سواد سلامت روانی و اختلال شخصیت وسواسی جبری

Abstract An opportunistic sample of 342 participants completed a vignette identification task that required them to name the possible psychological problem of an individual described in vignettes describing people with depression, schizophrenia, OCD and OCPD. Participants rated the degree to which they believed the individual experienced distress, they felt sympathetic towards the described individual, and the degree to which they believed the individual was well-adjusted in the community. There were very low recognition rates of OCPD, with participants more likely to identify depression, schizophrenia and OCD. Analysis of distress, sympathy and adjustment ratings also revealed significant differences between the disorders. The findings highlight the necessity of greater mental health awareness and the importance of psycho-education in order to increase successful treatment seeking of OCPD patients.

Introduction Mental Health Literacy (MHL) is defined as ‘the knowledge and beliefs about mental disorders which aid their recognition, management or prevention’ (Jorm et al., 1997). Jorm's (2000) review highlighted that a great majority of members of the public could not recognise mental disorders or pathological distress. For example, Jorm et al. (1997) found that 39% of the participants were able to label depression, but only 27% of them correctly identified schizophrenia. More recent studies have reported higher recognition rates on depression and schizophrenia: namely 97% for depression and 61% for schizophrenia but only 39% for anti-social personality disorder (Furnham et al., 2009). However, this increase in mental health literacy may not reflect an increase in awareness, but may be the result of methodological differences in the assessment and measurement of mental health literacy in different samples (Furnham and Dadabhoy, 2012). Yet recent longitudinal research has provided evidence of real positive changes over time in MHL (Reavley and Jorm, in press). Various demographic variables have also been found to have an effect on mental health literacy. Fischer and Goldney (2003) found that younger and more educated people have more informed beliefs about mental illnesses. Gender has also been found to have a significant effect on identification of disorders (Furnham et al., in press). Riedel-Heller et al. (2005) found that females were more likely to suggest psychotherapy as a treatment for depression and schizophrenia than psychotropic drugs. Culture may also have an impact on the explanatory models and attitudes towards mental health literacy (Kleinman, 1988) and can determine motivations and treatment decisions (Rogler and Cortes, 1993). Jorm et al. (1997) also suggested that contact with a mental patient affects the lay beliefs in the sense that they become better informed about the cause and manifestation of mental illnesses. Lauber et al. (2003) also found that previous contact with a mental patient increased recognition of depression. Schomerus et al. (2013) investigated the consequence of what they called continuum beliefs (as opposed to categorical beliefs) about people with various mental illnesses. They found, as predicted, that continuum beliefs were associated with less stigmatising attitudes, particularly with regard to schizophrenia and alcohol dependence suggesting the importance of educating people about the continuous nature of most psychopathological phenomena. Furnham and Winceslaus (2012) found the majority of their participants failed to recognise the personality disorders. The disorder that yielded the highest recognition rate was paranoid personality disorder, identified by only 36% of participants. Similarly, Furnham et al. (2011) found that a large proportion of their participants perceived a psychological problem as present, but very few of them were able to ‘correctly’ label the personality disorders. One of their hypotheses was that Obsessive–Compulsive Personality Disorder (OCPD) would be identified more due to its extensive projection in the media compared to other disorders. Although it yielded one of the highest scores in correct labelling, OCPD was recognised as a psychological problem by less than half of their participants. A highly salient paper for this research area is a study by Coles et al. (2013) on the public's knowledge of OCD. In all 575 American adults took part in a telephone interview study and they found 90% reported that they symptoms were a cause of concern and that the person described should seek professional help. They noted that only a third of the respondents labelled the disorder correctly as OCD, Better educated, higher social class and younger people were better at correctly labelling the symptoms. Interestingly the respondents were more hopeful of the success of psychotherapy than medication as a cure. This study concerned the recognition of OCPD which is a Cluster C personality disorder, according to the DSM classification system. It is, according to DSM-V (American Psychiatric Association, 2013) one of the most common of the personality disorders with an estimated prevalence from 2.1 to 7.9% of the population, diagnosed twice as often in males compared to females. There has been a heated debate regarding OCPD's relation to obsessive–compulsive disorder (OCD), with the two extreme standpoints claiming either that OCPD is completely unrelated to OCD or that OCPD is a prerequisite for the development of OCD. However, most individuals with OCD do not have a pattern of behaviour that fulfils the criteria for OCPD (Mancebo et al., 2005). Additionally, it is argued that OCPD is an egosyntonic disorder, implying that the symptoms are in congruency with the individual's goals and desires, whereas OCD is egodystonic, which means that symptoms cause distress and anxiety to the individual who recognises the abnormal nature of the symptoms (Taylor et al., 2011). Few studies have looked specifically at the mental health literacy of OCD and OCPD particularly how they compared with one another and the more commonly researched schizophrenia. It is suggested by MHL researchers that recognition of mental illness has benefits because people with particular conditions are more sympathetically dealt with and offer more and better (more professional) help. This seems to be the case where there are evidence-based treatments but the same may not be the case for OCPD. Indeed there seems to be very little evidence for the availability, feasibility or proven efficacy of any treatment for OCPD (de Reus and Emmelkamp, 2010) which would make the task near impossible for a person eager to help themselves and/or others who they suspected had the condition. However given the fact that many people with personality disorder fail to recognise their symptoms it often behoves others like family members who, with better MHL, may offer help and advice. This study aims to investigate the ability of lay people to identify OCPD as a psychological illness and to evaluate the individual's adjustment in the community. The first hypothesis (H1) was that OCPD will be significantly less recognised than depression, schizophrenia and OCD (Furnham et al., 2011). The second hypothesis (H2) was that lay ratings of distress and sympathy will be lower and adjustment ratings of the individual will be higher for OCPD individuals than other disorders (Furnham et al., 2011). The third hypothesis (H3) is that higher sympathy and adjustment but lower distress scores will predict increased obsessive symptoms due to the egosyntonic nature of OCPD and the theory that obsessive thoughts are in a continuum in the population and it is frequency and intensity that defines clinical pathology of obsessions and compulsions (Berry and Laskey, 2012). The fourth hypothesis (H4) is that gender (H4a), personal experience of mental illness (H4b), study of psychology (H4c) and contact with a mental patient (H4d) would predict mental health literacy of OCPD and ratings of distress, sympathy and adjustment.

3. Results 3.1. Vignette identification analysis Gender of patient described in the vignette was counterbalanced successfully as there were no significant differences in the two types of questionnaire (F (1, 340)=0.10, p=0.75). Depression was identified by 79.0% of the participants, schizophrenia by 59.0%, OCD by 63.0% of the participants and OCPD by only 2.0%. Thus if OCD and OCPD were combined and considered equivalently ‘correct’ it meant just under two thirds of the population were able to detect/label the disorder correctly. Depression was significantly more identified than OCPD (x2 (1, N=342)=261.00, p<0.001). Schizophrenia was also significantly more identified than OCPD (x2 (1, N=342)=188.24, p<0.001). Results from the two OCD cases were similar and not statistically different. Finally, OCD was also significantly identified more than OCPD (x2 (1, N=342)=202.12, p<0.001). 3.2. Vignette labelling analysis A content analysis was further conducted in order to identify the most common lay labels of OCPD. Table 1 shows the rankings of answers provided by participants in the open-ended question ‘What do you think is X's main problem?’ The label ‘perfectionism/perfectionist’ was most common in participants’ responses. Interestingly, 14.9% of participants identified OCPD as OCD. Table1. Ranking of lay beliefs of obsessive–compulsive personality disorder. Label category Participants (%) Perfectionism/perfectionist 20.5 ‘Workaholic’/addicted to work/works too hard/too focused on work 15.8 Obsessive compulsive disorder 14.9 Other/non-specific (i.e. selfish, indecisive) 14.5 Anxiety disorder/stress/unable to relax 12.6 ‘Control freak’/need to control/controlling 11.1 Obsessions/compulsions 3.8 Obsessive compulsive personality disorder 2.0 Retentive personality/type A personality/neurotic 1.8 Nothing/do not know 1.5 Mania/autism 1.5 Total 100.0 Table options Ratings of Distress, Sympathy and Adjustment. The results showed that the differences in the means of the ratings for patient distress were significant between the different disorders (F (2.8, 937.8)=134.28, p<0.001). Post hoc pairwise comparisons of the distress means of each disorder, with Bonferroni adjustments was conducted in order to identify where the significant differences lay. Depression (M=5.98) differed significantly from OCPD (M=4.92) (t (341)=12.60, p<0.001), schizophrenia (M=6.30) (t (341)=4.85, p<0.001) and OCD (M=5.50) (t (341)=6.88, p<0.001). Schizophrenia also yielded significantly higher distress scores than OCPD (t (341)=17.14, p<0.001) and OCD (t (341)=12.92, p<0.001). OCD differed significantly from OCPD (t (341)=7.73, p<0.001). Overall, OCPD ratings yielded the lowest distress ratings. Sympathy ratings towards vignette characters were also compared among mental disorders using a one-way repeated measure ANOVA. The results showed that the differences between ratings of sympathy towards the different cases of mental disorders were significant (F (2.8, 950.5)=186.76, p<0.001). Additional post hoc pairwise comparisons with Bonferroni adjustments indicated that depression (M=5.32) had significantly higher sympathy ratings than OCPD (M=3.67) (t (341)=17. 76, p<0.001), but lower than schizophrenia (M=5.51) (t (341)=2.37, p=0.019) and OCD (M=4.79) (t (341)=6.76, p<0.001). Schizophrenia differed significantly from OCPD (t (341)=18.80, p<0.001) and OCD (t (341)=9.67, p<0.001). OCD also yielded significantly higher sympathy scores than OCPD (t (341)=13.31, p<0.001). Overall, participants felt lowest sympathy for OCPD patients. Adjustment ratings of each person described in the vignettes were also compared between the different disorders. Adjustment scores were computed by adding up the participants’ ratings on the patient’s happiness, quality of relationships and success at work (Fig. 1). The rationale for this computation was that the ratings were highly significantly correlated (r>0.50) within and between vignettes. The results indicated that the differences between lay adjustment ratings for each disorder were significant (F (3, 1023)=456.47, p<0.001). Further post hoc pairwise comparisons with Bonferroni adjustments indicated that depression (M=5.82) had significantly lower adjustment ratings than OCPD (M=10.47) (t (341)=28.31, p<0.001) and OCD (M=9.83) (t (341)=24.39, p<0.001). Schizophrenia (M=5.89) differed significantly from OCD (t (341)=23.25, p<0.001) and OCPD (t (341)=26.79, p<0.001). OCD showed significantly lower adjustment ratings than OCPD (t (341)=3.85, p<0.001). However, depression and schizophrenia patients did not differ significantly in their adjustment ratings (t (341)=0.417, p=0.667). Mean lay ratings of adjustment for depression, OCPD, schizophrenia and OCD. Fig. 1. Mean lay ratings of adjustment for depression, OCPD, schizophrenia and OCD. Figure options 3.3. Demographic variables One-way independent samples ANOVAs were conducted for each control variable with OCPD identification and ratings of distress, sympathy and adjustment as dependent variables. In terms of gender, females’ mean rating of distress for the OCPD vignette was 5.08 whereas the males’ mean rating was 4.67. This difference was significant (F (1, 340)=7.06, p=0.008). Additionally, females yielded a lower average score of sympathy ratings (M=3.67) compared to males (M=4.43) and this difference was also significant (F (1, 340)=4.75, p=0.030). Finally, there was also a significant difference between genders in adjustment ratings (F (1, 340)=12.35, p<0.001) with females (M=10.10) scoring lower in the adjustment scale of the OCPD vignette than males (M=11.08). Participants who have studied psychology and mental illnesses yielded significantly higher scores on distress (M=5.22) than participants who have not studied psychology (M=4.81) (F (1, 340)=5.82, p=0.016). Similarly, participants who had studied psychology scored significantly higher in sympathy (M=4.30) than the ones who had not (M=3.45) (F (1, 340)=20.92, p<0.001). Finally, those who knew someone with a mental illness yielded significantly higher scores on sympathy towards OCPD patients (M=3.83) than the ones who did not (M=3.49) (F (1, 340)=3.92, p=0.048). They also scored the OCPD case with significantly lower adjustment score (M=9.97) than the participants who did not have contact with someone with a mental disorder (M=11.02). A multiple regression was computed to test the fourth hypothesis but was not significant. Personal experience of a mental disorder did not predict ratings of distress, sympathy or adjustment. None of the demographic variables predicted OCPD identification, but this could be due to the highly skewed responses and the very low percentage of correct responses.