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Purpose: Disclosure of mental illness to a supervisor can have positive (e.g. supervisor support) and negative consequences (e.g. stigma). However, research on the association between disclosure and sustainable employability and well-being at work is scarce. The aim of this study was to investigate the association between the disclosure decision (yes/no), experiences with the decision (positive/negative) and sustainable employment and well-being at work among military personnel with mental illness (N = 323). Methods: A cross-sectional questionnaire study was conducted. Descriptive and regression (linear and ordinal) analyses were performed. Comparisons were made between those with positive and negative disclosure experiences. Results: Disclosure decision (yes/no) was not significantly associated with any of the measures of sustainable employability and well-being at work. However, positive disclosure experiences were significantly associated with higher scores on almost all measures of sustainable employability and well-being at work. Those with negative disclosure experiences reported significantly more shame (Mpos = 2.42, Mneg = 2.78, p < .05) and discrimination (Mpos = 1.70, Mneg = 2.84, p < .001). Those with a positive disclosure experience, reported significantly more supervisor support (Mpos = 3.20, Mneg = 1.94, p < .001). Conclusion: We did not find evidence that the disclosure decision itself is related to measures of sustainable employment and well-being at work. In contrast, how participants had experienced their (non-)disclosure decision was significantly related to almost all measures. This emphasizes the importance of the work environments reactions to disclosure and mental illness in the workplace. Future research and interventions should focus on increasing the likelihood of positive disclosure experiences through creating a more inclusive work environment, with more supervisor support and less stig

Vanuit alle drie de perspectieven werd bevestigd dat bijna alle belemmerende factoren gerelateerd waren aan de angst een ‘stempel’ te krijgen, en daardoor negatiever beoordeeld te worden (stigma) of negatiever behandeld te worden (discriminatie). De onderzoeksbevindingen tonen daarmee aan dat stigma en discriminatie rond psychische klachten een aanzienlijke barrière vormen voor gezondheid, welzijn en duurzame inzetbaarheid, en dat destigmatiserende interventies nodig zijn. De kennis, de houding en het gedrag van leidinggevenden bleken van cruciaal belang voor het wel of niet bespreken van psychische klachten. Voor hen ligt daarom een sleutelrol voor militairen met dergelijke klachten. Tenslotte zou op beleidsniveau moeten worden bekeken wat gedaan kan worden bepaalde angsten, zoals de angst voor negatieve carrière gevolgen, weg te nemen. Samen kan dit zorgen voor betere bespreekbaarheid van psychische klachten in de werkomgeving. Betere bespreekbaarheid kan het ook makkelijker maken vroegtijdig hulp te zoeken, wat ook weer belangrijk is voor gezondheid, welzijn en duurzame inzetbaarheid.

BACKGROUND: Home treatment (HT) is a treatment modality for patients with severe mental illness (SMI) in acute mental crises. It is frequently considered equivalent to psychiatric inpatient treatment in terms of treatment outcome. Peer Support (PS) means that people with lived experience of a mental illness are trained to support others on their way towards recovery. While PS is growing in international importance and despite a growing number of studies supporting its benefits, it is still not comprehensively implemented into routine care. The HoPe (Home Treatment with Peer Support) study investigates a combination of both - HT and PS - to provide further evidence for a recovery-oriented treatment of psychiatric patients. METHODS: In our randomized controlled trial (RCT), HT with PS is compared with HT without PS within a network of eight psychiatric clinical centers from the North, South and East of Germany. We investigate the effects of a combination of both approaches with respect to the prevention of relapse/recurrence defined as first hospitalization after randomization (primary outcome), disease severity, general functioning, self-efficacy, psychosocial health, stigma resistance, recovery support, and service satisfaction (secondary outcomes). A sample of 286 patients will be assessed at baseline after admission to HT care (data point t0) and randomized into the intervention (HT + PS) and control arm (HT). Follow-Up assessments will be conducted 2, 6 and 12 months after admission (resulting in three further data points, t1 to t3) and will be analyzed via intention-to-treat approach. DISCUSSION: This study may determine the positive effects of PS added to HT, prove additional evidence for the efficacy of PS and thereby facilitate its further implementation into psychiatric settings. The aim is to improve quality of mental health care and patients' recovery as well as to reduce the risk of relapses and hospitalizations for patients with SMI. TRIAL REGISTRATION

Purpose: Previous research found sustained high levels of mental health service use among adults who experienced bullying victimization during childhood. This could be due to increased psychopathology among this group, but other factors, such as self-perception as having a mental health problem, might contribute to increased service use. Additionally, the relationship between informal help-seeking for mental health problems and bullying victimization is incompletely understood. Methods: The present study examined associations between the frequency of bullying victimization and both formal service use and informal help-seeking for mental health problems independent from psychopathology. Data on bullying victimization, service use, informal help-seeking for mental health problems, psychopathology, and self-labelling as a person with mental illness were collected among 422 young people aged 13–22 years. Results: In logistic regression models, controlling for past and current psychopathology and using no bullying victimization as the reference category, we identified a greater likelihood of mental health service use among persons who experienced frequent bullying victimization, as well as a greater likelihood of seeking informal help among persons who experienced occasional victimization. Increased self-identification as a person with mental illness completely mediated the positive association between frequent bullying victimization and mental health service use. Conclusions: Our findings suggest that services to support persons who experienced frequent bullying victimization should focus on improving empowerment and self-perception. Additionally, there might be unserved need for formal support among those who experienced occasional bullying victimization.

AIMS Compulsory admission can be experienced as devaluing and stigmatising by people with mental illness. Emotional reactions to involuntary hospitalisation and stigma-related stress may affect recovery, but longitudinal data are lacking. We, therefore, examined the impact of stigma-related emotional reactions and stigma stress on recovery over a 2-year period. METHOD Shame and self-contempt as emotional reactions to involuntary hospitalisation, stigma stress, self-stigma and empowerment, as well as recovery were assessed among 186 individuals with serious mental illness and a history of recent involuntary hospitalisation. RESULTS More shame, self-contempt and stigma stress at baseline were correlated with increased self-stigma and reduced empowerment after 1 year. More stigma stress at baseline was associated with poor recovery after 2 years. In a longitudinal path analysis more stigma stress at baseline predicted poorer recovery after 2 years, mediated by decreased empowerment after 1 year, controlling for age, gender, symptoms and recovery at baseline. CONCLUSION Stigma stress may have a lasting detrimental effect on recovery among people with mental illness and a history of involuntary hospitalisation. Anti-stigma interventions that reduce stigma stress and programs that enhance empowerment could improve recovery. Future research should test the effect of such interventions on recovery.

Aims. To examine stigma- and knowledge-related barriers to help-seeking among members of the general population. Methods. In a representative survey of young to middle-aged Swiss adults (n = 8875), shame about a potential own mental illness, perceived knowledge about and satisfaction with one's mental health, psychiatric symptoms and attitudes towards help-seeking were assessed. Results. A latent profile analysis of all participants yielded two groups with different attitudes towards help-seeking. Relative to the majority, a one-in-four subgroup endorsed more negative attitudes towards seeking professional help, including psychiatric medication, and was characterized by more shame, less perceived knowledge, higher satisfaction with their mental health, younger age, male gender and lower education. Among participants with high symptom levels (n = 855), a third subgroup was reluctant to seek help in their private environment and characterized by high symptoms as well as low satisfaction with their mental health. Conclusions. Shame as an emotional proxy of self-stigma as well as poor subjective mental health literacy may be independent barriers to help-seeking. Interventions to increase mental health service use could focus on both variables and on those individuals with more negative views about professional help, in the general public as well as among people with a current mental illness.

BACKGROUND: Stigma and discrimination associated with mental health problems is an important public health issue, and interventions aimed at reducing exposure to stigma and discrimination can improve the lives of people with mental health problems. Social contact has long been considered to be one of the most effective strategies for improving inter-group relations. For this study, we assess the impact of a population level social contact intervention among people with and without mental health problems. METHODS: This study investigated the impact of social contact and whether presence of specific facilitating factors (equal status, common goals, cooperation and friendship potential): (1) improves intended stigmatising behaviour; (2) increases future willingness to disclose a mental health problem; and (3) promotes behaviours associated with anti-stigma campaign engagement. Two mass participation social contact programmes within England's Time to Change campaign were evaluated via a 2-part questionnaire. 403 participants completed initial questionnaires (70% paper, 30% online) and 83 completed follow-up questionnaires online 4-6 weeks later. RESULTS: This study investigated the impact of social contact and whether presence of specific facilitating factors (equal status, common goals, cooperation and friendship potential): (1) improves intended stigmatising behaviour; (2) increases future willingness to disclose a mental health problem; and (3) promotes behaviours associated with anti-stigma campaign engagement. Two mass participation social contact programmes within England's Time to Change campaign were evaluated via a 2-part questionnaire. 403 participants completed initial questionnaires (70% paper, 30% online) and 83 completed follow-up questionnaires online 4-6 weeks later. Campaign events facilitated meaningful intergroup social contact between individuals with and without mental health problems. Presence of facilitating conditions predicted improved stigma-re

Zusammenfassung. In der jüngeren Forschung zu Stigma und Diskriminierung gewinnt die Frage an Bedeutung, wie Angehörige einer stigmatisierten Minderheit ihre eigene Stigmatisierung wahrnehmen und auf sie reagieren. Aus der sozialpsychologischen Literatur zu anderen Gruppen, etwa ethnischen Minderheiten, liegen gut belegte Modelle zu diesem Thema vor, die bisher jedoch noch kaum auf Menschen mit psychischen Erkrankungen angewandt wurden. Dazu zählen (1) ein Stress-Coping-Modell von Stigma, (2) das Modell, wie sich die Wahrnehmung der eigenen diskriminierten Gruppe (ingroup) auf Selbstbild und Stigma-Bewältigung Betroffener auswirkt, sowie (3) die Unterscheidung zwischen ausdrücklichen («expliziten») und automatisch aktivierten («impliziten») Aspekten stigmatisierender Einstellungen. Letztere können etwa durch den Implicit Association Test beurteilt werden. In dieser Übersicht werden einige Studien vorgestellt, die die Bedeutung dieser Modelle für das Stigma psychischer Erkrankung und Stigma-Bewältigung untersuchen, etwa zu Stigma als Stressor und Auswirkungen wie Angst, Scham, Coping-Reaktionen und Sozialverhalten; automatischen Scham-Reaktionen und Selbststigma; biogenetischen Modellen psychischer Erkrankung und Selbstvorwürfen Betroffener; implizitem Selbststigma; und zum Zusammenhang zwischen (Selbst-)Stigma und meritokratischen Weltanschauungen wie der Protestantischen Ethik. Schließlich werden Schlussfolgerungen für Anti-Stigma-Initiativen, Stigma-Messinstrumente und künftige Forschung skizziert. = Abstract. Recent research on stigma and discrimination has focused on how members of a stigmatized group perceive and react to being discriminated. Well-established models from social-psychological work on other groups, e.g., ethnic minorities, exist, but so far they have not been applied to people with mental illness. They include (1) a stress-coping (or identity threat) model of stigma, (2) a model how the perception of one’s ingroup affects self-concept and coping