Psychosis: Has perceived public stigma changed in Hong Kong?

Perceived public stigma (PPS) towards psychosis has remained static over 9 years in Hong Kong, with different education groups showing unique patterns of changes in PPS and endorsement of medication treatment across the years, researchers from the University of Hong Kong (HKU) have reported.

Various antistigma programmes for psychosis, such as renaming schizophrenia to psychosis and the Jockey Club Early Psychosis Project, were introduced between 2009 and 2018 in Hong Kong. To investigate the role of education level on changes in PPS towards psychosis and endorsement of medication treatment, three population-based telephone surveys were conducted in 2009 (n=1,016; mean age, 45.18 years; male, 46.4 percent), 2014 (n=1,018; mean age, 45.84 years; male, 45.4 percent) and 2018 (n=1,514; mean age, 48.98 years; male, 47.5 percent). [BMC Psychiatry 2022;22:641]

Respondents were categorized into three education groups (primary, secondary, and tertiary), and PPS was assessed by the revised Chinese Link’s Perceived Discrimination-Devaluation Scale (LPDDS), with a higher score suggesting a stronger perception of devaluation and discrimination. [Front Psychiatry 2021;12:754774; BMC Psychiatry 2022;22:641]

The level of PPS was at 2.63, 2.67 and 2.65 in surveys conducted in 2009, 2014 and 2018, respectively. “[Results] suggested that PPS towards psychosis was relatively stable at the population level in Hong Kong, even with a range of antistigma public campaigns conducted over the period,” noted the researchers.

Interestingly, the relationship between education level and PPS varied between the three surveys. “In 2009 and 2014, the tertiary education group had the highest PPS [2.73 in 2009; 2.80 in 2014], while the primary education group had the lowest PPS [2.52 in 2009; 2.53 in 2014],” reported the researchers. “In 2018, the tertiary education group showed decreased PPS, with a score not significantly different from the other two education groups. This suggests that the nature of the relationship between education level and PPS of psychosis is unstable and likely to change with different circumstances.”

A binary question (ie, do people with psychosis need prescription drugs to control their symptoms) was used to assess endorsement of medication. A significant increase in endorsement of medication treatment over the 9-year study period was observed among the primary education group (from 86.7 percent in 2009 to 93.1 percent in 2018; p=0.009), while no significant change was seen among the secondary education group (82.8–86.7 percent in 2009–2018; p=0.136). Furthermore, significantly fewer respondents in the tertiary education group endorsed the use of medication in 2018 vs 2009 and 2014 (76.9 percent vs 86.0–89.4 percent).

“The different directions of changes in medication endorsement and stigma seen among the primary and tertiary education groups between 2014 and 2018 suggest that the campaign’s effect may be more persistent within these groups. In contrast, those in the secondary education group may be more static,” noted the researchers. “These findings highlight that public antistigma campaigns may require different approaches for different education groups.”