Hui-Ing Ma

Individuals with illness or disability constitute a major portion of the client base served by healthcare professionals. However, these conditions are often associated with devaluation and stigma [...

Objective: This study assessed changes in attitudes towards mental illness and physical disabilities in occupational therapy (OT) students after an anti-stigma course (AS group) and compared the changes in attitudes with a control (CT group) attending a sociology course. Methods: A quasi-experimental design was used in this study with 65 OT students across two academic years (AS group: n = 33; CT group: n = 32). Stigmatizing attitudes and social distance towards mental illness and physical disabilities were measured before and after course completion. Results: Compared with the CT group, the AS group showed a significantly greater reduction in social distance towards mental illness ( t = 1.974, p = .027) and decreases in stigmatizing attitudes ( t = 2.087, p = .021) and social distance ( t = 2.512, p = .008) towards physical disabilities. In addition, both groups reported greater social distance towards mental illness than towards physical disabilities in both the pretest and posttest. Conclusions: A multimodal anti-stigma course may decrease social distance towards mental illness as well as stigmatizing attitudes and social distance concerning physical disabilities among OT students. However, further refinement of the anti-stigma course, with a particular emphasis on mental health stigma, is warranted.

Attitudes of healthcare professionals towards people with disorders/disabilities are important for the development of therapeutic relationships, as well as to the evaluation and intervention processes. Therefore, it is critical to be aware and reduce stigmatizing attitudes in future healthcare professionals. An 18-week anti-stigma course was developed for occupational therapy students based on literature review and focus group interview. The course consisted of three components, including social contact, roleplaying, and critical reflection strategies. A quasi-experimental design was implemented to evaluate participants at three time points (i.e., pre-test, post-test, and one year after completion) using the Social Distance Scale and several questionnaires (i.e., stigmatising attitudes towards mental illness, physical disabilities, and children with emotional behavioural disorders). A total of 16 students completed the course and had significantly decreased social distance and stigmatising attitudes towards mental illness and emotional behavioural disorders in the post-test. These decreases remained one year later. The results support the provision of an anti-stigma course for occupational therapy students to reduce stigmatising attitudes. Future research should extend the anti-stigma course to occupational therapy students at other universities to increase both the sample size and overall generalisability.

Background: People may be stigmatized if they have mental illness, emotional and behavioral disorders (EBD), or physical or intellectual disabilities. Being stigmatized adversely affects one’s psychological well-being and quality of life. While occupational therapists frequently work with people with EBD and disabilities, all healthcare practitioners may encounter these populations, and stigmatizing attitudes of healthcare professionals towards such clients can negatively affect the therapeutic relationship, evaluation, and treatment. Therefore, understanding attitudes of healthcare students—as future practitioners in all fields of healthcare—towards people in this regard is fundamental to the future implementation of anti-stigma programs. We aimed to develop and test questionnaires for examining stigmatizing attitudes of healthcare students towards people with mental illness or disabilities and children with EBD. Methods: A literature review was conducted to identify surveys related to attitudes towards people with mental illness, EBD, and disabilities. Items that were pertinent to the concept of stigma were selected and modified to fit into the Taiwanese context. A total of 336 students from departments of occupational therapy, physical therapy, nursing, and medicine in 7 universities across Taiwan completed the questionnaires. Item analysis and factor analysis were used to examine the reliability and validity of the questionnaires. Gender differences were also considered. Results: Factor analyses of the three questionnaires yielded factor structures that explained 61.34 to 67.15% of the variance, with Cronbach’s α values ranging from 0.71 to 0.89. The Questionnaire on Stigmatizing Attitudes Towards Mental Illness consisted of 16 items with 4 subscales: deviant behavior, social isolation, negative stereotype, and self-stigma. The Questionnaire on Stigmatizing Attitudes Towards Children with EBD consisted of 14 items with 3 subscales: rejective attitude, negative stereotype, and deviant behavior. The Questionnaire on Stigmatizing Attitudes Towards Disabilities consisted of 10 items with 3 subscales: positive stereotype, negative stereotype, and pessimistic expectation. In addition, men had slightly higher stigmatizing attitudes than women. Conclusions: The results showed satisfactory factor structures and internal consistency, and thus support the use of these questionnaires to understand attitudes of healthcare students towards these populations. In addition, particular attention should be paid to gender differences in stigmatizing attitudes of healthcare students.

Patients with schizophrenia not only have psychiatric symptoms, but also have movement problems, which might also be associated with their reduced quality of life. Little is known about how to improve their movement performance for patients. Manipulating object size and distance is common in occupational therapy practice to evaluate and optimize reaching performance in patients with physical disabilities, but effects of the manipulation in patients with schizophrenia remain unclear. The purpose of this study was to examine whether object size and distance could change performance of reaching kinematics in patients with mild schizophrenia. Twenty-nine patients with mild schizophrenia and 15 age- and gender-matched healthy controls were required to reach for, as quickly as possible, a small or large object that was placed at a near or far distance. We measured movement time, peak velocity, path length ratio, percentage of time to peak velocity, and movement units to infer movement speed, forcefulness, spatial efficiency (directness), control strategies, and smoothness. Patients’ reaching movements were slower (p = .017) and less direct (p = .007) than those of controls. A larger object induced faster (p = .016), more preprogrammed (p = .018), and more forceful (p = .010) movements in patients. A farther object induced slower, more feedback dependent, but more forceful and more direct movements (all p < .001). The results of kinematic deficiencies suggest the need of movement training for patients with mild schizophrenia. Occupational therapists may grade or adapt reaching activities by changing object size and distance to enhance movement performance in patients with schizophrenia.

Generic and disease-specific health-related quality of life (HRQoL) instruments may reflect different aspects of lives in patients with Parkinson’s disease (PD) and thus be associated with different determinants. We used the same cluster of predictors for the generic and disease-specific HRQoL instruments to examine and compare the determinants of HRQoL. HRQoL was measured in 92 patients with PD by the 36-item Short-Form Health Survey (SF-36) and the 39-item Parkinson’s Disease Questionnaire (PDQ-39). The predictors included demographic and disease characteristics, and motor and non-motor symptoms. Multiple regression analyses were used to identify HRQoL determinants. Depressive symptoms and motor difficulties of daily living were the first two significant determinants for both instruments. The other significant determinant for the SF-36 was fatigue and non-motor difficulties of daily living, and for the PDQ-39 was motor signs of PD. The results suggest the importance of the evaluation and intervention focused on depressive symptoms and motor difficulties of daily living in patients with PD. In addition, the SF-36 seems more related to non-motor symptoms, while the PDQ-39 appears more associated with motor symptoms. This information is important for understanding results from these two instruments and for choosing which to use.

The responsiveness of a measurement instrument is important for understanding its ability to detect changes in the progression of a disease. We examined and compared the internal and external responsiveness of the 36-item Short-Form Health Survey (SF-36) and the 39-item Parkinson’s Disease Questionnaire (PDQ-39) in patients with Parkinson’s Disease (PD). Seventy-four patients with PD were evaluated using the SF-36 and PDQ-39 at baseline and again after one year. In addition, their motor signs, motor difficulties of daily living, and depressive symptoms were assessed as external criteria. The internal responsiveness was examined using effect size, standardized response mean, and the Wilcoxon signed rank test. The external responsiveness was examined using receiver operating characteristic curves, correlation analyses, and regression models. Both instruments were partially sensitive to changes during the 1-year follow-up and able to discriminate between patients with improved versus deteriorated motor signs. In addition, both were similarly responsive to changes in the motor difficulties of daily living; the SF-36 appeared to be more sensitive than the PDQ-39 to changes in depressive symptoms. The SF-36 and the PDQ-39 were acceptably internally and externally responsive during the 1-year follow-up.

Postural dysfunctions are prevalent in patients with schizophrenia and affect their daily life and ability to work. In addition, sensory functions and sensory integration that are crucial for postural control are also compromised. This study intended to examine how patients with schizophrenia coordinate multiple sensory systems to maintain postural stability in dynamic sensory conditions. Twenty-nine patients with schizophrenia and 32 control subjects were recruited. Postural stability of the participants was examined in six sensory conditions of different level of congruency of multiple sensory information, which was based on combinations of correct, removed, or conflicting sensory inputs from visual, somatosensory, and vestibular systems. The excursion of the center of pressure was measured by posturography. Equilibrium scores were derived to indicate the range of anterior-posterior (AP) postural sway, and sensory ratios were calculated to explore ability to use sensory information to maintain balance. The overall AP postural sway was significantly larger for patients with schizophrenia compared to the controls [patients (69.62±8.99); controls (76.53±7.47); t_1,59 = -3.28, p<0.001]. The results of mixed-model ANOVAs showed a significant interaction between the group and sensory conditions [F_5,295 = 5.55, p<0.001]. Further analysis indicated that AP postural sway was significantly larger for patients compared to the controls in conditions containing unreliable somatosensory information either with visual deprivation or with conflicting visual information. Sensory ratios were not significantly different between groups, although small and non-significant difference in inefficiency to utilize vestibular information was also noted. No significant correlations were found between postural stability and clinical characteristics. To sum up, patients with schizophrenia showed increased postural sway and a higher rate of falls during challenging sensory conditions, which was independent of clinical characteristics. Patients further demonstrated similar pattern and level of utilizing sensory information to maintain balance compared to the controls.

Purpose People with Parkinson’s disease (PD) may experience stigma due to their visible features of movement and communication difficulties. This paper aimed to examine the role of experienced stigma in health-related quality of life (QOL), after controlling for personal and clinical characteristics. Methods This is a preliminary analysis of a subset of baseline data from the Social Self-Management of Parkinson’s Disease Study (SocM-PD), an ongoing 3-year prospective cohort study. Seventy-three people with PD (M _age = 65.72, 29 women) participated in this study. Hierarchical multiple regression analyses were used to determine the role of stigma in QOL, after controlling for gender, disease severity, depression, and motor difficulties of daily living. Results Significant correlations were found between QOL with gender (r = .26), disease severity (r = .38), depression (r = .65), motor difficulties of daily living (r = .71), and stigma (r = .83). After controlling for the significant covariates, stigma made a significant and unique contribution to the explanation of QOL by 13.7 % (p < 0.001). A final hierarchical multiple regression with stigma and the 4 covariates revealed an overall model that explained 77.8 % of the total variance of QOL (F [5, 63] = 48.79, p < 0.001). Conclusions Experienced stigma appears to be a key determinant of QOL in people with PD. The results suggest the importance of further understanding stigma in PD to develop possible intervention strategies. Future work is also needed to verify the results with a larger and longitudinal dataset of the SocM-PD.