Page 147 - GHES-3-1

Global Health Economics and
Sustainability
Reducing public stigma related to psychosis

addressing misconceptions about PMIH, sharing lived (Grusec et al., 2002; Lampridis & Papastylianou, 2014;
experiences, and highlighting recovery potential (Corrigan Markus & Kitayama, 1991; Martí-Vilar et al., 2019).
et al., 2012; Knaak et al., 2014), this study shows that a Singaporeans often value maintaining harmony and
brief, cost-effective, 30-min digital psychoeducational showing kindness, which aligns with collectivistic values
session incorporating these elements effectively reduces (Chang et al., 2003). Therefore, the sustained increase in
public stigma across multiple dimensions. participants’ willingness to help and interact with PMIH
However, significant effects did not persist from post- may reflect these local collectivistic values.
intervention to follow-up for five stigma-related factors: Interestingly, there were no significant changes
coercive treatment, empathy, social distancing, social in negative emotions from pre-intervention to post-
restrictiveness, and prejudice and misconception. This intervention compared with the control group. As the only
lack of sustained impact may be due to participants’ factor measuring affective responses, its lack of significant
continued exposure to societal stigma about PMIH change might be due to affective reactions toward mental
during the 1 month period after the intervention, which ill-health being more resistant to change than cognitive
diminished the benefits of psychoeducation on a broader, and behavioral aspects of stigma (Na et al., 2022).
community level (Na et al., 2022). Previous studies have Psychoeducational interventions focus on providing
highlighted the strong influence of sociocultural norms knowledge to challenge incorrect stereotypes, which likely
and beliefs on maintaining public stigma (Angermeyer & impacts cognitive rather than affective responses (Na
Dietrich, 2006; Cheon & Chiao, 2012; Yang et al., 2007). et al., 2022). This may explain why our findings did not
In Singapore’s collectivistic society, stigmatizing and align with the original hypothesis.
discriminatory beliefs are common, with PMIH often The lack of significant increase in tolerance and support
linked to negative traits (Lai et al., 2000; Mankiewicz & from pre-intervention to post-intervention may be due to
Kam, 2024; Ong et al., 2020). These cultural norms may this factor encompassing all three dimensions of public
reinforce misconceptions and hinder long-term change. stigma: stereotyping, prejudice, and discrimination. The
For example, societal pressure to conform can perpetuate complex nature of public stigma, influenced by cultural
views of mental ill-health as abnormal and deviant from factors as noted by Abdullah & Brown (2011), may
accepted norms (Abdullah & Brown, 2011). Thus, while have limited the effectiveness of the psychoeducational
the psychoeducational intervention was effective in intervention in significantly boosting tolerance and
reducing stigma on an individual level immediately after support. Some researchers suggest that educational
the intervention, it was less effective in maintaining these materials alone might have limited impact on reducing
changes over time due to the strong cultural influences public stigma, particularly if interventions focus solely on
encountered by participants between the post-intervention individual mechanisms (Corrigan et al., 2000; Rao et al.,
and follow-up measurements. 2019).
However, significant effects were maintained at Therefore, psychoeducational interventions may need to
follow-up for the dimensions of fear and dangerousness. go beyond individual-level delivery and include strategies
Several studies have highlighted the importance of targeting stigma at a systemic level, such as within families
including factual information that directly addresses and communities, to achieve substantial and lasting change
and corrects misconceptions about mental ill-health and across all aspects of stigma (Hinshaw & Stier, 2008).
psychosis in psychoeducational interventions (Corrigan Multilevel interventions should also integrate evidence-
et al., 2000; Corrigan et al., 2012; Lincoln et al., 2008; Tan based strategies to address public stigma effectively (Rao
& Mankiewicz, 2024). This suggests that providing relevant et al., 2019). For example, FIp, which is evidence-based
information is crucial for achieving and maintaining a and used in clinical settings, has demonstrated positive
long-term reduction in stigma. The sustained reduction effects in reducing negative caregiver evaluations and
in fear and perceived dangerousness at follow-up may be enhancing empathy toward family members with psychosis
attributed to the intervention’s focus on directly countering (Girón et al., 2014; Lowenstein et al., 2010). Since
the myth that people with psychosis are dangerous, psychoeducation is a key component of FIp and contributes
consistent with existing evidence (Schrack et al., 2021). to these outcomes (Onwumere et al., 2018), it suggests
The continued increase in willingness to help and its potential as a systemic intervention for addressing
interact at follow-up might be influenced by collectivistic misperceptions about psychosis. Thus, psychoeducational
values. Research indicates that people with collectivistic interventions may also need to be implemented at a
values are more likely to engage with, cooperate with, systemic level to effectively improve and sustain changes
and support others than those with individualistic values in the multidimensional aspects of stigma, especially

Volume 3 Issue 1 (2025) 139 https://doi.org/10.36922/ghes.3363