Combatiendo el estigma psiquiátrico en el salón de clases

7/31/2019 Combatiendo el estigma psiquitrico en el saln de clases

1/9

http://isp.sagepub.com/International Journal of Social Psychiatry

http://isp.sagepub.com/content/58/5/544The online version of this article can be found at:

DOI: 10.1177/00207640114136782012 58: 544 originally published online 9 August 2011Int J Soc Psychiatry

M. Economou, E. Louki, L. E. Peppou, C. Gramandani, L. Yotis and C. N. Stefanisschool students' attitudes to schizophrenia

ghting psychiatric stigma in the classroom: The impact of an educational intervention on seconda

Published by:

http://www.sagepublications.com

can be found at:International Journal of Social PsychiatryAdditional services and information for

http://isp.sagepub.com/cgi/alertsEmail Alerts:

http://isp.sagepub.com/subscriptionsSubscriptions:

http://www.sagepub.com/journalsReprints.navReprints:

http://www.sagepub.com/journalsPermissions.navPermissions:

http://isp.sagepub.com/content/58/5/544.refs.htmlCitations:

What is This?

- Aug 9, 2011OnlineFirst Version of Record

- Aug 23, 2012Version of Record>>

at HINARI on October 21, 2012isp.sagepub.comDownloaded from
http://isp.sagepub.com/http://isp.sagepub.com/http://isp.sagepub.com/content/58/5/544http://isp.sagepub.com/content/58/5/544http://isp.sagepub.com/content/58/5/544http://www.sagepublications.com/http://www.sagepublications.com/http://isp.sagepub.com/cgi/alertshttp://isp.sagepub.com/cgi/alertshttp://isp.sagepub.com/subscriptionshttp://www.sagepub.com/journalsReprints.navhttp://www.sagepub.com/journalsReprints.navhttp://www.sagepub.com/journalsPermissions.navhttp://www.sagepub.com/journalsPermissions.navhttp://www.sagepub.com/journalsPermissions.navhttp://isp.sagepub.com/content/58/5/544.refs.htmlhttp://isp.sagepub.com/content/58/5/544.refs.htmlhttp://isp.sagepub.com/content/58/5/544.refs.htmlhttp://online.sagepub.com/site/sphelp/vorhelp.xhtmlhttp://online.sagepub.com/site/sphelp/vorhelp.xhtmlhttp://isp.sagepub.com/content/early/2011/08/07/0020764011413678.full.pdfhttp://isp.sagepub.com/content/early/2011/08/07/0020764011413678.full.pdfhttp://isp.sagepub.com/content/58/5/544.full.pdfhttp://isp.sagepub.com/content/58/5/544.full.pdfhttp://isp.sagepub.com/http://isp.sagepub.com/http://isp.sagepub.com/http://online.sagepub.com/site/sphelp/vorhelp.xhtmlhttp://isp.sagepub.com/content/early/2011/08/07/0020764011413678.full.pdfhttp://isp.sagepub.com/content/58/5/544.full.pdfhttp://isp.sagepub.com/content/58/5/544.refs.htmlhttp://www.sagepub.com/journalsPermissions.navhttp://www.sagepub.com/journalsReprints.navhttp://isp.sagepub.com/subscriptionshttp://isp.sagepub.com/cgi/alertshttp://www.sagepublications.com/http://isp.sagepub.com/content/58/5/544http://isp.sagepub.com/


2/9


3/9

Economou et al. 545

choices about mental illness and hence can act as the first

step towards attitudinal and behavioural change (Corrigan,

2004b). Corrigan and Penn (1999) have shed light on this

strand of research by identifying four key components of

successful educational interventions: the provision of

personal information about the patient with mental illness;

a direct attack of myths; an increase in empathy levels bysimulation; and an in-depth discussion on the topic. In

addition, to increase the effectiveness of any anti-stigma

approach, including an educational one, the intervention

should target specific population groups (Corrigan, 2004a;

Thornicroft, 2006).

With regard to young population groups, converging

evidence has supported that school-based anti-stigma initi-

atives may constitute an effective vehicle for advancing

knowledge about mental illness and improving attitudes

towards the patients who suffer from it (Pinfold, Toulmin,

Thornicroft, & Huxley, 2003; Rickwood, Cavanagh, Leigh,

& Sakrouge, 2004; Schachter et al., 2008; Schulze, Richter-

Werling, Matschinger, & Angermeyer, 2003; Stuart, 2006).

Children and adolescents have emerged as a promising tar-

get group for anti-stigma interventions, because throughout

this developmental period attitudes to mental illness are

consolidated. Various studies have demonstrated that chil-

dren do not yet have a clear idea of what mental illness

denotes (Corrigan & Watson, 2007), and that the person-

ality traits that constitute the foundation for stereotype

endorsement are not well entrenched until adolescence

(Flavell, Miller, & Miller, 2001). Therefore, by altering

unfavourable and rejecting attitudes among children and

adolescents, one can prevent them from becoming adults

who hold traditional stereotypical beliefs about people withmental illness and hence stigmatize them. Furthermore,

addressing children and adolescents merits special atten-

tion in light of the high prevalence of psychiatric disorders

in this population (Schulze et al., 2003; Stuart, 2006).

Evidence from the World Health Organization (2005) sug-

gests that while one in five adolescents experiences a men-

tal disorder, only 20% of them will seek professional help

for fear of being labelled as mentally ill. This finding is

important given that many psychiatric disorders emerge

during adolescence, such as obsessive compulsive disorder

(Maggini et al., 2001) and schizophrenia (Thomsen, 1996).

In spite of the significance of this type of intervention,the literature on the effectiveness of anti-stigma initiatives in

children and adolescents is scarce (Schachter et al., 2008).

The limited number of studies on the topic have indicated

that prior to the intervention, the majority of students are

either unsure about the correctness of stereotypical views

about patients with psychiatric disorders or less rejecting

towards them in comparison to adults; with variables such

as gender and familiarity with mental illness playing a

prominent role in stigma endorsement (Corrigan et al., 2005;

Ng & Chan, 2002; Pinfold et al., 2003; Schulze et al., 2003;

Watson et al., 2004). In terms of effective interventions,

education has been shown to yield improvements of short

duration in attitudes towards mental illness in adolescents

(Ng & Chan, 2002; Schulze et al., 2003; Watson et al., 2004;

Williams & Pow, 2007). However, social distance measures,

which constitute the most widely used index of stigmatiza-

tion (Jorm & Oh, 2009), have been found to display the

greatest resistance to change upon completion of the edu-cational intervention (Pinfold et al., 2003; Schulze et al.,

2003). Recent evidence has indicated that when personal

contact with a patient with mental illness, either in vivo or in

a video, is added to education, attitudes towards patients are

improved and desired social distance from them is remark-

ably reduced (Chan, Mak, & Law, 2009; Schachter et al.,

2008; Stuart, 2006)

The anti-stigma programme, run by the University

Mental Health Research Institute, has designed and imple-

mented a series of anti-stigma interventions in adolescents

within the framework of World Psychiatric Association

Open the Doors global program against stigma and dis-

crimination because of schizophrenia. Due to the focus of

the programme on schizophrenia at the time (Economou,

Gramandani, Richardson, & Stefanis, 2005; Economou,

Richardson, Gramandani, Stalikas, & Stefanis, 2009), the

interventions addressed the stigma surrounding severe

mental illness in general and schizophrenia in particular.

The aim of the intervention was to advance students

knowledge about schizophrenia, to improve their attitudes

towards the patients who suffer from it and to reduce their

desired social distance levels. Consistent with this, the

intervention aimed to yield changes in all three dimensions

of stigma, namely knowledge, attitudes and behaviour

(Thornicroft, 2006); however, changes in the behaviourdimension were assessed indirectly by employing a social

distance measure, which constitutes a proxy of behavioural

intention. To achieve its aims, the initial intervention proto-

col incorporated a combined education and personal con-

tact strategy, in line with the literature underscoring its

effectiveness (Chan et al., 2009; Schachter et al., 2008;

Stuart, 2006). However, a number of objections and com-

plaints on the part of parents, school principals and teachers

necessitated changes in the protocol resulting in the elimi-

nation of the personal contact components. Therefore, in its

final form, the intervention was largely educational in

nature but it did entail some narratives of patients withschizophrenia read by a mental health professional. To opti-

mize the interventions effectiveness, its content was based

on Corrigan and Penns (1999) recommendations. In the

context of patient narratives, personal information about

the patient and his/her aftercare was provided to students,

the myths that surround schizophrenia were attacked one

by one, students empathic feelings towards patients were

enhanced by role-play exercises and an in-depth discussion

on the topic was conducted. Consistent with these, the pre-

sent study set the twofold aim of exploring high school

students beliefs, attitudes and desired social distance

http://isp.sagepub.com/http://isp.sagepub.com/http://isp.sagepub.com/


4/9


5/9

Economou et al. 547

students. The self-reported instrument comprised two parts,

one exploring beliefs and attitudes towards schizophrenia

and PwS, and another addressing the degree of desired

social distance from them. The beliefs and attitudes part

encompassed 11 items, rated on a four-point Likert scale

(1 = never, 4 = always), with some of them being nega-

tively phrased in order to avoid response bias (e.g. PwScan be creative). Similarly, the social distance section of

the instrument consisted of seven items, rated on a four-

point Likert scale (1 = definitely no, 4 = definitely yes),

with some of them being also negatively phrased in order to

avoid bias (e.g. Would you invite someone with schizo-

phrenia to your party?). For both sections, a composite

score was calculated by adding up the responses to all

items, after having reversed the negatively phrased items

(subtracting their rating from 5). For both composite scores,

higher values indicated more stereotypical beliefs and neg-

ative attitudes towards schizophrenia and PwS as well as a

greater desired social distance from them. A reliability

analysis utilizing Cronbachs indicated moderate internal

consistency for both composite scores (for beliefs, =

0.60.76 and for social distance, = 0.760.78).

Statistical analysis

For a descriptive analysis of students baseline beliefs,

attitudes and social distance answers, percentages of

pooled responses for each item were used. For the analysis

of associations between gender and familiarity with men-

tal illness on the one hand, and baseline beliefs, attitudes

and social distance measures on the other, two composite

scores were calculated: one for beliefs and attitudes andanother for social distance. A t test for independent sam-

ples was then used to reveal any differences. In order to

evaluate the short-term effect of the intervention on beliefs,

attitudes and social distance, the mean baseline score for

each item was compared to the mean post-intervention

score for the corresponding item by using a repeated

measures t test analysis. Similarly, to evaluate the long-

term effectiveness of the intervention, a pairwise ttest was

used between the baseline mean scores for each item and

its corresponding follow-up score. The rationale for con-

ducting item analysis in the study was to identify which

beliefs, attitudes and social interactions displayed thegreatest change and which displayed the least. In addition,

for the beliefs and attitudes section of the instrument, the

reliability analysis demonstrated wide variability in the

values of Cronbachs (range 0.60.76) and as a result of

this, analysis on a scale level was contentious and hence

was avoided. On the contrary, as social distance scales

have been empirically supported in terms of their psycho-

metric properties, the results pertaining to the social dis-

tance items were analysed on a scale level as well. The

effect of the intervention on the social distance composite

score was assessed using repeated measures ANOVA.

A multiple linear regression model on follow-up scores

was used in order to identify which factors could signifi-

cantly predict students follow-up results.

Results

The two groups (control and intervention) did not displaysignificant differences in terms of their basic demographic

variables, such as gender, age and personal acquaintance

with someone with serious mental illness (p > .05).

Baseline beliefs, attitudes and social distance

The two groups did not differ significantly with regard to

the distribution of their baseline responses to all items (p >

.05). To increase the statistical power of the analysis, data

were pooled in such a way that two categories were formed:

always/often and seldom/never for the beliefs and atti-

tudes section and definitely/probably yes and definitely/probably no for the social distance section.

The majority of students espoused the stereotypical

view of a PwS talking to him/herself or shouting in city

streets (80.1%). Similarly, a high percentage of students

reported that PwS always/often suffer from split or multi-

ple personalities (70.9%) or cannot work at regular jobs

(81.2%). Furthermore, one in two viewed PwS as danger-

ous (51.25% believed this is always/often the case) and

a public nuisance (50.5% answered always or often).

Interestingly, a relatively high percentage of the sample

held the positive view that PwS can be creative (67.15%),

can be successfully treated outside of the hospital in the

community (67.95%) and need prescription drugs to con-trol their symptoms (72.6%).

In terms of social distance items, the vast majority of

students would not fall in love with a PwS (86.8%) nor

would share their room with him/her during a school excur-

sion (81.85%). Furthermore, one in two would not invite a

PwS to their party (41.4% would probably/definitely do

so). Nonetheless, only 35.55% would be upset or disturbed

to be in the same class with a PwS, 46.75% would be afraid

to talk to him/her, while 70.5% would start a friendship

with him/her.

When composite scores were calculated, no gender

effect on beliefs, attitudes and social distance at baselineemerged (t= 0.3,p > .05 for the beliefs and attitudes section

and t= 0.89, p > .05 for the social distance section). By

contrast, previous contact with a person with a severe men-

tal illness was found to differentiate in a significant manner

the social distance scores at baseline (t= -2.57,p < .01).

Intervention effect

To evaluate the effectiveness of the intervention, students

answers before and after the workshop were compared for

the experimental and control groups separately.

http://isp.sagepub.com/http://isp.sagepub.com/http://isp.sagepub.com/http://isp.sagepub.com/


6/9

548 International Journal of Social Psychiatry 58(5)

Short-term effect: Upon completion of the intervention.

For the experimental group, beliefs and attitudes were

improved in all items but one (PwS can be successfully

treated without drugs using psychotherapy; Table 1) andthis cannot be explained by variables other than the inter-

vention, since the control group did not manifest the same

pattern of results (p > .05 for all items). Nonetheless, even

upon completion of the intervention, students still sub-

scribed to some negative stereotypes about PwS. Specifically,

the majority of students still believed that PwS can be seen

talking to themselves or shouting in city streets (mean score

= 3, which is higher than the neutral point 2.5 and closer to

the extreme always) and cannot hold a job in an open

labour market (mean score = 1.83, which is below the

neutral point 2.0 and closer to the extreme never).

Likewise for the social distance items, there was a

significant change in all items for the experimental group

(Table 2), whereas no significant changes were recorded for

the control group (p > .05 for all items). However, evenafter the intervention the mean score for the item Would

you fall in love with a PwS? was 1.88, which is below the

neutral point 2.0 and closer to the extreme definitely no.

Long-term effect: Follow-up. In order to address the long-

term effect of the intervention, the answers at the pre-inter-

vention and follow-up time points were compared. With

regard to students beliefs and attitudes to PwS, a

gradual worsening was observed from post-intervention

mean item scores to the corresponding follow-up scores.

Nonetheless, the statistical analysis revealed that follow-up

scores were significantly different from baseline scores on

Table 1. Mean item scores for beliefs and attitudes section at baseline, post-intervention and follow-up time points.

Beliefs and attitudes BaselineM (SD) Post-interventionM (SD) 12-month follow-upM (SD)

PwS suffer from split or multiplepersonalities

2.97 (0.69) 1.78 (0.95)* 2.5 (0.91)*

PwS tend to be mentally retarded or oflower intelligence

2.4 (0.83) 1.76 (0.82)* 2.18 (0.83)*

PwS hear voices telling them what to do 2.79 (0.77) 3.1 (0.85)* 2.86 (0.97)

PwS can be seen talking to themselvesor shouting in city streets

3.27 (0.69) 3 (0.78)* 3.04 (0.78)*

PwS are dangerous to the public 2.61 (0.82) 1.85 (0.83)* 2.05 (0.85)*

PwS are a public nuisance due topanhandling, poor hygiene or oddbehaviour

2.63 (0.9) 2.13 (0.98)* 2.37 (0.93)*

PwS can be successfully treated outsideof the hospital, in the community

3.01 (0.74) 3.32 (0.85)* 3.13 (0.7)

PwS can be successfully treated withoutdrugs using psychotherapy

2.6 (0.86) 2.75 (0.92) 2.70 (0.86)

PwS can work at regular jobs 1.7 (0.78) 1.83 (0.89)* 1.94 (0.86)*

PwS can be creative 2.85 (0.72) 3.45 (0.73)* 3.07 (0.75)*

Mean scores per item for the intervention group ranged from 1 (almost never) to 4 (almost always)*p< .01 difference compared to baseline

Table 2. Mean item scores for social distance section at baseline, post-intervention and follow-up time points.

Social distance BaselineM (SD) Post-interventionM (SD) 12-month follow-upM (SD)

Would you be afraid to talk to a PwS? 2.45 (0.91) 1.97 (0.91)* 2.28 (0.83)

Would you be upset or disturbed to be inthe same class with a PwS?

2.22 (1) 1.74 (0.8)* 1.85 (0.86)*

Would you start a friendship with a PwS? 2.95 (0.91) 3.15 (0.92)* 2.72 (0.89)

Would you invite a PwS to your party? 2.22 (0.9) 2.64 (0.94)* 2.44 (0.89)*

Would you feel embarrassed or ashamed

if your friends knew that someone in yourfamily had schizophrenia?

2.17 (1.11) 1.93 (1.12)* 2.08 (1.04)

Would you share your room on a schoolexcursion with a PwS?

1.72 (0.87) 2.35 (0.98)* 1.93 (0.85)*

Would you fall in love with a PwS? 1.49 (0.81) 1.88 (1)* 1.73 (0.92)

Mean scores per item for the intervention group ranged from 1 (definitely no) to 4 (definitely yes)*p < .01 difference compared to baseline



7/9

Economou et al. 549

all items apart from two (PwS hear voices and PwS can be

successfully treated outside the hospital, in the community),

lending support to the long-term effectiveness of the inter-

vention. Concerning desired social distance from PwS, of the

seven items of the section, significant differences between

baseline and follow-up measures emerged for only three:

being classmates with a PwS, inviting him/her to a party and

sharing a room in a school excursion. For the remaining

items, the improvement observed at post-intervention was

not maintained. For the control group, no significant differ-

ences were observed between the pre-intervention and fol-

low-up measures for any item (p > .05).

When social distance was analysed on a scale level, a

repeated measures ANOVA with post hoc comparisons

using the Bonferroni correction revealed a significant dif-

ference between the baseline and post-intervention social

distance scores (M = 18.36, SD = 2.46 and M = 15.63,SD = 2.67, respectively), indicating a positive short-term

effect of the intervention; however, no significant differ-

ence was discerned between the baseline and the follow-up

scores (follow-up M= 17.96, SD = 2.23), indicating that

one year after the intervention, the students returned to their

baseline social distance levels (Figure 1).

Positive baseline scores and female gender were the

only two variables that predicted positive attitudes and

lower social distance scores at follow-up (R2 = 5.1%,F=

2.79,p < .05 for beliefs and attitudes composite score and

R2 = 20.1%, F= 11.41,p < .001 for social distance com-

posite score).

Discussion

The findings of the present study lend support to the imper-

ative need for developing effective anti-stigma interven-

tions targeting children and adolescents. Prior to receiving

any intervention, students were found to hold stereotypical

beliefs and rejecting attitudes towards PwS. The majority

of them espoused the belief that PwS are dangerous, cannot

work, speak to themselves or shout in city streets, suffer

from split personality and constitute a public nuisance. A

similar pattern of results has been recorded in the adult

population in Greece (Economou, Gramandani et al., 2005;

Economou et al., 2009). In spite of dissimilarities in the

sampling methods between the current study and those

carried out in adults, one can observe that adults are more

stigmatizing and negative towards PwS. Among the adoles-

cents, 51.25% held the view that PwS are dangerous in con-

trast to 70.1% of adults, after controlling for urbanruraldifferences. Similarly, 50.5% of adolescents were found to

deem PwS a public nuisance, while this figure is 62.9% in

adults. This finding is consistent with other studies that

have indicated that adolescents hold more favourable

attitudes than adults to people with mental illness (Schulze

et al., 2003; Watson et al., 2004).

Comparing the findings of the present study to those in

other countries, the young population in Greece appears to

be very distancing towards PwS. Schulze et al. (2003)

report that only 6.5% of students (average percentage

between the experimental and control group) stated that

they would be afraid to talk to a PwS, a rate that reaches

as high as 46.75% in our sample. Furthermore, while in

Germany, 20.5% of students admitted that they could fall in

love with a PwS, in Greece the rate is slightly lower, i.e.

13.2%. Interestingly, while adolescents in Greece express

greater desire for social distance from PwS in comparison

to their counterparts in Germany, the difference between

the two countries is more striking in items concerning

superficial encounters with the patient. In particular, the

difference in percentages between the two countries with

regard to the item Would you be afraid to talk to a PwS?

reaches 26.75%. Adolescents high levels of stigmatization

against PwS in Greece may be attributed to the Greek ori-

gin of the word schizophrenia and the strongly stigmatiz-ing media portrayals of PwS in the country (Economou,

Kourea et al., 2005). In Greek society the term schizophre-

nia is linked to fear and devastation and even mental health

professionals are avoiding its use by replacing it with that

of psychosis. Therefore, it is not surprising that while

most of the adolescents are oblivious to what the word

denotes, based on its literal meaning (i.e. split mind), they

usually speculate that the term is germane to a split person-

ality or a fragmented mind, both of which are mainly

associated with the traits of violence, dangerousness and

unpredictability (Economou et al., 2009). Furthermore,

adolescents in Greece are continuously exposed to stigma-tizing portrayals of PwS in the media, especially on TV and

at the cinema. An illustration of this point is the film Texas

Chainsaw Massacre, which has been repeatedly broadcast

on TV and in the cinema but which in Greece was released

as The Schizophrenic Killer with the Chainsaw. The very

stigmatizing Greek title capitalized on the association

between a schizophrenic patient and a serial killer in lay

peoples mind and therefore strengthened the stereotype of

dangerousness pertaining to PwS. It is noteworthy that

during the anti-stigma intervention when students were

asked about their sources of information with regard

to severe mental illness, the majority identified TV as

1

3

5

7

9

11

13

15

17

19

Baseline Post-intervenon 12-month follow-up

Comp

ositescore

Social distance

Figure 1. Differences in social distance composite scoresacross the three time points of the study.



8/9

550 International Journal of Social Psychiatry 58(5)

their primary source and spontaneously referred to The

Schizophrenic Killer with the Chainsaw.

Compared to the literature that points towards gender

and familiarity with mental illness as factors that play a

prominent role in stigma endorsement, the present study

found no gender effect for baseline measures but a signifi-

cant impact of personal experience with mental illness. Theinfluence of gender on beliefs and attitudes to people with

mental illness has yielded conflicting results, with some

studies reporting that girls are more positive towards the

patients (Ng & Chan, 2002; Williams & Pow, 2007) and

some others failing to find a significant difference (Schulze

et al., 2003). Similarly, familiarity with mental illness has

been found to be associated with both more positive (Pinfold

et al., 2003) and more negative attitudes (Corrigan et al.,

2005). An interesting finding of the study was that only

female gender and baseline scores could predict follow-up

scores. While this is in line with the findings of an earlier

study (Pinfold et al., 2003), it is surprising that personal

experience with mental illness had a non-significant contri-

bution to the model. A possible explanation for this is the

diversity in the intensity of familiarity, which can vary from

a person watching TV portrayals of mental illness to having

a distant or a close relative suffering from a psychiatric dis-

order (Corrigan, Backs-Edwards, Green, Lickey-Diwan, &

Penn, 2001). It is therefore plausible that the educational

intervention increased students familiarity with mental ill-

ness and as a result of this, the differences that emerged at

baseline were compensated for at follow-up.

In terms of the effectiveness of the educational interven-

tion in modifying beliefs, attitudes and desired social dis-

tance from PwS, immediately upon its completion and at a12-month follow-up, the results that emerge support the

existing literature. In line with other studies (Ng & Chan,

2002; Schulze et al., 2003; Watson et al., 2004), the educa-

tional intervention was found to have a positive impact as

indicated by an improvement in attitudes and a remarkable

decrease in the frequency of stereotypical beliefs and in the

degree of desired social distance. With regard to the follow-

up results, the picture is more diverse. On the one hand, sig-

nificant improvements in adolescents beliefs and attitudes

after the intervention were largely maintained 12 months

after its completion. On the other, the improvement recorded

on the social distance items upon completion of the inter-vention was not maintained at follow-up, where students

almost returned to their baseline answers. In line with

Pinfold et al. (2003), it appears that social distance is more

resistant to change than other measures of stigmatization

and possibly necessitates a different approach for targeting

it. The intervention of the present study was brief and lacked

a personal contact component. As a result, an anti-stigma

intervention aiming at decreasing adolescents desired social

distance from PwS should consider involving patients and

allow for an interaction between them and the adolescents.

Furthermore, this intervention should be longer and con-

stantly delivered throughout the developmental period of

stereotype formation and consolidation. In this way, even if

adolescents are exposed to stigmatizing portrayals of people

with mental illness, in the media for example, their personal

contact with a number of PwS in the classroom coupled with

the appropriate education will enable them to stand critically

towards the vehicles that perpetuate the stigma attached to

mental illness. Health promotion programmes, like thoseimplemented at the participating schools, should become an

integral part of the high school curriculum and should be

delivered throughout school years.

Limitations

The major shortcoming of the present study was its inabil-

ity to extrapolate its findings to a representative sample of

adolescents throughout the country. The sample was

restricted to urban areas and only schools with a health pro-

motion programme in their curriculum took part. Given

that the preponderance of psychiatric stigma in Greek

urban areas has been found to be lower compared to rural

areas (Economou et al., 2009) and that students from

schools with a health promotion programme in their cur-

riculum are possibly more tuned and sensitized to issues of

health, stigma endorsement might have been stronger if a

more diverse sample was attained. This assumption is

further supported by the opposition expressed by many

schools to deliver any kind of intervention related to severe

mental illness to their students. In Greece, talking about

severe mental illness, and especially about schizophrenia,

to students is still a major taboo and demonstrates further

how entrenched psychiatric stigma is in the Greek culture.

Therefore, a future study aiming at broadening its recruit-ment scope would cast light on adolescents degree of

stigma endorsement and subsequently on the potential of

an anti-stigma intervention to fight it.

Acknowledgements

The authors would like to express their gratitude to Dimitris

Kolostoumpis, psychiatrist, and Maria Charitsi, psychologist,

University Mental Health Research Institute, for their valuable

contribution to the implementation of the study, as well as to

Anastassios Stalikas, Professor of Psychiatry, Panteion University,

for his contribution to the analysis of the results.

Funding

This research was conducted within the framework of the

Greek Programme against Stigma and Discrimination because

of Schizophrenia, whose major sponsor was the National Bank of

Greece.

References

Chan, J. Y., Mak, W. W. & Law, L. S. (2009). Combining edu-

cation and video-based contact to reduce stigma of mental

illness: The Same or Not the Same anti-stigma program for

secondary schools in Hong Kong. Social Science and Medi-

cine, 68, 15211526.



9/9

Economou et al. 551

Corrigan, P. W. (2004a). Target-specific stigma change: A strategy

for impacting mental illness stigma.Psychiatric Rehabilitation

Journal, 28, 113121.

Corrigan, P. W. (2004b). How stigma interferes with mental

health care.American Psychologist, 59, 614625.

Corrigan, P. W. (2005). On the stigma of mental illness: Practical

strategies for research and social change. Washington, DC:

American Psychological Association.Corrigan, P. W., Backs-Edwards, A., Green, A., Lickey-Diwan,

S. & Penn, D. L. (2001). Prejudice, social distance and

familiarity with mental illness. Schizophrenia Bulletin, 27,

219225.

Corrigan, P. W., Demming-Lurie, B., Goldman, H. H., Slopen, N.,

Medasani, K. & Phelan, S. (2005). How adolescents perceive

the stigma of mental illness and alcohol abuse. Psychiatric

Services, 56, 544550.

Corrigan, P. W. & Penn, D. L. (1999). Lessons from social psy-

chology on discrediting psychiatric stigma. American Psy-

chologist, 54, 765776.

Corrigan, P. W., River, L., Lundin, R. K., Penn, D. L., Uphoff-

Wasowski, K., Campion, J., Mathisen, J., Qagnon, C., Bergman,M., Qoldstein, H. & Kubiak, M. A. (2001). Three strate-

gies for changing attributions about severe mental illness.

Schizophrenia Bulletin, 27, 187195.

Corrigan, P. W. & Watson, A. C. (2007). How children stigma-

tize people with mental illness.International Journal of Social

Psychiatry, 53, 526546.

Drolen, C. S. (1993). The effect of educational setting on student

opinions of mental illness. Community Mental Health Jour-

nal, 29, 223234.

Economou, M., Gramandani, C., Richardson, C. & Stefanis, C.

(2005). Public attitudes towards people with schizophrenia in

Greece. World Psychiatry, 4, (Suppl 1), 4044.

Economou, M., Kourea, A., Gramandani, C., Leontiadou, A.,

Louki, E. & Stefanis, C. (2005b). Mental disorder and mentalhealth representations in Greek newspapers and magazines.

World Psychiatry, 4, (Suppl 1), 4549.

Economou, M., Richardson, C., Gramandani, C., Stalikas, A.

& Stefanis, C. (2009). Knowledge about schizophrenia

and attitudes towards people with schizophrenia in Greece.

International Journal of Social Psychiatry, 55, 361371.

Flavell, J. H., Miller, P. H. & Miller, S. A. (2001). Cognitive devel-

opment, 4th edition. Upper Saddle River, NJ: Prentice-Hall.

Jorm, A. F. & Oh, E. (2009). Desire for social distance from

people with mental disorders: A review. Australian and

New Zealand Journal of Psychiatry, 43, 183200.

Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S. &

Phelan, J. C. (2001). Stigma as a barrier to recovery: Theconsequences of stigma for the self-esteem of people with

mental illnesses.Psychiatric Services, 52, 16211626.

Maggini, C., Ampollini, P., Gariboldi, S., Cella, P. L., Peglizza,

L. & Marchesi, C. (2001). The Parma High School Epide-

miological Survey: Obsessive-compulsive symptoms. Acta

Psychiatrica Scandinavica, 103, 441446.

Ng, P. & Chan, K. F. (2002). Attitudes towards people with

mental illness. Effects of a training program for secondary

school students.International Journal of Adolescent Medicine

and Health, 14, 215224.

Perlick, D. A., Rosenheck, R. A., Clarkin, J. F., Sirey, J. A.,

Salahi, J., Struening, E. L. & Link, B. G. (2001). Stigma as

a barrier to recovery: Adverse effects of perceived stigma on

social adaptation of persons diagnosed with bipolar affective

disorder.Psychiatric Services, 52, 16271632.

Pinfold, V., Toulmin, H., Thornicroft, G., Huxley, P., Farmer,

P. & Graham, T. (2003). Reducing psychiatric stigma and

discrimination: Evaluation of educational interventions in

UK secondary schools. British Journal of Psychiatry, 182,

342346.Rickwood, D., Cavanagh, S., Leigh, C. & Sakrouge, R. (2004).

Educating young people about mental health and mental illness:

Evaluating a school-based programme. International Journal

of Mental Health Promotion, 6, 2332.

Sartorius, N. (2002). Iatrogenic stigma of mental illness.British

Medical Journal, 324, 14701471.

Sartorius, N. (2004). The World Psychiatric Association global

programme against stigma and discrimination because of

schizophrenia. In A. H. Crisp (Ed.),Every family in the land:

Understanding prejudice and discrimination against people

with mental illness (pp. 373375). London, UK: Royal Society

of Medicine Press.

Schachter, H. M., Girardi, A., Ly, M., Lacroix, D., Lumb, A.B.,van Berkom, J. & Gill, R. (2008). Effects of school-based

interventions on mental health stigmatization: A systematic

review. Child and Adolescent Psychiatry and Mental Health,

2, 18.

Schulze, B., Richter-Werling, M., Matschinger, H. & Anger-

meyer, M. C. (2003). Crazy? So what? Effects of a school

project on students attitudes towards people with schizophre-

nia.Acta Psychiatrica Scandinavica, 107, 142150.

Stuart, H. (2006). Reaching out to high school youth: The effec-

tiveness of a video-based antistigma program. Canadian

Journal of Psychiatry, 51, 647653.

Thompson, A. H., Stuart, H., Bland, R. C., Arboleda-Florez, J.,

Warner, R. & Dickson, R. A. (2002). Attitudes about schizo-

phrenia from the pilot site of the WPA worldwide campaignagainst the stigma of schizophrenia. Social Psychiatry and

Psychiatric Epidemiology, 37, 475482.

Thomsen, P. H. (1996). Schizophrenia with childhood and adoles-

cent onset: A nationwide register-based study.Acta Psychiat-

rica Scandinavica, 94, 187193.

Thornicroft, G. (2006). Shunned: Discrimination against people

with mental illness. Oxford, UK: Oxford University Press.

Vogel, D., Wade, N. & Hackler, A. (2007). Perceived public

stigma and the willingness to seek counseling: The mediating

roles of self stigma and attitudes toward counseling. Journal

of Counseling Psychology, 54, 4050.

Watson, A. C., Otey, E., Westbrook, A. L., Gardner, A. L., Lamb,

T. A., Corrigan, P. W. & Fenton, W. S. (2004). Changingmiddle schoolers attitudes about mental illness through edu-

cation. Schizophrenia Bulletin, 30, 563572.

Williams, B. & Pow, J. (2007). Gender differences and mental

health: An exploratory study of knowledge and attitudes to

mental health among Scottish teenagers. Child and Adoles-

cent Mental Health, 12, 812.

World Health Organization. (2001). The World Health Report

2001. Mental health: New understanding, new hope. Geneva,

Switzerland: World Health Organization.

World Health Organization. (2005). Atlas: Child and adolescent

mental health resources: Global concerns, implications for the

future. Geneva, Switzerland: World Health Organization.

Combatiendo el estigma psiquiátrico en el salón de clases

Documents

Transcript of Combatiendo el estigma psiquiátrico en el salón de clases