ars.els-cdn.com · Web viewacross renaming: dividing . the . 20-year . period at . 2001 . or. 2003. The 20-year period was divided into two periods at 2001 or 2003. The ratio (number

Supplementary information

1. Method

1.1. Inclusion/Exclusion criteria

1.1.1. Inclusion criteria

Articles containing the search terms (either schizophrenia or bipolar disorder) and

information on schizophrenia/bipolar disorder were included, regardless of whether the

information contained in the article was correct or not.

Example:

Articles containing either schizophrenia or bipolar disorder that described:

schizophrenia or bipolar disorder, individuals with schizophrenia or bipolar

disorder, medical and social services for schizophrenia or bipolar disorder,

incidents and events that involved individuals with schizophrenia or bipolar

disorder, and so on.

1.1.2. Exclusion criteria

Articles containing the search terms (either schizophrenia or bipolar disorder) but

containing no information on either schizophrenia or bipolar disorder were excluded.

Articles containing metaphorical usage of either schizophrenia or bipolar disorder were

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also excluded.

Examples:

Articles containing either schizophrenia or bipolar disorder that described an

individual’s professional career, but did not contain information on schizophrenia

or bipolar disorder.

Articles containing either schizophrenia or bipolar disorder that indicated or

announced other articles and did not contain information on either schizophrenia


1.2. Coding frame

The most prominent theme of the article was coded. When an article included multiple

themes, the most prominent theme was found by the heading, an amount of paragraphs

on each theme, and the order of themes in the article.

1.2.1. Negative category

Articles containing stigmatising information, for example, negative incidents such as

murder or suicide, and negative portrayal of an individual with either schizophrenia or

bipolar disorder.

1.2.1.1. Danger subcategory

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This included articles linking danger and either schizophrenia or bipolar disorder

(regardless of whether the reported link was true or not).

Examples:

Articles on violent or threatening crime by an individual with either schizophrenia


Articles that linked danger and either schizophrenia or bipolar disorder.

Articles that described either schizophrenia or bipolar disorder as representative of

conditions that have dangerous elements (e.g., doubt about the individual being

affected by either schizophrenia or bipolar disorder was removed).

Articles about legislation on the “Medical Care and Treatment for Persons Who

Have Caused Serious Cases Under the Condition of Insanity” focusing danger

rather than treatment.

Articles on mock cases for mock trials for initiation in the citizen judge system, in

which the defendant committed a murder as an expression of schizophrenia.

Articles on prisoners suspected to be affected by either schizophrenia or bipolar

disorder.

1.2.1.2. Suicide and self-injury subcategory

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This included articles that linked suicide and self-injury and either schizophrenia or

bipolar disorder.

Examples:

Articles on the suicide and self-injury of individuals with either schizophrenia or

bipolar disorder.

Articles on suicide and either schizophrenia or bipolar disorder from an

epidemiological viewpoint.

1.2.1.3. Criminal victimisation and severe mistreatment subcategory

These articles focused on extremely negative attitudes towards an individual with either

schizophrenia or bipolar disorder and criminal victimisation.

Examples:

Articles on severe mistreatment or abuse by a carer.

Articles on the joint suicide of individuals with either schizophrenia or bipolar

disorder and carers due to great suffering from schizophrenia or bipolar disorder.

Articles on severe treatment conditions in mental health care (e.g., abuse).

Articles on medical malpractice through which patients died.

1.2.1.4. Strange, inept or burdensome subcategory

This included articles with negative attitudes towards individuals with either

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schizophrenia or bipolar disorder not included in other three negative subcategories.

Examples:

Articles on minor crimes (e.g., stealing).

Articles on minor criminal victimisation (e.g., fraud).

Articles on opinions that a diagnosis of schizophrenia or bipolar disorder should

be kept secret.

1.2.2. Positive category

Articles containing anti-stigmatising information, for example, correct information on

either schizophrenia or bipolar disorder, information promoting receiving treatment, and

information on improving social attitudes towards individuals with either schizophrenia


1.2.2.1. Explaining either schizophrenia or bipolar disorder subcategory

This included articles explaining either schizophrenia or bipolar disorder and positive

portrayals of individuals with either schizophrenia or bipolar disorder.

Examples:

Explanations of cause, treatment, prevalence, and symptoms of either

schizophrenia or bipolar disorder.

Explanations of biological, psychosocial, and general explanations of either

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Positive articles on individuals with either schizophrenia or bipolar disorder.

Articles on research achievements.

1.2.2.2. Health service inadequacies and improvements subcategory

This included articles on mental health services used by individuals with either

schizophrenia or bipolar disorder, mental health policy and its improvement, and similar

topics.

Examples:

Articles on mental health policy.

Articles on hospitals and clinics and the services provided.

Articles promoting community mental health care.

Articles on activities of service user’s organizations.

Articles on social security.

1.2.2.3. Stigma, discrimination and public education subcategory

This included articles on stigma and discrimination with anti-stigmatising messages.

Examples:

Negative articles on discriminative activity against individuals with either


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Announcements of events for public education.

Book reviews intended to educate readers about either schizophrenia or bipolar

disorder.

Articles promoting receiving mental health care at early stages.

1.2.2.4. Renaming subcategory

This included articles on the renaming of schizophrenia.

Examples:

Announcements of renaming

Explanations of the reason and purpose of renaming

Opinions on renaming.

1.3. Statistical Analyses

1.3.1. Change in trend of the ratio of articles that linked schizophrenia and danger

across renaming: analysis excluding outlier

To investigate the change in trend after renaming, the 20-year period was divided into

two decades: before and after renaming. To exclude the effect of an outlier, the highest

year was excluded. The ratio (number of articles on schizophrenia and danger in a

year)/(number of articles on bipolar disorder and danger in a year) was used as a

variable of interest. As some years contained no articles on bipolar disorder and danger,

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one was added to the number of articles for both disorders in each year to avoid a

denominator of zero. Pearson’s correlation analyses were conducted between the ratio

and number of years passed. Fisher’s r-to-z transformation was performed to examine

difference in correlation coefficients between the two periods.


across renaming: dividing the 20-year period at 2001 or 2003

The 20-year period was divided into two periods at 2001 or 2003. The ratio (number of

articles on schizophrenia and danger in a year)/(number of articles on bipolar disorder

and danger in a year) was used as a variable of interest. As some years contained no

articles on bipolar disorder and danger, one was added to the number of articles for both

disorders in each year to avoid a denominator of zero. Pearson’s correlation analyses

were implemented to examine association between the ratio and number of years

passed. We have conducted Fisher’s r-to-z transformation to examine difference in

correlations between the two periods.


across renaming: discarding the first and the last year

The years 1992 and 2011 were discarded. To investigate the change in trend after

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renaming, the 18-year period was divided into two 9-year periods (before and after

renaming). The ratio (number of articles on schizophrenia and danger in a

year)/(number of articles on bipolar disorder and danger in a year) was used as a

variable of interest. As some years contained no articles on bipolar disorder and danger,

one was added to the number of articles for both disorders in each year to avoid a

denominator of zero. Correlation between the ratio and number of years passed was

examined using Pearson’s correlation analyses. Fisher’s r-to-z transformation was

performed to examine difference in correlations between the two periods.


across renaming: adding different numbers to the numerator and denominator

To investigate the change in trend after renaming, the 20-year period was divided into

two decades (before and after renaming). The ratio (number of articles on schizophrenia

and danger in a year)/(number of articles on bipolar disorder and danger in a year) was

used as a variable of interest. As some years contained no articles on bipolar disorder

and danger, 0.5 and two were added to the number of articles for both disorders in each

year to avoid a denominator of zero. Pearson’s correlation analyses were performed

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between the ratio and number of years passed. Fisher’s r-to-z transformation was

conducted to investigate difference in correlations between the two periods.

1.3.5. Difference in trend of number of report of individuals with an expression of

mental illness who behaved dangerously toward others or themselves

Data were extracted from online database provided by the Japanese Ministry of Health,

Labour and Welfare (Ministry of Health, Labour and Welfare, 1990-2011). The number

of reports from 1992 to 2011 was searched. To investigate the change in trend after

renaming, the 20-year period was divided into two decades: the period from 1992 to

2001 and the period from 2002 to 2011. Pearson’s correlation analyses were performed

between the ratio and number of years passed. To examine difference in correlations

between the two periods, Fisher’s r-to-z transformation was implemented.

1.3.6. Difference in trend of number of mandatory hospitalisations

Data were extracted from online database provided by the Japanese Ministry of Health,

Labour and Welfare (Ministry of Health, Labour and Welfare, 1990-2011). The number

of mandatory hospitalisations from 1992 to 2011 was searched. To investigate the

change in trend after renaming, the 20-year period was divided into two decades: the

period from 1992 to 2001 and the period from 2002 to 2011. Association between the

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ratio and number of years passed was investigated using Pearson’s correlation analyses.

Further, in order to investigate difference in correlation coefficients, Fisher’s r-to-z

transformation was utilised.

2. Results

2.1. Change in trend of the ratio of articles that linked schizophrenia and danger across

renaming: analysis excluding outlier

The ratio was highest in 2002. In case where 2002 was excluded as an outlier, there was

an increase in the number of reports over time before renaming (r=0.54, R2=0.30,

SD=14.69, p=0.104), and a decrease over time after renaming (r=-0.53, R2=0.28,

SD=11.46, p=0.140). The change across renaming was significant (Z=2.16, p=0.031).

2.2 Change in trend of the ratio of articles that linked schizophrenia and danger across

renaming: dividing the 20-year period at 2001 or 2003

When the time period was divided at 2001, there was an increase in the number of

reports over time during the period before 2001 (r=0.44, R2=0.20, SD=15.59, p=0.232),

and a significant decrease over time during the period after 2001 (r=-0.69, R2=0.48,

SD=15.25, p=0.019). The change across renaming remained significant (Z=2.46,

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p=0.014).

When the time period was divided at 2003, there was a significant increase in the

number of reports over time during the period before 2003 (r=0.69, R2=0.47, SD=16.77,

p=0.020), and a decrease over time during the period after 2003 (r=0.53, R2=0.28,

SD=11.46, p=0.140). The significance in change of trends survived (Z=2.66, p=0.008).


renaming: discarding the first and the last year

When 1992 and 2011 were discarded, there was an increase in the number of reports

over time before renaming (r=0.41, R2=0.17, SD=15.32, p=0.273), and a significant

decrease over time after renaming (r=0.67, R2=0.45, SD=16.69, p=0.047). The change

across renaming was significant (Z=2.17, p=0.030).


renaming: adding different number to numerator and denominator

When 0.5 was added to the number of articles for both schizophrenia and bipolar

disorder, there was an increase in the number of reports over time before renaming

(r=0.29, R2=0.08, SD=33.46, p=0.423), and a significant decrease over time after

renaming (r=0.67, R2=0.44, SD=34.21, p=0.036). The change across renaming was still

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significant (Z=2.05, p=0.040).

In case where two was added to the number of articles for both schizophrenia and

bipolar disorder, there was a significant increase in the number of reports over time

before renaming (r=0.76, R2=0.58, SD=6.64, p=0.011), and a decrease over time after

renaming (r=-0.62, R2=0.38, SD=8.27, p=0.056). The change of trends remained

significant (Z=3.22, p=0.001).

2.5. Difference in trend of the ratio of number of reports of individuals with an

expression of mental illness who behaved dangerously toward others or themselves

The analyses demonstrated that there was a significant increase in the number of reports

over time before renaming (r=0.87, R2=0.75, SD=857.69, p=0.001), and a significant

increase over time after renaming (r=0.97, R2=0.95, SD=520.58, p<0.001). There was

no significant difference in trends across 2003 (Z=-1.66, p=0.096).

2.6. Difference in trend of number of mandatory hospitalisations

The analyses demonstrated that there was a significant increase in the number of

mandatory hospitalisations over time before renaming (r=0.93, R2=0.86, SD=286.53,

p<0.001), and a significant increase over time after renaming (r=0.96, R2=0.93,

SD=104.01, p<0.001). There was no significant difference in trends before and after

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2003 (Z=-0.64, p=0.526).

Figure legends

Supplementary Figure 1. Articles in the analysis containing the previous and new

names for schizophrenia.

Supplementary Figure 2. Articles in the analysis containing bipolar disorder.

Supplementary Figure 3. Transition of the number of articles from 1992 to

2011containing the previous name for schizophrenia (Seishin-bunretsu-byo), the new

name for schizophrenia (Togo-sitcho-syo), and both.

Supplementary Figure 4. Change in trend of the ratio of all articles, negative articles,

and positive articles on schizophrenia to that of bipolar disorder (a) Change in trend of

the ratio of articles on schizophrenia to bipolar disorder (from r=0.31, R2=0.09,

SD=3.24, p=0.390 to r=-0.20, R2=0.04, SD=2.75, p=0.589, Z=0.96, p=0.337) (b)

Change in trend of the ratio of negative articles on schizophrenia to that of bipolar

disorder (from r=0.21, R2=0.04, SD=19.09, p=0.560 to r=-0.49, R2=0.24, SD=8.20,

p=0.153, Z=1.40, p=0.162) (c) Change in trend of the ratio of positive articles on

schizophrenia to that of bipolar disorder (from r=0.44, R2=0.19, SD=1.31, p=0.204 to

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r=-0.12, R2=0.01, SD=2.30, p=0.744, Z=1.10, p=0.269).

Supplementary Figure 5. Change in trend of the ratio of the number of articles on

schizophrenia to those on bipolar disorder in each subcategory (a) Change in trend of

the ratio of articles on schizophrenia to those on bipolar disorder on suicide and self-

injury (from r=0.32, R2=0.10, SD=0.74, p=0.362 to r=0.47, R2=0.22, SD=2.48, p=0.173,

Z=-0.32, p=0.749) (b) Change in trend of the ratio of articles on schizophrenia and

criminal victimization and severe mistreatment to those on bipolar disorder (from r=-

0.48, R2=0.23, SD=4.41, p=0.162 to r=0.54, R2=0.29, SD=7.05, p=0.108, Z=-2.10,

p=0.036) (c) Change in trend of the ratio of articles on schizophrenia and strange, inept,

or burdensome to those on bipolar disorder (from r=0.70, R2=0.49, SD=2.65, p=0.025 to

r=0.17, R2=0.03, SD=2.57, p=0.636, Z=1.29, p=0.197) (d) Change in trend of the ratio

of articles on schizophrenia and explaining to those on bipolar disorder (from r=0.39,

R2=0.15, SD=1.28, p=0.268 to r=0.10, R2=0.01, SD=1.98, p=0.786, Z=0.58, p=0.559)

(e) Change in trend of the ratio of articles on schizophrenia and health service

inadequacies and improvements to those on bipolar disorder (from r=0.19, R2=0.04,

SD=2.79, p=0.592 to r=0.13, R2=0.02, SD=8.74, p=0.718, Z=0.12, p=0.904) (f) Change

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in trend of the ratio of articles on schizophrenia and stigma, discrimination, and public

education to those on bipolar disorder (from r=0.33, R2=0.11, SD=1.52, p=0.357 to r=-

0.34, R2=0.12, SD=2.98, p=0.330, Z=1.31, p=0.192) (g) Change in trend of the ratio of

articles on schizophrenia and renaming to those on bipolar disorder (from r=0.53,

R2=0.28, SD=10.63, p=0.114 to r=-0.68, R2=0.46, SD=2.90, p=0.032, Z=2.65, p=0.008)

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Reference

Ministry of Health, Labour and Welfare, 1990-2011. Patient survey, portal site of

official statistics of Japan. (http://www.e-stat.go.jp/SG1/estat/NewList.do?

tid=000001031167, last accessed: 1st Dec 2015)

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Supplementary Table1. Classification of articles containing bipolar disorder

　Entire period*

Period before

renaming **

Period after

renaming***

Category

Negative 24.57% 18.82% 27.73%

Positive 75.43% 81.18% 72.27%

Negative subcategory

Danger 11.24% 7.53% 13.27%

Suicide and self-injury 3.24% 5.91% 1.77%

Criminal victimisation and severe mistreatment 5.14% 3.23% 6.19%

Strange, inept, or burdensome 4.95% 2.15% 6.49%

Positive subcategory

Explaining schizophrenia/bipolar disorder 39.05% 38.71% 39.23%

Health service inadequacies and improvement 13.71% 16.13% 12.39%

Stigma, discrimination, and public education 22.67% 26.34% 20.65%

Renaming 0.00% 0.00% 0.00%

*from 08/1992 to 07/2012

**from 08/1992 to 07/2002

***from 08/2002 to 07/2012

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Supplementary Table 2. Differences in trends before and after renaming

　 Period before renaming* Period after renaming**Difference in trend

between two periods

Variables r R2 SD p value r R2 SD P value Z score p value

Total 0.31 0.09 3.24 0.39 -0.2 0.04 2.75 0.589 0.96 0.337

Category

Negative 0.21 0.04 19.09 0.56 -0.49 0.24 8.2 0.153 1.4 0.162

Positive 0.44 0.19 1.31 0.204 -0.12 0.01 2.3 0.744 1.1 0.269

Negative subcategory

Danger 0.54 0.3 14.69 0.104 -0.69 0.47 15.83 0.028 2.72 0.007†

Suicide and self-injury 0.32 0.1 0.74 0.362 0.47 0.22 2.48 0.173 -0.32 0.749

Criminal victimisation and severe

mistreatment-0.48 0.23 4.41 0.162 0.54 0.29 7.05 0.108 -2.1 0.036

Strange, inept, or burdensome 0.7 0.49 2.65 0.025 0.17 0.03 2.57 0.636 1.29 0.197

Positive subcategory

Explaining schizophrenia/bipolar disorder 0.39 0.15 1.28 0.268 0.1 0.01 1.98 0.789 0.58 0.559

Health service inadequacies and

improvement0.19 0.04 2.79 0.592 0.13 0.02 8.74 0.718 0.12 0.904

Stigma, discrimination, and public

education0.33 0.11 1.52 0.357 -0.34 0.12 2.98 0.33 1.31 0.192

Renaming 0.53 0.28 10.63 0.114 -0.68 0.46 2.9 0.032 2.65 0.008

*from 08/1992 to 07/2002

**from 08/2002 to 07/2012

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† statistically significant

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Supplementary Figure 1.

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