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      Depression stigma and management of suicidal callers: a cross-sectional survey of crisis hotline counselors

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          Abstract

          Background

          Crisis hotlines play a key role in suicide prevention worldwide following different approaches regarding risk assessment and management of suicidality. This is to our knowledge the first study investigating depression stigma in crisis hotline counselors. The association between stigma and self-rated knowledge and their exploration of suicide risk and consecutive management of suicidal callers is being investigated.

          Methods

          Data on depression stigma, self-rated knowledge, self-reported exploration and management of suicidality was collected from 893 counselors working for the German crisis hotline. Stigma in counselors had been compared to matched population sample (1002).

          Results

          Crisis hotline counselors reported significantly lower depression stigma compared to the general population. Depression stigma and age associations differed in both samples. The reported exploration of suicide risk in callers differed depending on the self-rated knowledge about suicidality and depending on the personal depression stigma, but not the reported consecutive management.

          Conclusion

          Compared to the general population, crisis hotline counselors seem to have fewer stigmatizing attitudes toward depression. Attitudes and self-rated knowledge seem to influence the confidence in counselors regarding the exploration of suicidal callers, but not the consecutive management. The results indicate that a profound training and hands-on information about depression and suicide risk seem to be essential.

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          Most cited references36

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          Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial.

          Little is known about the efficacy of educational interventions for reducing the stigma associated with depression. To investigate the effects on stigma of two internet depression sites. A sample of 525 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website (BluePages), a cognitive-behavioural skills training website (MoodGYM) or an attention control condition. Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention. Relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control. Changes in stigma were not mediated by changes in depression, depression literacy or cognitive-behavioural therapy literacy. The internet warrants further investigation as a means of delivering stigma reduction programmes for depression.
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            Attitudes of mental health professionals toward people with schizophrenia and major depression.

            Several studies reveal poor knowledge about mental illness in the general population and stigmatizing attitudes toward people with mental illness. However, it is unknown whether mental health professionals hold fewer stigmatizing attitudes than the general population. A survey was conducted of the attitudes of mental health professionals (n = 1073) and members of the public (n = 1737) toward mental illness and their specific reaction toward a person with and without psychiatric symptoms ("non-case" as a reference category). Psychiatrists had more negative stereotypes than the general population. Mental health professionals accepted restrictions toward people with mental illness 3 times less often than the public. Most professionals were able to recognize cases of schizophrenia and depression, but 1 in 4 psychiatrists and psychologists also considered the non-case as mentally ill. The social distance toward both major depression and the non-case was lower than toward schizophrenia. However, in this regard, there was no difference between professionals and the public. The study concludes that the better knowledge of mental health professionals and their support of individual rights neither entail fewer stereotypes nor enhance the willingness to closely interact with mentally ill people.
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              Predictors of depression stigma

              Background To investigate and compare the predictors of personal and perceived stigma associated with depression. Method Three samples were surveyed to investigate the predictors: a national sample of 1,001 Australian adults; a local community sample of 5,572 residents of the Australian Capital Territory and Queanbeyan aged 18 to 50 years; and a psychologically distressed subset (n = 487) of the latter sample. Personal and Perceived Stigma were measured using the two subscales of the Depression Stigma Scale. Potential predictors included demographic variables (age, gender, education, country of birth, remoteness of residence), psychological distress, awareness of Australia's national depression initiative beyondblue, depression literacy and level of exposure to depression. Not all predictors were used for all samples. Results Personal stigma was consistently higher among men, those with less education and those born overseas. It was also associated with greater current psychological distress, lower prior contact with depression, not having heard of a national awareness raising initiative, and lower depression literacy. These findings differed from those for perceived stigma except for psychological distress which was associated with both higher personal and higher perceived stigma. Remoteness of residence was not associated with either type of stigma. Conclusion The findings highlight the importance of treating the concepts of personal and perceived stigma separately in designing measures of stigma, in interpreting the pattern of findings in studies of the predictors of stigma, and in designing, interpreting the impact of and disseminating interventions for stigma.
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                Author and article information

                Contributors
                +49 341 22387440 , ines.heinz@medizin.uni-leipzig.de
                roland.mergl@unibw.de
                ulrich.hegerl@deutsche-depressionshilfe.de
                christine.rummel-kluge@medizin.uni-leipzig.de
                elisabeth.kohls@medizin.uni-leipzig.de
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                6 November 2019
                6 November 2019
                2019
                : 19
                : 342
                Affiliations
                [1 ]ISNI 0000 0001 2230 9752, GRID grid.9647.c, Department of Psychiatry and Psychotherapy, Medical Faculty, , University Leipzig, ; Semmelweisstr. 10, Haus 13, 04103 Leipzig, Germany
                [2 ]German Alliance Against Depression, Goerdelerring 9, 04109 Leipzig, Germany
                [3 ]ISNI 0000 0000 8801 1556, GRID grid.7752.7, Bundeswehr University Munich, Institute of Clinical Psychology and Psychotherapy, ; Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany
                [4 ]ISNI 0000 0004 1936 9721, GRID grid.7839.5, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, , Goethe University Frankfurt (Distinguished Professorship funded by Dr. Senckenbergische Stiftung), ; Heinrich-Hoffmann-Strasse 10, 60528 Frankfurt am Main, Germany
                Author information
                http://orcid.org/0000-0001-7352-2422
                Article
                2325
                10.1186/s12888-019-2325-y
                6836490
                31694588
                97493710-f8da-4f63-87c1-8e7e4d66b434
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 May 2019
                : 15 October 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Clinical Psychology & Psychiatry
                depression stigma,suicide prevention,helpline,crisis hotline,counselor

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