Portrayals of narcolepsy from 1980 to 2020: a descriptive analysis of stigmatizing content in newspaper articles

Abstract

Study Objectives:

The media are the primary sources of information about health for the public. The media portrayal of narcolepsy might contribute to the stigmatization of people affected by this condition. This study aimed to describe how narcolepsy is portrayed in newspapers.

Methods:

We collected 257 newspaper articles from the digital archive of La Stampa published between 1980 and 2020 that mentioned key search terms. The content was assessed using an ad hoc coding schema developed to evaluate the presence of sensationalistic title, negative language, stigmatizing content, stereotypical description, disclosure of a person diagnosed with narcolepsy, person with narcolepsy described as dangerous, presence of an accurate diagnosis, identifiable symptoms, indications about diagnostic and treatment services. Chi-square analysis was performed to identify changes over time in the type of content.

Results:

In 10.9% of the articles, there was a sensationalistic title; inappropriate, negative, and outdated language appeared in 10.5% of the articles. Stigmatizing and stereotypical content was reported in 19.5% and 14.8% of the articles, respectively. In 62.3% of the articles, it was disclosed that a person had narcolepsy, and in 5.1% of the articles patients with narcolepsy were described as dangerous. The presence of an accurate diagnosis was referred to in 30.4% of the articles, while 16.7% described identifiable symptoms. Services for diagnosis and treatment were mentioned in 24.1% of the articles. Changes over time in the content of articles are discussed.

Conclusions:

Our findings highlight areas for improvement in the media portrayal of narcolepsy and could help guide the development of new targeted anti-stigma campaigns.

Citation:

Varallo G, Pingani L, Musetti A, et al. Portrayals of narcolepsy from 1980 to 2020: a descriptive analysis of stigmatizing content in newspaper articles. J Clin Sleep Med. 2022;18(7):1769–1778.

BRIEF SUMMARY

Current Knowledge/Study Rationale: The representation of narcolepsy spread through mass communication sources might contribute to the stigmatization of people affected by this condition, impacting their health-related quality of life and psychological well-being. Indeed, patients affected by this condition have reported that the general misunderstanding of narcolepsy and the associated stigmatization are all significant factors that affect their quality of life. However, to our knowledge, no study has examined representations of narcolepsy in the mass media.

Study Impact: In this paper, we describe how narcolepsy has been portrayed in a high-circulation newspaper and assess the presence of stigmatizing content in the articles.

INTRODUCTION

Health-related stigma is defined as a social process, experienced or anticipated and characterized by rejection and disqualification, that results from the experience, perception, or anticipation of an adverse social judgment about a person or group of people who have been identified with specific health problems.¹ Thus, people are regarded as “different” as a result of the diagnosis and the associated stereotypical and stigmatizing beliefs.² Importantly, health-related stigma appears to be a predictor of poorer health-related quality of life³ and psychological well-being⁴ and it has been described as a “hidden burden” of chronic diseases by the World Health Organization.^1,5 It has been reported in several chronic conditions such as epilepsy,⁶ inflammatory bowel disease,⁷ depression,⁸ migraine,⁹ schizophrenia,¹⁰ and also narcolepsy.¹¹

Narcolepsy is a chronic neurologic disorder characterized by excessive daytime sleepiness, cataplexy, hallucinations upon awakening or going to sleep, sleep paralysis, and disturbed night-time sleep.¹² It is often associated with overweight/obesity, mainly when it arises in childhood.¹³ The onset of narcolepsy reaches its peak around the age of 15.¹⁴ In the period between adolescence and emerging adulthood, social integration plays a central role in development, and at this age, patients with narcolepsy may be more vulnerable to experiences of stigmatization, with consequences on mental health. There are both pharmacological and nonpharmacological treatments available. Pharmacological treatment (eg, sodium oxybate, pitolisant, or modafinil) acts on symptoms such as excessive daytime sleepiness, cataplexy, and nocturnal sleep disturbances.¹⁵ Nonpharmacological treatment, on the other hand, includes behavioral strategies as well as cognitive behavioral therapy, and could play an important role in containing and reducing the negative effects of narcolepsy symptoms, while also promoting adequate compliance with pharmacological therapy.¹⁵

People with narcolepsy, according to preliminary evidence, experience significantly more stigma than healthy people, which has a negative impact on their quality of life and functioning.¹⁶ Furthermore, it appears that health-related stigma in people with narcolepsy is at a level comparable to that observed in individuals affected by human immunodeficiency virus.¹⁶ Patients with narcolepsy reported that the negative perception, the general misunderstanding of the disease, and the lack of sensitivity toward their “invisible disease” are all significant factors that affect their quality of life.¹⁷ Narcolepsy is frequently misdiagnosed and misunderstood, resulting in significant delays in proper identification and diagnosis.¹⁸ Notably, stigma may act as an additional barrier to help-seeking behavior and cause further delays in diagnosis, as suggested for other health conditions.^19–21

Living with this condition, aside from pharmacological and nonpharmacological symptom management, is a challenging experience that involves a complex interweaving of psychosocial dynamics, with stigma playing an important role.¹⁶ Healthy psychosocial development in several important life domains may be limited by health-related stigma. It has been suggested in other health conditions that stigma contributes to economic disparities and difficulties with social relationships, and has a negative impact on access to and quality of health care, as well as medication adherence.^3,22 Thus, despite the lack of prior evidence, health-related stigma could be an important factor to consider and evaluate in people with narcolepsy.

The public knowledge about narcolepsy is limited and frequently incorrect.²³ Stigmatizing messages may be spread through mass communication sources, contributing to health-related stigma.²⁴ The media portrayal of narcolepsy might contribute to the lack of understanding and misperception of the disorder, as reported in other health conditions.^25–27 Better public education, awareness of narcolepsy and available treatments could lead to greater acceptance and understanding, as well as a reduction in social misperception.²⁸

Newspaper articles could contribute to the development and maintenance of stigmatizing beliefs and attitudes by shaping public perceptions of health-related conditions. Newspapers, both print and online editions, play a unique role among national media as indicators of broader public opinion²⁹ and sources of information about health-related conditions.²⁵ Specifically, in Italy, according to a recent survey, 32.4 million Italians read at least one of the major print or digital replica titles every month.³⁰

However, to the best of our knowledge, no study has explored the stigmatization of narcolepsy in newspapers. The present work offers the first investigation of newspaper portrayals of narcolepsy in Italy.

Specific objectives were to describe 1) the portrayal of narcolepsy in newspaper articles and 2) the change over time of stigmatizing content.

METHODS

A cross-sectional descriptive study was carried out based on a review of newspaper articles related to narcolepsy. Data were collected from the online archives of an Italian daily newspaper, La Stampa. All articles included were written in Italian. The daily newspaper La Stampa was selected because it is the third-most circulated newspaper in Italy and the only one among the 5 nonthematic daily newspapers (ie, Corriere della Sera, Repubblica, Quotidiano Nazionale, La Stampa, and Il Messaggero) to make available, at the time of research, a free digital archive of all articles published from 1867 to today.³¹ It has a reliable journalistic style, generally not sensationalistic, and is also one of the most trusted daily newspapers for its lower level of political partisanship.³² Indeed, it has been used in several scientific studies, including one that evaluated the representation of schizophrenia in the media.^26,33,34

The following search terms (*wildcard) were used: narcolep* OR cataplexy OR orexin OR hypocretin* OR hypersomnia OR idiopathic hypersomnia OR sleep* OR encephalitis lethargica.

Two experienced researchers independently performed the following procedure for all articles published between January 1, 1980, and January 1, 2020. The articles were arranged chronologically and then numbered from 1 to 257. In the initial stage, the researchers assigned a series of codes (0 = no, 1 = yes, 2 = uncategorized) relative to the content of the articles using a 9-item coding framework. The “unresolved” responses were planned to be resolved by consensus and finally categorized as “yes” (ie, 0) or “no” (ie, 1). Because there was no evidence for narcolepsy, the coding framework was developed ad hoc based on observations and input from 2 experts in sleep disorders (C.F. and G.P.), as well as previous research in the field of stigma toward mental illness.^26,35–38 We emphasize that this coding schema was not validated in this study; it represented a tool used to describe the content of the included articles.

The complete coding schema is reported in Table 1. It was aimed at determining the presence of stigmatizing content. The following domains were assessed: 1) sensationalistic title, 2) negative and inappropriate language, 3) stigmatizing content, 4) stereotypical description, 5) disclosure of a person diagnosed with narcolepsy, 6) a person affected by narcolepsy described as dangerous, 7) presence of an accurate diagnosis, 8) description of identifiable symptoms, and 9) indications about available diagnostic and treatment services. Specifically, domains 1 through 6 were considered indicators of negative portrayal of narcolepsy, whereas domains 7 through 9 were considered indicators of positive representation.

Table 1.

Coding framework used to evaluate stigmatizing attitudes toward individuals with narcolepsy in newspaper articles.

	Question	Code
Q 1	Is the title unnecessarily sensationalistic?	0 = no 1 = yes
Q 2	Does the article use negative, inappropriate, or outdated language?	0 = no 1 = yes
Q 3	Is the content of the article stigmatizing toward people with narcolepsy?	0 = no 1 = yes
Q 4	Does the article highlight a stereotypical patient (described as lazy, unmotivated, bored)?	0 = no 1 = yes
Q 5	Does the article publicly disclose that a particular person has narcolepsy?	0 = no 1 = yes
Q 6	Is the patient with narcolepsy described as potentially dangerous?	0 = no 1 = yes
Q 7	Does the article refer to an accurate diagnosis of narcolepsy?	0 = no 1 = yes
Q 8	Are the symptoms of narcolepsy clearly identifiable?	0 = no 1 = yes
Q 9	Does the article provide help and guidance on referral services for diagnosis and treatment?	0 = no 1 = yes

Q = question.

The codes for each domain were first entered into Excel (Microsoft Corporation, Redmond, WA),³⁹ which was used for primary data storage. The dataset was then exported to Jamovi⁴⁰ for analysis.

Statistical analysis

The category “unresolved” was used in fewer than 2% of all assigned codes. After resolution by consensus, the agreement between the 2 assessors was calculated using the Fleiss’ kappa⁴¹ according to the published guidelines: 0 poor agreement, 0.01–0.20 slight agreement, 0.21–0.40 fair agreement, 0.41–0.60 moderate agreement, 0.61–0.80 substantial agreement, 0.81–1.00 almost perfect agreement.⁴¹ The agreement was calculated for the coding items described above. We divided the articles by decades (ie, 1980–1989, 1990–1999, 2000–2009, 2010–2020) to facilitate the interpretation of the results, given the wide time range considered. The frequency count, and percentages were then calculated. The chi-square test was used to determine whether a statistically significant relationship existed between the pattern of responses to the coding schema and different time periods. A P value less than or equal to the significance level in the chi-square analysis indicated that there was sufficient evidence to conclude that the observed distribution differed from the expected distribution and that there was an association between the variables. Cramer’s V coefficient was also calculated to determine the effect size of the association. A post hoc analysis was performed for significant chi-square values by calculating the adjusted residual analysis to identify the cells that contributed the most to the chi-square test result (ie, cells with an adjusted residual > 1.96 or < 1.96).^42,43 The level of significance was established as P < .05 with 2 tails, and in post hoc analyses it was adjusted using Bonferroni correction for multiple comparisons to avoid Type 1 error.⁴⁴

RESULTS

A total of 257 articles were identified. The search terms that led to the identification of most of the articles were “narcolepsy” (n = 89; 34%), “encephalitis lethargica” (n = 71; 27%), “narcoleptic” (n = 41; 19%), “hypersomnia” (n = 28; 11%).

Once all of the articles had been coded, the agreement between the 2 assessors was performed for all questions in the coding schema and resulted in excellent agreement (κ = 0.97).⁴⁵

Table 2 displays the percentages of articles coded as “0 = no” or “1 = yes” in response to each item in the coding schema. The results of the chi-square analysis and Cramer’s V are also presented. Extracts from the included articles are reported in Table S1 ^{(30.5KB, pdf)} in the supplemental material as examples of each domain of the coding schema.

Table 2.

Percentages of coded articles divided by decade and relative chi-square, P value, and Cramer’s V.

	1980–1989, n (%)	1990–1999, n (%)	2000–2009, n (%)	2010–2020, n (%)	Total, n (%)	χ2	P	Cramer’s V
Q 1
0	15 (5.8)	88 (34.2)	60 (23.3)	66 (25.7)	229 (89)	8.16	.043	.178
1	6 (2.3)	7 (2.7)	8 (3.1)	7 (2.7)	28 (10.9)
Q 2
0	16 (6.2)	89 (34.6)	60 (23.3)	65 (25.3)	230 (89.5)	5.86	.119	.149
1	5 (1.9)	6 (2.3)	8 (3.1)	8 (3.1)	27 (10.5)
Q 3
0	13 (5.1)	89 (32.7)	51 (19.8)	59 (23)	207 (80.5)	9.75	.021	.195
1	8 (3.1)	11 (4.3)	17 (6.6)	14 (5.4)	50 (19.5)
Q 4
0	16 (6.3)	84 (32.8)	60 (23.4)	58 (22.7)	219 (85.2)	3.85	.278	.123
1	5 (2)	11 (4.3)	8 (3.1)	14 (5.5)	38 (14.8)
Q 5
0	11 (4.3)	27 (10.5)	34 (13.2)	25 (9.7)	97 (37.7)	10.2	.017	.199
1	10 (3.9)	68 (26.5)	34 (13.2)	48 (18.7)	160 (62.3)
Q 6
0	19 (7.4)	90 (35)	64 (24.9)	71 (27.6)	244 (94.9)	1.79	.529	.084
1	2 (0.8)	5 (1.9)	4 (1.6)	2 (0.8)	13 (5.1)
Q 7
0	16 (6.2)	85 (33.1)	33 (12.8)	45 (17.5)	179 (69.6)	34.6	< .001	.367
1	5 (1.9)	10 (3.9)	35 (13.6)	28 (10.9)	78 (30.4)
Q 8
0	12 (4.7)	88 (34.2)	53 (20.6)	56 (21.8)	209 (83.3)	17.6	< .001	.262
1	9 (3.5)	7 (2.7)	15 (5.8)	17 (6.6)	48 (16.7)
Q 9
0	12 (4.7)	87 (33.9)	46 (17.9)	50 (19.5)	195 (75.9)	21.5	< .001	.267
1	9 (3.5)	8 (3.1)	22 (8.6)	23 (8.9)	62 (24.1)
Total	8.2	37	26.5	28.4

Q = question.

The years from 1980 to 1989 recorded the lowest number of articles about narcolepsy (n = 21). The years between 1990 and 1999 are those that recorded the greatest number of narcolepsy-related articles (n = 92). The years 2000 to 2009 and 2010 to 2020, published a similar number of articles (respectively, n = 68 and n = 73), slightly lower than the 1990 to 1999 decade (see Figure 1).

Figure 1. Total number of articles across the decades.

Sensationalistic headlines appeared in 10.9% (n = 28) of the total articles examined, and 10.5% (n = 27) of the articles contained inappropriate, negative, and outdated language. Stigmatizing and stereotypical content were reported in 19.5% (n = 50) and 14.8% (n = 38) of the articles, respectively. In 62.3% (n = 160) of the articles it was disclosed that a person had narcolepsy, and in 5.1% (n = 13) of the articles patients with narcolepsy were described as dangerous. The 30.4% (n = 78) of the articles mentioned a possible accurate diagnosis of narcolepsy, while 16.7% described identifiable symptoms. Finally, 24.1% (n = 62) of the articles mentioned services for diagnosis and treatment.

Chi-square analysis indicated a significant association between the time period and the pattern of responses to questions 1 (ie, sensationalistic title), 3 (ie, stigmatizing content), 5 (ie, disclosure of a person with narcolepsy), 7 (ie, presence of an accurate diagnosis), 8 (ie, clear description of identifiable symptoms), and 9 (ie, clear indications about diagnostic and treatment services). According to the Cramer’s V analysis, the effect size of the association was small except for question 7, for which the effect size was moderate (see Table 2). A post hoc analysis corrected by the Bonferroni method was performed for all these domains found to be significant.

The analysis of chi-square showed an association between the time period and the pattern of responses with regard to question 1, which was related to the presence of sensationalistic title: χ² (3,257) = 8.16, P < .05, Cramer’s V =.178. Specifically, the post hoc analysis showed a higher than expected presence of articles with sensationalistic titles than expected between 1980 and 1989 (P < .001) (see Figure 2).

Figure 2. Presence of a sensationalistic title.

The association between the time period and the pattern of responses given to question 3 about the presence of stigmatizing content was significant: χ² (3,257) = 9.75, P < .05, Cramer’s V = .178). Post hoc analysis suggested that there is a higher than expected presence of articles with stigmatizing content in the years 1980–1989 (P < .001), while in the years 1990–1999, there was a significant reduction in the number of articles with stigmatizing content (P < .001) (see Figure 3).

Figure 3. Presence of stigmatizing content.

The association between the time period and the pattern of responses given to question 5 (ie, disclosure of a person with narcolepsy) was significant: χ² (3,257) = 10.2, P < .05, Cramer’s V = .199.

Between 1990 and 1999, there was a significant increase in the number of articles indicating that a person had narcolepsy (P < .001). Then, from 2000 to 2010, there was a significantly higher number of articles that did not mention specific people diagnosed with narcolepsy (P < .001) (see Figure 4).

Figure 4. Disclosure of a person with narcolepsy.

The association between the time period and the pattern of responses given to question 7 (ie, presence of an accurate diagnosis) was significant: χ² (3,257) = 34.6, P < .001, Cramer’s V = .367. According to our post hoc analysis, the number of articles that mention the presence of an accurate diagnosis was significantly lower than expected between 1990 and 1999 (P < .001), while it increased significantly between 2000 and 2010 (P < .001) (see Figure 5).

Figure 5. Presence of an accurate diagnosis of narcolepsy.

The relationship between time period and pattern of responses to the question 8 related to the presence of a description of identifiable symptoms within the article was also significant: χ² (3,257) = 17.6, P < .001, Cramer’s V = .262.

According to post hoc analysis, there is a significantly higher than expected number of articles in the years 1980–1990 that mention the symptoms of narcolepsy (P < .001). On the contrary, the number of articles referring to clear symptomatology is significantly lower than expected in the years 1990–1999 (P < .001) (see Figure 6).

Figure 6. Description of identifiable symptoms.

Additionally, for question 9 regarding the presence within the article of indications of services for diagnosis and treatment, a significant association with the time period was found: χ² (3,257) = 21.5, P < .001, Cramer’s V = .267). Specifically, it appears that the number of articles mentioning the availability of services was lower than expected in the years 1990–1999 (P < .001). On the other hand, there was a significant increase in articles that referred to services in the years 2000–2010 and 2010–2020 (P < .001) (see Figure 7).

Figure 7. Presence of indications about diagnostic and treatment services.

DISCUSSION

This is the first study to describe the portrayals of narcolepsy and assess the presence of stigmatizing content toward people with narcolepsy in the Italian press during the years between 1980 and 2020.

Between 1990 and 1999, the percentage of articles related to narcolepsy reached its highest point. We can hypothesize that the establishment of the Associazione Italiana Narcolettici (AIN; www.narcolessia.org) during this decade heightened media interest in this condition. Indeed, AIN is a nonprofit organization dedicated to raising awareness about narcolepsy and encouraging the dissemination of information to the public and physicians through annual conferences and campaigns.

In the following years, the number of articles remained relatively stable and slightly lower than in the decade from 1990–1999, but the overall number of articles on narcolepsy was relatively low compared both to the period covered in our study (ie, from 1980 to 2020) and the number of articles relative to mental health conditions, such as schizophrenia as highlighted by other evidence.²⁶ Increasing press coverage regarding narcolepsy could be a goal for the coming years.

Between 1980 and 1989, there was a higher than expected number of articles with sensationalistic titles, stigmatizing content, and a clear reference to symptomatology. However, it should be noted that in the 1980s, scientific knowledge about this narcolepsy was limited,⁴⁶ which might have resulted in greater use of sensationalistic headlines and stigmatizing content. There was a significant decrease in articles with sensationalistic headlines, stigmatizing content, and articles referring to diagnosis and services between 1990 and 1999. However, there were more articles than expected in which a person with narcolepsy was publicly disclosed, a trend that decreased significantly between 2000 and 2009. Also, there was evidence of an increase in the number of articles mentioning a diagnosis and the availability of services. Finally, even between 2010 and 2020, the number of articles mentioning diagnostic and treatment services increased significantly. Overall, the media seems to have acquired more accurate ways of reporting information on narcolepsy and over time presented less personal data and raised awareness of available services and treatment options.

We can hypothesize that AIN’s efforts to raise awareness may have contributed to improving the representation of narcolepsy in newspaper articles. Indeed, AIN promoted two major public awareness campaigns between 2000 and 2020 throughout the whole country. The first one began in 2005, followed by the second in 2012. The two campaigns included an educational advertisement aired on the Italian national television and the distribution of a brochure to Italian students from elementary to high school on the “red flags” of narcolepsy. This had been developed by sleep experts and illustrated by a well-known Italian cartoonist to make it accessible and appealing. Physicians across the country received an educational brochure with the goal of increasing medical professionals’ understanding of narcolepsy and promoting the association’s contact information. Interestingly, the Italian validation of the Epworth Sleepiness Scale,⁴⁷ which was published in 2003 and provided a tool for identifying at-risk individuals, was reported in the brochure. In addition, the association promoted multidisciplinary seminars open to the public with sleep experts. The two AIN campaigns, as well as the availability of a new easy-to-use tool for identifying symptoms, may have increased awareness of the diagnostic process and available services. Scientific advances in the field of narcolepsy diagnosis and treatment may also have influenced the accuracy of information and representation in newspaper articles. For example, deficiencies in orexin function were discovered in human narcolepsy in 2001,⁴⁸ and this may have drawn media interest in the diagnostic process. Furthermore, during the early 2000s, scientific advances in pharmacological treatment^49,50 may have resulted in a greater focus on narcolepsy treatment. However, these are only two of a wide range of factors that could have contributed to improvement in media reporting.

Overall, it appears that the majority of articles related to narcolepsy did not contain sensationalistic titles, stigmatizing content, or stereotypical descriptions of patients. Nevertheless, most of the articles disclosed publicly that a specific person had a diagnosis of narcolepsy. This is significant because in studies on stigma toward mental illnesses a lack of respect for the person’s privacy has been identified as a predictor of negative stereotypes.⁵¹ The right to privacy should be ensured, and information about a person’s medical history should not be published in a newspaper or elsewhere without consent.^52,53 However, only a small percentage of the articles mentioned specific symptoms, precise diagnosis, and treatment options. Despite the many effective treatment options available, readers may perceive narcolepsy as an undefined, untreatable, and irreversible condition due to a lack of this information. These might be specific areas to target. Editors and journalists could be encouraged to write about patients who are undergoing treatment. Experts and advocacy groups may also consider proactively engaging with the media to improve the accuracy of the information on diagnosis, symptoms, and recovery stories.

Evaluating the content of articles related to narcolepsy could be useful for advocacy groups that attempt to change the portrayal of narcolepsy provided to the public. Indeed, research in this field can be useful in defining new goals for anti-stigma campaigns and tracking changes. Our findings could help direct advocacy efforts; for example, advocates and sleep experts could inform and educate reporters and journalists about symptoms, the path to diagnosis and treatment, and the available services. They should also emphasize the importance of not publicly revealing the name of a person with narcolepsy without consent and continue efforts to reduce sensationalistic headlines and stereotypical, stigmatizing content.

Several limitations should be discussed. Only the La Stampa newspaper was considered due to the free online availability of the historical archives. Thus, it is not possible to rule out the possibility that the content of the articles was primarily determined by the editor’s choice. Extending the analysis to multiple newspapers would have allowed us to determine the presence of a broader trend in the Italian press. In addition, by focusing on large newspapers, local newspapers were overlooked. Future studies should include articles from other newspapers, including small newspapers, to improve the generalizability of the findings. Also, our findings do not accurately reflect the extent to which the media’s portrayal of narcolepsy has influenced the public. The coding schema used was not validated and did not include patient participation, although it was developed with the help of sleep experts and informed by research on the stigma of mental illnesses. It was designed to identify the number of articles that fit into predefined categories, but it may have overlooked other crucial aspects of media communication. Future research could improve the coding framework using qualitative methods that involve patients and advocates for narcolepsy to take into account their perspective. Furthermore, even though the interrater agreement in our study was excellent, a more detailed coding framework might be developed to avoid an overreliance on subjective interpretation. To our knowledge, no instrument related to narcolepsy or chronic health conditions has been developed. Finally, the purpose of this study was purely descriptive. Statistical analysis in this context only indicated a significant association, in this case between time periods and responses to the coding schema. Thus, it is not possible to establish a cause-and-effect relationship.

In conclusion, the media play a critical role in promoting a balanced and accurate understanding of narcolepsy. As a result, more research on how narcolepsy is portrayed in other media could be a fruitful exploration of the wide sources of stigma. Newspapers are, after all, only a small part of the information media. Extending the investigation to social networks could be useful.

DISCLOSURE STATEMENT

All authors have seen and approved the final manuscript. Work for this study was performed at the Department of Biomedical, Metabolic, and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, Modena, Italy. G.P.’s research is supported by Takeda, Jazz Pharmaceuticals, Bioproject, and Idorsia. The authors report no conflicts of interest.

ABBREVIATION

AIN

Associazione Italiana Narcolettici