were administered on participants before and immediately after exposure to the programme. RESULTS: 34 out of the 55 participants who attended the conference responded (response rate 62%). 34/34 (100%) of the respondents were Muslim and the mean age was 22.7 years (Std. Dev. 6.04, min. 18, max. 49). There were no statistically significant changes in stigma across the domains of knowledge, attitude and behaviour in respondents following exposure to the event. CONCLUSION: Previous FOSIS anti-stigma conferences in England and Ireland featuring an Expert by Lived Experience were associated with statistically significant reductions in mental health related stigma. The results of the FOSIS Glasgow study supports the, 'Power of contact' with an Expert by Lived Experience at reducing mental health related stigma in the Muslim community. More robust research in this area is urgently required.

Improvement of Saccadic Eye Movements after Head-Eye Vestibular Motion (HEVM) Therapy and Neuro-Psychiatric Considerations.

INTRODUCTION: Eye movement pathology can assist in the identification, diagnosis and treatment of mental health disorders. Eye-tracking paradigms have been utilized to provide greater ecological validity, and directly capture the detailed sequence of processes in perception and attention, while quantifying classifiers in mood, anxiety, and psychotic disorders. Saccadic eye movements serve as an endophenotype for various mental health disorders. SUBJECTS AND METHODS: Patients suffering from post-concussive syndrome and mental health concerns performed saccadic eye movements that were quantified for amplitude, velocity, latency and accuracy before and after Head-Eye Vestibular Motion therapy (HEVM). RESULTS: HEVM therapy is associated with statistical and substantive significant improvements in mental health and in saccadic metrics. CONCLUSIONS: Oculomotor dysfunction is related to the symptom dimensions of mental health disorders that may be treated with physical rehabilitation modalities. We feel it reasonable to suggest that psychiatrists and others involved in the treatment of mental health disorders quantify eye movements and use them as biomarkers in the evaluation of the outcomes of varied therapies.

Metrological Performance of Instruments used in Clinical Evaluation of Balance.

Clinical assessment of a patient, monitoring the progress of a condition, and/or titration of a therapy is dependent on the metrological characteristics of diagnostic equipment. While metrological performance of instruments is commonly assessed in research, it is not so often done in clinical practice. Physical rehabilitation applications may benefit individuals with mental health concerns and are associated with an accurate analysis of balance and gait. There is a paucity of published data regarding the metrological characteristics of commonly used clinical instruments used in posturographic measurements. We desired to assess the accuracy, trueness, precision and resolution of four posturography systems that we use clinically in practice: a Bertec BP-5050, a Vestibular Technologies CAPS® Professional and a Vestibular Technologies CAPS® Lite threecomponent balance platforms, and a NeuroCom® Balance Manager SMART EquiTest®. Metrological performance by posturography instruments was recommended in 2013 by the International Standardization Committee for Clinical Stabilometry of the International Society for Posture and Gait Research (ISPGR). Clinical and research findings may be erroneous, or at the least misleading, if the instruments used to make clinical decisions are associated with significant error. We suggest that there is a strong need for posturographic instrumentation with appropriate metrological characteristics used in clinical applications. The ISPRG recommendations appear to be reasonable and appropriate, and our results show they are obtainable. Physical measurements and functional testing used to correlate and design mental health and physical based rehabilitation strategies are often dependent upon the accuracy and metrological integrity of diagnostic instruments used in posturography.

Gender differences in the portrayals of depressive illness in popular culture: a comparison of literary texts.

Gender differences in the prevalence, experiences and presentations of mental illnesses are well-known and are reflected in research findings, clinical practice, society and popular culture. This paper will compare and contrast the role that gender and other factors play in the portrayals of depressive illness in two acclaimed texts, 'The Bell Jar' by Sylvia Plath and, 'Darkness Visible' by William Styron.

Innovative approaches to improving the image of psychiatrists and psychiatry amongst medical students and doctors in the UK.

In this paper we identify some of the critical factors that contribute to the ongoing shortage of psychiatrists in the UK. We discuss initiatives that have been launched to try and encourage more medical students and trainee doctors to choose psychiatry as a career. We describe the innovative anti-stigma Wounded Healer programme that was pioneered in the UK with the aim of improving the image of psychiatry and psychiatrists and that was subsequently scaled up and rolled out to over 65,000 medical students and doctors in 14 countries in five continents worldwide. We conclude, with some suggestions that we believe will help recruitment efforts into psychiatry.

The Treatment of Autism Spectrum Disorder With Auditory Neurofeedback: A Randomized Placebo Controlled Trial Using the Mente Autism Device.

Introduction: Children affected by autism spectrum disorder (ASD) often have impairment of social interaction and demonstrate difficulty with emotional communication, display of posture and facial expression, with recognized relationships between postural control mechanisms and cognitive functions. Beside standard biomedical interventions and psychopharmacological treatments, there is increasing interest in the use of alternative non-invasive treatments such as neurofeedback (NFB) that could potentially modulate brain activity resulting in behavioral modification. Methods: Eighty-three ASD subjects were randomized to an Active group receiving NFB using the Mente device and a Control group using a Sham device. Both groups used the device each morning for 45 minutes over a 12 week home based trial without any other clinical interventions. Pre and Post standard ASD questionnaires, qEEG and posturography were used to measure the effectiveness of the treatment. Results: Thirty-four subjects (17 Active and 17 Control) completed the study. Statistically and substantively significant changes were found in several outcome measures for subjects that received the treatment. Similar changes were not detected in the Control group. Conclusions: Our results show that a short 12 week course of NFB using the Mente Autism device can lead to significant changes in brain activity (qEEG), sensorimotor behavior (posturography), and behavior (standardized questionnaires) in ASD children.

Part I: Muslims, social inclusion and the West. Exploring challenges faced by stigmatized groups.

The rise of radicalisation, the 'demonization' of Muslims in the media and the immigration crisis in Europe have all contributed and colluded to heightened levels of Islamophobia in the West. The stigmatisation of Muslims can and has resulted in negative outcomes in this group such as elevated levels of psychological distress and an increase in hate crime and terrorist attacks perpetrated against Muslims from members of the far right. There are 1.6 billion Muslims on the planet and Islam is the fastest growing religion in the world. Now, more than ever it seems, is a critical time to learn about what the true message of Islam is and who the blessed prophet Muhammad peace be upon him (PBUH) was from reliable and authentic sources. This paper aims to challenge the stigma attached to Muslims through the following means: 1. It contains information to educate people about Islam, debunk myths and challenge negative stereotypes; 2. It utilizes the power of 'story-telling' to engage readers and to equip them with facts and the necessary skills to combat Islamophobia. Part I includes a brief introduction of Islam and concludes with a concise description and evaluation of an anti-Islamophobia programme that was piloted in Cambridge University (UK) and delivered as a Keynote Address at the Carrick Institute for Graduate Studies International Symposium of Clinical Neuroscience in Orlando, (USA). Our hope is that through this initiative we can create a critical mass and inspire and empower people, Muslims and non-Muslims alike to stand in solidarity and collectively challenge extremism in any of its many forms. Our hypothesis is that this will result in better outcomes such as reductions in radicalization and Islamophobia.