Purpose of the review To collect and update published information on the stigma associated with substance abuse in non-clinical samples, which has not been recently reviewed. Recent findings Searching large databases, a total of only 20 studies were published since 1999, with the majority of studies conducted outside the United States. Using major stigma concepts from a sociological framework (stereotyping, devaluation in terms of status loss, discrimination and negative emotional reactions), the studies reviewed predominantly indicated that the public holds very stigmatized views towards individuals with substance use disorders, and that the level of stigma was higher towards individuals with substance use disorders than towards those with other psychiatric disorders. Summary The prevalence of substance use disorders is increasing in the U.S. general population, but these disorders remain seriously under-treated. Stigma can reduce willingness of policy-makers to allocate resources, reduce willingness of providers in non-specialty settings to screen for and address substance abuse problems, and may limit willingness of individuals with such problems to seek treatment. All of these factors may help explain why so few individuals with substance use disorders receive treatment. Public education that reduces stigma and provides information about treatment is needed.

Background Task-sharing is a promising strategy to expand mental healthcare in low-resource settings, especially in low- and middle-income countries (LMICs). Research on how to best implement task-sharing mental health interventions, however, is hampered by an incomplete understanding of the barriers and facilitators to their implementation. This review aims to systematically identify implementation barriers and facilitators in evidence-based task-sharing mental health interventions using an implementation science lens, organizing factors across a novel, integrated implementation science framework. Methods PubMed, PsychINFO, CINAHL, and Embase were used to identify English-language, peer-reviewed studies using search terms for three categories: “mental health,” “task-sharing,” and “LMIC.” Articles were included if they: focused on mental disorders as the main outcome(s); included a task-sharing intervention using or based on an evidence-based practice; were implemented in an LMIC setting; and included assessment or data-supported analysis of barriers and facilitators. An initial conceptual model and coding framework derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework was developed and iteratively refined to create an integrated conceptual framework, the Barriers and Facilitators in Implementation of Task-Sharing Mental Health Interventions (BeFITS-MH), which specifies 37 constructs across eight domains: (I) client characteristics, (II) provider characteristics, (III) family and community factors, (IV) organizational characteristics, (V) societal factors, (VI) mental health system factors, (VII) intervention characteristics, and (VIII) stigma. Results Of the 26,935 articles screened (title and abstract), 192 articles underwent full-text review, yielding 37 articles representing 28 unique intervention studies that met the inclusion criteria. The most prevalent facilitators occur in domains that are more amenable to adaptation (i.e., the intervention and provider characteristics domains), while salient barriers occur in domains that are more challenging to modulate or intervene on—these include constructs in the client characteristics as well as the broader societal and structural levels of influence (i.e., the organizational, mental health system domains). Other notable trends include constructs in the family and community domains occurring as barriers and as facilitators roughly equally, and stigma constructs acting exclusively as barriers. Conclusions Using the BeFITS-MH model we developed based on implementation science frameworks, this systematic review provides a comprehensive identification and organization of barriers and facilitators to evidence-based task-sharing mental health interventions in LMICs. These findings have important implications for ongoing and future implementation of this critically needed intervention strategy, including the promise of leveraging task-sharing intervention characteristics as sites of continued innovation, the importance of but relative lack of engagement with constructs in macro-level domains (e.g., organizational characteristics, stigma), and the need for more delineation of strategies for task-sharing mental health interventions that researchers and implementers can employ to enhance implementation in and across levels. Trial registration PROSPERO CRD42020161357

No abstract

IMPORTANCE Cognitive deficits constitute core features of schizophrenia, but the trajectories of cognitive difficulties in chronic untreated schizophrenia remain unclear. OBJECTIVE To assess the association of neuropsychological deficits with duration of untreated psychosis in individuals with chronic untreated schizophrenia. DESIGN, SETTING, AND PARTICIPANTS Community-dwelling individuals with chronic untreated schizophrenia (untreated patient group) and individuals without mental illness (control group) were recruited from predominantly rural communities in Ningxia, China between June 20, 2016, and August 6, 2019, and administered the Structured Clinical Interview for DSM-IV, the Mini-Mental State Examination, an 8-test version of the MATRICS Consensus Cognition Battery adapted for use in individuals with low levels of education, and a measure of social cognition. MAIN OUTCOMES AND MEASURES Comparison of cognitive test scores between the two groups and association of cognitive test scores with duration of untreated schizophrenia. RESULTS The patient group included 197 individuals with chronic untreated schizophrenia (101 men [51.3%]; mean [SD] age, 52.1 [11.8] years; median [interquartile range] years of schooling, 3 [0-6] years; median [interquartile range] years of untreated psychosis, 22.9 [14.9-32.8] years). The control group included 220 individuals (118 men [53.6%]; mean [SD] age, 52.1 [11.2] years; median [interquartile range] years of schooling, 4 [0-6] years). The untreated patient group performed significantly worse than the control group on all cognitive measures (adjusted partial Spearman correlation coefficient [Spearman ρ] ranged from −0.35 for the revised Chinese version of the Reading the Mind in the Eyes Test to −0.60 for the Brief Visuospatial Memory Test-Revised; P < .001 for all comparisons). Longer durations of untreated psychosis were associated with lower performance in 3 MATRICS Consensus Cognition Battery measures assessing different aspects of executive functioning (Brief Visuospatial Memory Test-Revised [ρ = −0.20; P = .04]; Brief Assessment of Cognition in Schizophrenia, Symbol Coding subtest [ρ = −0.35; P < .001]; and Neuropsychological Assessment Battery, Mazes subtest [ρ = −0.24; P = .01]). The median duration of untreated psychosis (22.9 years) was associated with estimated score reductions in the 3 measures of 34% (95% CI, 10%-52%), 43% (95% CI, 28%-55%), and 57% (95% CI, 31%-73%), respectively. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that long-term untreated schizophrenia was associated with decreases in selective cognitive abilities; both neurodegenerative pathology and neurodevelopmental dysfunction may be factors in cognition in persistent psychosis. Expanding research to include cohorts of patients from underserved rural communities in low-and middle-income countries may provide new insights about the etiological factors, disease course, and management of schizophrenia.

Masculinity has been theorized to be an anxiety-provoking state. Consequently, many researchers have examined masculinity in relation to negative psychological outcomes such as anxiety, depression, and alcohol or substance use. However, emerging research suggests that certain facets of masculinity may also be related to positive psychological outcomes and that there is a need for more empirical research examining the differential impact of distinct masculine norms on both negative and positive outcomes. Accordingly, this study longitudinally examined the influence of masculine norms and gender role conflict on eudaimonic psychological well-being among young adult college men (N = 278). Participants were recruited from a public university and completed Time 1 (baseline) measures of masculine norm conformity and gender role conflict as well as Time 2 (6 months follow-up) measure of eudaimonic well-being. Results demonstrated that both masculine norm conformity and gender role conflict were predictive of increased and decreased well-being among young adult men. Specifically, the masculine norms of power and playboy were negatively associated with prospective well-being. In addition, gender role conflict, particularly restricted emotionality, was negatively associated with well-being. The norm of winning was positively associated with prospective well-being. In sum, men’s baseline adherence to traditional masculine norms was predictive of both positive and negative psychological well-being at follow-up, highlighting the differential impact of masculine norms on men’s health. The study’s theoretical and clinical implications, limitations, and future directions are discussed.